Choosing Your Physical Therapist You are the most important member of your health care team, and you are entitled to choose the most appropriate health care professional to meet your goals. Freedom of Choice You have the freedom to choose your own physical therapist. 

Currently, you may be evaluated by a physical therapist without a physician’s referral in all 50 states and the District of Columbia. In addition, 48 states and the District of Columbia allow some level of treatment by a physical therapist without a physician’s referral (all but Michigan and Oklahoma).* Keep in mind that your insurance policy may require a visit to the primary care physician first or may limit your access to preferred providers only.

Your physician may refer you for physical therapy that is to be provided in the physician’s office, or to a facility in which the physician has a financial interest. If this is your situation, be aware that you have the right to choose your own physical therapist and that you are not obligated to receive physical therapy in any specific facility.

Always insist that your physical therapy be provided by a licensed physical therapist.

How to Choose a Physical Therapist Make sure that you receive physical therapy from a licensed physical therapist. Physical therapists are professional health care providers who are licensed by the state in which they practice. 

If you are receiving physical therapy from a physical therapist assistant, be sure that he or she is supervised by a licensed physical therapist. Ask the physical therapist’s clinic if it participates with your insurance company.

Receiving care from a participating physical therapist should minimize your financial responsibility. There may be good reasons, however, to see a physical therapist who does not participate with your insurance plan.

If you need a physical therapist who has special skills related to your particular condition or if the location or other aspects of the care or the facility meet your needs ,this may be a good choice for you.

Some policies require copayments for services, and the amount of the copayment will depend on whether the physical therapist is part of the insurer’s provider network. You also will have to meet your deductible.

Your physical therapist’s clinic should be able to help you calculate an estimate of your financial responsibilities.

Your first visit should include an evaluation by the physical therapist. Your physical therapist will perform an examination to identify current and potential problems. Based on the results of the examination, and considering your specific goals, your physical therapist will design a plan of care to include specific interventions and will propose a timetable to achieve these goals and optimize your movement and function.

Your physical therapist will likely provide you with instructions to perform exercises at home to facilitate your recovery. You should feel comfortable asking your physical therapist any questions regarding your course of care, including specifics regarding interventions and expectations.

Find a physical therapist in your area at www.moveforwardpt.com

Acknowledgment: Shannon L. Hoffman, PT, DPT

Medicare and Direct Access to Physical Therapy

As promised here is some more information on Direct Access and Medicare ;

Direct Access and Medicare

Medicare beneficiaries are able to go directly to physical therapists (PT) without a referral or visit to a physician. This policy became effective in 2005 through revisions to the Medicare Benefit Policy Manual (Publication 100-02).

Medicare beneficiaries are able to go directly to physical therapists (PT) without a referral or visit to a physician. This policy became effective in 2005 through revisions to the Medicare Benefit Policy Manual (Publication 100-02). The 2005 revisions eliminated the physician visit requirement. However, a patient must be "under the care of a physician," which is indicated by the physician certification of the plan of care. Learn more from a summary of the 2005 revisions..
 

The following information is offered to help physical therapists provide access to PT services to patients and remain in compliance with laws and regulations. For more detailed information on CMS requirements, review section 220.1.1-3 of the Medicare Benefits Policy Manual (.pdf) and national and local coverage determinations.

What the Rules Say

·         PTs must comply with the laws in their state related to the need for a referral for physical therapy. Review your state practice act.

·         The plan of care developed by the PT must be certified by a physician or nonphysician practitioner (NPP) within 30 days of the initial therapy visit.

·         The plan of care must include, at a minimum, (1) diagnoses; (2) long-term treatment goals; and (3) type, amount, and duration of therapy services.

·         Certification requires a dated signature on the plan of care or some other document that indicates approval of the plan of care. Stamped signatures are not acceptable. If the order to certify is verbal, it must be followed within 14 days by a signature.

·         Medicare does not require that the patient visit the physician/NPP. However, a physician/NPP may require the visit.

·         Medicare does not require a physician order for PT services.

·         Recertification of the plan of care is required if changes in a patient's condition requires revision of long-term goals or within 90 calendar days from the date of the initial treatment, whichever is first.

