Direct Access rules for physical therapy professionals holds a high level of importance. Not only can these rules directly impact the treatments that you offer, they can shape the overall functionality of your practice.
The law that governs Direct Access provides patients with the ability to visit a physical therapist on their own, without the necessity of a prescription and/or referral from their primary care physician.
In 2015, this law came into place in all 50 states, as well as the U.S Virgin Islands and the District of Columbia.
By understanding a few basic facts about Direct Access, you can educate the public on what your practice can offer and how easily your physical therapist services may be obtained.
State Limitations
Each state offers Direct Access for patients; however, there are differences among many states. These are referred to as “limitations”. In order to offer the optimal benefits to patients, you must become familiar with the limitations in your state. To date, there are three different types of restrictions.
Below, you will find the name of each of these limitations, as well as a brief explanation of each:
- Limited – This level of access is limited in terms of evaluation and treatments, which means it is only available to certain types of patients or in patients that are in need of certain types of treatments.
- Patient Access w/Provisions – Patients have access to evaluations and to treatments, with provisions in place – such as limitations on the number of visits or requirements pertaining to very specific treatments.
- Unrestricted – If there is no PCP referral, patients have no restrictions in terms of treatments that may be pursued.
Insurance Coverage
As a physical therapy professional, you must learn how Direct Access complies and works directly with the various health insurance companies. The following lists examples of coverage with insurance company types:
- Private health insurance companies with the designation of a PPO are typically covered in Direct Access laws.
- Private health insurance companies that have a HMO designation will require that a proper referral be in place for physical therapy services.
- Medicare insurance allows for the treatment of a patient through Direct Access; however, you will be required to stay within the confines of the limitations with the governing state in which you practice.
Conclusion
Throughout history, physical therapists have had to work on accumulating a network of doctors that make patient referrals. Direct Access will allow you to bypass this necessity. Instead, patients that need or want physical therapy will seek out the services offered at your practice. As a result of this fact, you have the unique ability to market directly to your clients.
Once patients are in your practice, you should foster a strong commitment of those individuals to utilize your services. Additionally, you should keep your clients satisfied. In doing so, they will express their satisfaction to other people – including their doctors – which could result in a massive amount of success for your practice.
Resources:
http://www.apta.org/PTinMotion/2016/10/DirectAccess/
https://www.webpt.com/blog/post/what-direct-access-and-why-should-pts-care
