Patient Information

Initial Visit
Initial visits are around 1.25 hours in duration, depending upon complexity of injury.  Follow up visits are 45 minutes in duration.
Please bring any medical records and a physical therapy prescription if available (prescription for physical therapy not required in MD).
Please wear loose clothing to easily access injured body part.

Payment
Charges are based upon time spent at each visit and are due at each visit.
Cash/Venmo/check preferred. Visa/Mastercard accepted.  HSA/FSA accepted.

Kim Shemer Kurtzman PT does not participate with in-network insurance, but medical receipts are provided.  If your insurance policy offers out-of-network benefits, submit the receipt for reimbursement. Kim Shemer Kurtzman PT is not a MEDICARE provider. It is unlawful to bill/submit to Medicare for her services.

Cancellations
Please provide at least 24 hours notice for cancellations. Full payment of services applies for late cancellations (less than 24 hours) and no shows.

Good Faith Estimate for Health Care Items and Services

Estimate for Physical Therapy services by Kim Shemer Kurtzman Physical Therapy ranges from $53-$250.

Disclaimer:

This Good Faith Estimate shows the costs of services that are reasonably expected for your health care needs for a service.  The estimate is based on information known at the time the estimate was created.  The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.  You could be charged more if complications or special circumstances occur.  If this happens, federal law allows you to dispute (appeal) the bill. 

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.  You may contact the provider to let them know the billed charges are higher than the Good Faith Estimate.  YOu can ask them to update the bill to match the Good Faith Estimate, as to negotiate the bill, or as if there is financial assistance available.  You may also start a dispute resolution process with the US Dept of Health and Human Services.  IF you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days of the date on the original bill.  There is a $25 fee to use the dispute process.  If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate.  IF the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount. Go to www.cms.gov/nosurprises/consumers or call 800-985-3059 to learn more.

HIPPA 

Notice of Privacy Practices 

This notice describes the circumstances under which Kim Shemer Kurtzman Physical Therapy (“We or Us”) may use and/or share your healthcare information and how  you can access this information. Please review carefully.  

Uses and Disclosure:

We may use and disclose your protected health information, without your written  consent or authorization, for certain treatment, payment activities and healthcare  operations. There are certain restrictions on uses and disclosures of treatment  records, which include registration and all other records concerning individuals who  are receiving, or who at any time have received services for mental illness,  developmental disabilities, alcoholism, or drug dependence. There are also  restrictions on disclosing HIV test results.  

For Treatment:

-We may use health information about you to provide your treatment. -We may disclose health information about you to other healthcare professionals  involved in your treatment. 

-We may consult between healthcare providers concerning your treatment.  -We may refer to other providers or agencies for treatment.  

For Payment:

-We may use and disclose health information about you so that services may be  billed to you and payment may be collected from you.  

-We may review healthcare services and discuss with your insurance company the  medical necessity of certain services or procedures, coverage under your health  plan, appropriateness of care, or justification of charges. 

For Health Care Operations:

-We may contact healthcare providers and patients with information about treatment alternatives;  -Conducting quality assessment and improvement activities;  -Conducting outcomes evaluation and developmental of clinical guidelines  -Protocol development, case management, or care coordination;  -Conducting or arranging for medical review, legal services, and auditing functions.  We may use your diagnosis, treatment, and outcome information to measure the  quality of the services that we provide, or assess the effectiveness of your  treatment when compared to patients in similar situations.  

We may contact you by telephone or email, to provide appointment reminders. You  must notify us if you do not wish to receive appointment reminders.  We may disclose your protected health information to family members or friends  who may be involved with your treatment or care with your verbal permission.  Health information may be released without permission to a parent, guardian, or  legal custodian of a child; the guardian of an incompetent adult, the healthcare  agent designated in an incapacitated patient’s healthcare power of attorney; or the  personal representative or spouse of a deceased patient. 

There are additional situations we are permitted or required to use or disclose your  protected health information without your consent or authorization. Examples  include:  

-As permitted or required by law.  

-For Public Health Activities  

-For Health Oversight Activities  

-Judicial and Administrative Proceedings  

-For activities related to Death  

-For Research  

-To avoid a serious threat to health or safety  

-For workers compensation  

We will not make any other use or disclosure of your protected health information  without your written authorization. You may revoke such authorization at any time,  except to the extent we may have taken action in reliance thereon. Any revocation  must be in writing.  

Your Rights regarding Your Protected Health Information  

You are permitted to request that restrictions be placed on certain uses or  disclosures of your protected health information by Us to carry out treatment,  payment, or healthcare operations. You must request such a restriction in writing.  We are not required to agree to your request, but if We do agree, we must adhere to the restriction, except when your protected health information is needed in an  emergency treatment situation. In this event, information may be disclosed only to  healthcare providers treating you. Also, a restriction would not apply when We are  required by law to disclose certain healthcare information.  

You have a right to review and/or obtain a copy of your healthcare records or  information compiled for use (or in anticipation for use) in a civil, criminal, or  administrative action preceding. We may deny Kim Shemer Kurtzman Physical Therapy (Notice of Privacy Practice) an access under other circumstances, in which case you can have such a denial  reviewed. We may charge a reasonable fee for copying your records.  You may request that We send protected health information, including billing  information, to you by alternative means or to alternative locations. You may also  request we send information to a particular address or location or contact you at a  specific location, perhaps your place of employment. This request must be  submitted in writing. We will accommodate reasonable requests by you.  You have the right to request we amend portions of your healthcare records, as long as such information is maintained by us. You must submit this request in writing,  and under certain circumstances the request may be denied.  

You may request an accounting of the disclosures of your protected health  information made Us for six years prior to the date of the request. We are not  required, however, to record disclosures we make pursuant to a signed consent or  authorization.  

You may request and receive a paper copy of this Notice, if you had previously  received or agreed to receive the Notice electronically.  

Any person may file a complaint with Us and/or the Secretary of Health  and Human Services if they believe their privacy rights have been violated. To file a  complaint, please contact:  

Kimberly Shemer Kurtzman, PT, DPT 

Kim Shemer Kurtzman Physical Therapy 

2152 Renard Ct, Annapolis, MD 21401

It is the policy of Kim Shemer Kurtzman Physical Therapy that no retaliatory action  will be made against any individual who submits or conveys a complaint of  suspected or actual non-compliance or violation of the privacy standards  The effective date of this Notice is September 9, 2013.