What This Means for PTs

To be paid by Medicare for their services, PT practices should have procedures in place to ensure that the plan of care is certified. Medicare does not require certification of the plan of care before treatment is initiated. However, if the PT does not have a relationship with the physician or is not confident that the physician will sign the plan of care, it may be prudent for the PT to contact the physician for verbal authorization before initiating treatment. If state law is more restrictive that Medicare regulations, physical therapists must comply with state law.

Filing Medicare Claims Under Direct Access

Medicare regulations specify how to report information on the certifying physician/NPP on claims for outpatient therapy services:

·         Effective October 1, 2012, providers must report the name and NPI number of the certifying physician/NPP on the claim for therapy services.

·         For claims processing purposes, the certifying physician/NPP is considered a referring provider. The term “referring provider” is used by Medicare in this case simply because this is the term that is currently on the claim form.

·         The use of the term “referring provider” does not change existing regulations stating that Medicare does not require a patient visit with the physician/NPP.

DIRECT ACCESS FOR PHYSICAL THERAPY -- YES YOU ARE IN CONTROL IN WORKING WITH YOUR PHYSICAL THERAPIST

In the State of Kentucky, each individual is allowed direct access to Physical Therapy.  What this means is that you are not only allowed to choose who you want to go to for your physical therapy, but when.  Of course it is a given that early intervention is important in gaining a quick and positive outcome.  There are some caveats for certain insurances like Medicare and Medicaid and I will post that later. However, even with these you are allowed direct access.

Below is a short summary of what Direct Access actually means

"What is Direct Access to Physical Therapy

Question: What is Direct Access to Physical Therapy?

In the past my doctor prescribed physical therapy for me. Now she says that I can have direct access to physical therapy. What is direct access?

Answer:

Direct access refers to the ability of patients to be evaluated and treated by a physical therapist without being referred by a doctor or other healthcare practitioner. If you feel you have a problem that may benefit from the skilled services of a physical therapist, you may be able to refer yourself to physical therapy for treatment. Sometimes direct access is called self-referral.

In the United States, provisions for physical therapy services are governed by each individual state through a "state-practice" act. The practice act is legislation that outlines how physical therapy services will be delivered. Historically, each state's practice act provided that physical therapy services would be provided only if ordered by a licensed physician or other licensed healthcare practitioner. Each state lists different professionals who may refer patients to physical therapy, including podiatrists, dentists and nurse practitioners.

The American Physical Therapy Association (APTA) has lobbied successfully in many states to help change the law to allow patients direct access to physical therapy. By having direct access in each state, physical therapists are recognized as the licensed professionals of choice to initially manage musculoskeletal and movement disorders in patients. You can check to see if your state allows direct access on the APTA's website.

Why Is Direct Access Important?

Healthcare is expensive. It seems that with every passing year, more money is being spent on healthcare, with no objective data that patients are achieving better outcomes. A system that allows the patient to directly seek the services of a physical therapist can help save healthcare dollars by eliminating unnecessary tests or other specialist referrals. Many conditions can be successfully evaluated and treated with no expensive diagnostic testing.

Is Direct Access Safe?

Some opponents of direct access to physical therapy services argue that patients may be put at risk if they visit a physical therapist directly. Physical therapists lack the ability to order certain diagnostic tests or prescribe medication to help manage pain.

To date, there is no objective data indicating that self-referral to physical therapy puts patients at increased risk. Also, there is nothing indicating that self-referred patients consume more healthcare dollars during or after their physical therapy care episode.

Physical therapists are also trained to recognize "red flags" that may signal the need for more invasive medical intervention. In those cases, referral to your physician or healthcare provider is made immediately.

Many states also have safety nets built into the legislation that governs the practice of physical therapy. For instance, some states allow direct access only to therapists who have been practicing for three or more years. Others allow a certain time frame or specific number of physical therapy visits during an episode of care. If the patient requires skilled physical therapy after the time frame or visit threshold is reached, referral to the patient's doctor is mandatory.

If you are suffering from a musculoskeletal condition that causes functional movement limitations, use your best judgment when deciding which healthcare practitioner to see. A visit to your local physical therapist is a safe place to start on the road to recovery. Remember that not all states allow for direct access to physical therapy. You can check the APTA direct access map to see if your state allows direct access. If you are unsure if physical therapy is right for you, a discussion with your doctor may be necessary to help you decide.

_Sources:

_{APTA Direct Access in Practice} http://www.apta.org/directaccess/

_{Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research "}

_{I hope this encourages to take your health care needs into your own control, seeking out your family Physical Therapist}