January 09, 2018
1. Q: Do I have to treat my patients without a referral from a physician?
A: No. You may continue to require a referral from a healthcare practitioner if you so desire.
2. Q: My patient has a referral for treatment. Do I have to utilize the referral?
A: No. You may treat the patient as you desire, following the established restrictions.
3. Q: Will insurance companies pay for PT without a referral?
A: Most insurance companies do not require a physician referral for payment. Medicare requires a signed plan of care, but not a referral. Check your contracts with participating insurance companies. Remember, the new law changes how Kansans access physical therapy services, not how physical therapy services are reimbursed.
4. Q: When do I start counting days or numbers of visits during which patient improvement must be documented?
A: Begin numbering the first visit following your initial evaluation.
5. Q: Can the 10 patient visits spread out over the course of 1-2 months if they are not progressing toward documented treatment goals?
A: No. You may treat without a referral for 10 visits or 15 business days, WHICHEVER COMES FIRST. So, once you reach 15 business days starting the first visit after your initial evaluation (usually 3 weeks), and your patient shows no sign of improvement, you must seek a referral.
6. Q: The patient made progress toward my documented treatment goals for the first 10 days of treatment, but experienced a setback and lost ground. By the 15th business day after my initial evaluation, no progress could be noted. Do I need to obtain a referral, or can I continue treatment since progress was made at one time?
A: To continue treating without a referral, you must show “progress toward documented treatment goals as demonstrated by objective, measureable or functional improvement, or any combination thereof, after 10 patient visits or in a period of 15 business days from the initial treatment visit following the initial evaluation”. You must show progress at the time of the 10th visit or at the 15 business-day cut off. In this case, you would need to obtain a referral prior to continuing treatment.
7. Q: If the patient has shown documented progress and no referral was needed after the allotted time frame, will I ever need to obtain a referral during the same episode of care?
8. Q: The patient did not progress during the allotted time frame. Must the patient see the physician or other healthcare practitioner prior to continuing physical therapy?
A: The law states that the “physical therapist shall obtain a referral from an appropriate health care practitioner prior to continuing treatment”. The patient is not required to visit the physician.
9. Q: I am providing physical therapy services for injury prevention, fitness, health promotion, and/or education. Are there referral requirements in these situations?
A: No referral is needed at any time in this instance.
10. Q: Can I perform wound care without a referral from an approved healthcare practitioner?
A: You may perform wound care without a referral as long as debridement is not part of the care given. Any debridement will require “approval” from the healthcare practitioner.
11. Q: Will I pay more for my malpractice insurance now that Kansas has patient self-referral?
A: Patient self-referral laws (many which allow complete, unrestricted patient self-referral to PT services) have been in effect in many states for 25-50 years. There has never been a documented increase in liability claims or an increase in liability premiums resulting from patient self-referral.