Contemporary Outpatient Issues
Direct access 30 days for Physical Therapy has been successfully lobbied for by the APTA allowing PTs to treat patients without a physician referral. This is honored by most major insurance providers but not by this US government sponsored provider?
What is Medicare
Outpatient clinics see a majority of this type of condition?
What are musculoskeletal conditions.
These professionals can legally and ethically bill medicare patients fully during their treatments in an outpatient setting.
Who is a PT and PTA
Prohibits a physician from referring a Medicare patient to any organization for certain designated health services (i.e., laboratory services, radiology, physical therapy) if that physician holds a financial interest in that organization.
What is the Stark Law
A term used when a PT clinic does not have a contract with the patient’s insurance payer leading to additional cost for the patient.
What is out of network
Latin and means "for the public good." It is used to describe professional services that are voluntarily provided without payment to people who are unable to afford them.
What are Pro Bono Services
This is a required communication with insurers which is a means of ensuring that payment for patient care is not intentionally, or unknowingly, denied. Managers must be certain that approvals necessary to initiate and continue services are consistently and accurately followed by members of their professional and business office staff
What is authorization
What strategy might a clinic employ to ensure clinic specialization?
What is hiring board certified specialists
These are contracted services with a large employer(s) to provide all physical therapy services to employees, typically including job analysis and injury prevention services. They are frequently located at the business location, and involve a per capita payment model that eliminates third-party payer challenges.
What is a workplace-based practice
An act passed to address compensation arrangements that had the potential to adversely affect clinical decision-making and lead to unfair competition.
What is an anti-kickback statute
The most defining feature of outpatient physical therapy is that, unlike all other settings, the therapists do not have...
What is a captive audience
This type of marketing uses TV ads, billboards, cold calling, and display ads to deliver intent of Physical Therapy practices with the intent of reaching a large number of potential clients.
What is outbound marketing
The APTA is currently lobbying for legislation to remove these limitations placed by Medicare Part B on monies for PT, Speech, and OT. These Annual Financial maximums may deny patients access to care.
What is capitation
A sports management clinic has what type of advantage when treating injured athletes?
What is clinical specialization
Physical therapists who wish to be truly autonomous may decide not to contract with insurance payers at all. This expression of Direct Access allows patient to select and pay out of pocket for particular services.
What is a cash-based physical therapy practice