Questions About Physical Therapy
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Physical Therapists are experts in movement and function, so they do not confine their talents to only treating people who are ill. A large part of a Physical Therapist’s program is directed at preventing injury, loss of movement, and even surgery. Physical Therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing lower back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs.
The cornerstones of Physical Therapy treatment are therapeutic exercise and functional training. In addition to “hands-on” care, Physical Therapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, Physical Therapists may also “mobilize” a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physical Therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice.
Most forms of Physical Therapy treatment are covered by insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a Physical Therapist (Direct Access). Most of the time all you have to do is ask your doctor if Physical Therapy is right for you.
More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many do not even know that Physical Therapists are well equipped to not only treat pain but also its source.
Physical Therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and Physical Therapists can help correct the disorder and relieve the pain.
Would you prefer treatment from a Physical Therapist (PT) who works for a physician or one that owns a private practice? We leave it up to you to draw your own conclusions but here are some facts from three different studies:
- Results indicate there were more treatments, and the cost was greater for those patients that attended a physician-owned Physical Therapy practice vs. private physical therapy practice (visits per patient were 39% to 45% higher in physician-owned clinics; and both gross and net revenue per patient were 30% to 40% higher in physician-owned clinics)1.
- Results indicate that licensed and non-licensed Physical Therapy providers spent less time with each patient in physician-owned clinics, and more often, Physical Therapy Assistants were substituted for Physical Therapists.2
- Results concluded that “Therapists who had treated patients through Direct Access were significantly more likely to believe that Direct Access had benefited them professionally and benefited their patients than were Therapists who had not practiced through Direct Access.”3
At Professional, we believe we can provide you with the highest quality of care available and do it in a cost-effective manner.4 You will work closely with your Physical Therapist and in most instances, your treatment will be managed by the same Physical Therapist from the beginning to the end of your experience with us.
- Mitchell, J., Scott, E., Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics, Journal of the American Medical Association, 1992.
- “Joint Ventures Among Health Care Providers in Florida,” State of Florida Health Care Cost Containment Board, 1991.
- Domholdt E, Durchholz AG. Direct access use by experienced therapists in states with direct access. Phys Ther. 1992 Aug;72(8):569-74.
- Federal Office of the Inspector General May 1, 2006 – This report calls into question billing processes done by non-physical therapist owned practices.
For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your Physical Therapist will provide you with the appropriate exercises not only for pain relief, but to recover range of motion, strength, and endurance.
In some cases, Physical Therapy techniques can be painful. For example, recovering knee range of motion after total knee replacement, or shoulder range of motion after shoulder surgery, may be painful. Your Physical Therapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your Therapist. Without this information, it is difficult for the Physical Therapist to adjust your Treatment Plan.
In most states, Physical Therapists cannot make a medical diagnosis. This is something that your Medical Doctor will provide for you.
While Physical Therapists are important members of your medical team, physicians are typically the healthcare providers that will provide you with a medical diagnosis.
Physical Therapists (PTs) and Physical Therapist Assistants (PTAs) are licensed by their respective states.
Yes. Professional maintains records electronically, so we can provide you with the added convenience of visiting any of our many clinics, and any of our Physical Therapists will be able to follow your specified Treatment Plan.
Questions about Billing/Insurance?
In most cases, health insurance will cover all or a portion of the treatment costs. There may be out of pocket expenses (such as co-payments or deductibles) that the patient may be required to pay, which is determined by the patient’s insurance provider. If needed, we have a financial counseling team to assist with payment arrangements.
Any question pertaining to your coverage and financial responsibility is directed to our Eligibility and Benefits Department.
In most cases, you have the right to choose any Physical Therapy clinic. Our practices are in network with various insurance plans. The Eligibility and Benefits team can assist in answering insurance related questions.
Also, since Professional Physical Therapy maintains clinical records electronically, we can provide you with the added convenience of visiting any of our clinics, and our Physical Therapists will be able to follow your specified treatment plan.
Direct Access policy is driven by each individual state or specific insurance carrier.
Some states have a Physical Therapy Practice Act, which requires a diagnosis code before a patient can see a Therapist.
In addition, some payers also require a diagnosis code (physician referral or prescription) for services being rendered (for example – NY Medicare, ConnectiCare, Tricare, all require written prescriptions from the patients’ medical provider).
Billing for Physical Therapy services is similar to billing for a doctor’s visit. The following occurs when a patient is scheduled for treatment:
- The patient’s insurance is verified to ensure coverage from the insurance carrier for the specified course of treatment. Authorization is obtained and we bill the insurance company based on the results of the verification of benefits. The patient is notified if there are issues obtaining authorization for services, or if we are unable to verify coverage.
- The patient’s insurance is billed based on charges or Common Procedure Terminology (CPT) codes that are determined based on the course of treatment from the patient’s Physical Therapist.
- The insurance carrier processes the information submitted and makes payments according to an agreed upon contract or fee schedule.
- The patient will receive an Explanation of Benefits (EOB) from the insurance carrier; we receive a similar EOB indicating the payment has been issued. The EOB also provides patient responsibility, and if applicable, the patient is obligated to make the payment for any balance.
It is important to understand that there are many small steps (beyond those outlined above) within the billing process. Exceptions are common, and missing information and/or miscommunications may occur. This can delay the payment process.