Re: Chiro's Writing PT prescriptions?

[Guest guest]

I believe it depends on your state's practice act. In Wisconsin, we can

accept scripts from chiropractors. However, payment sources may or may not

accept chiropractors as the primary referral source. For example, it is my

understanding that Medicare does not accept a script from a chiropractor.

You need to check your state PT practice act.

Kim Harbst, PT

Gundersen Lutheran

La Crosse, WI 54601

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

>

[Guest guest]

I believe it depends on your state's practice act. In Wisconsin, we can

accept scripts from chiropractors. However, payment sources may or may not

accept chiropractors as the primary referral source. For example, it is my

understanding that Medicare does not accept a script from a chiropractor.

You need to check your state PT practice act.

Kim Harbst, PT

Gundersen Lutheran

La Crosse, WI 54601

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

>

[Guest guest]

I believe it depends on your state's practice act. In Wisconsin, we can

accept scripts from chiropractors. However, payment sources may or may not

accept chiropractors as the primary referral source. For example, it is my

understanding that Medicare does not accept a script from a chiropractor.

You need to check your state PT practice act.

Kim Harbst, PT

Gundersen Lutheran

La Crosse, WI 54601

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

>

[Guest guest]

Not for Medicare patients. For many other carriers, if you are in a

direct access state, you do not technically need a script . . . Not

even from an MD. That said, it is often company policy to do so.

Accept the kind referal and simply let the DC know thatbit is company

policy to have all POC signed off on by a PCP (MD or DO).

M. Ball, PT, DPT, Ph.D

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

Hello ,

Something you would need to check your states practice act for. Here in Arizona

we have open access and many of our patients come directly to us without

prescriptions. However, the insurance companies have a different take on this.

When we verify insurance benefits we ask if an RX is required and they will tell

you if it can be a MD, DO, or DC. Most of the insurance companies will accept a

DC's prescription for P.T. services in our area.

Hope that helps.

Pabor

Practice Administrator

Exclusively Spine Physical Therapy

www.exclusivelyspine.com

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

[Guest guest]

I am aware of 2 states (TX, NM) that allow Chiropractors, prescriptive

authority for PT.

New Mexico

16.20.10.7 DEFINITIONS: " Primary health care provider "

means a health care professional who is licensed in the U.S. and

provides the first level of basic or general health care for

individual's health needs, including diagnostic and treatment services,

and includes a physician (M.D., D.O., D.P.M.), doctor of veterinary

medicine (D.V.M.), doctor of chiropractic (D.C.), doctor of dental

surgery (D.D.S.), doctor of oriental medicine (D.O.M.), certified nurse

practitioner (C.N.P.), and physician assistant (P.A.) practicing under

the auspices of one of the providers listed herein.

[12-15-97; 16.20.10.7 NMAC - Rn, 16 NMAC 20.10.7, 08-31-00; A, 02-15-04]

B. Stowers

Clinical Manager

CHRISTUS -St. Regional Medical Center

Rehabilitation Services

455 St. s Dr.

Santa Fe, NM 87505

(505)470-2927 Cell

(505)820-5392 Ofc

(505)989-6021 Fax

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of windyskate

Sent: Monday, April 06, 2009 10:14 AM

To: PTManager

Subject: Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

:

MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign

their POC! A bit different.

I practice in FL like you. We have direct access, as you know.

Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999%).

If your company has such policy, you need to start trying to change their

policies! ASAP!

" I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

I hope this helped.

Feel free to contact me if you want to discuss it more.

Armin Loges, P.T.

Tampa, FL

From: windyskate

Sent: Monday, April 06, 2009 12:13 PM

To: PTManager

Subject: Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

Armin,

You do not have unlimited direct access in Florida. A practitioner of record

must sign your plan of care after 21 days.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 6, 2009, at 7:02 PM, " Armin Loges, PT "

wrote:

:

MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

I practice in FL like you. We have direct access, as you know.

Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999%).

If your company has such policy, you need to start trying to change their

policies! ASAP!

" I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

I hope this helped.

Feel free to contact me if you want to discuss it more.

Armin Loges, P.T.

Tampa, FL

From: windyskate

Sent: Monday, April 06, 2009 12:13 PM

To: PTManager

Subject: Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

Armin,

 

To further clarify, a plan of care that has to be signed by a physician or

non-physician practitioner for all practical purposes is a physician

order/referral/prescription or any other term that you want to use as it must

contain al the requirements of the terms I just mentioned. In addition, BCBS of

Florida requires the following:

 

Physical therapy modalities and procedures and physical therapy

evaluation/re-evaluation are eligible for coverage provided the services are:

rendered in accordance with a written physician prescribed treatment plan; AND

the treatment plan contains stated attainable short and long term goals; AND

the treatment plan includes specific modalities, including frequency and

duration, that are based on the individuals diagnosis and prognosis; AND

necessary to provide expected restoration of a physical function; AND

rendered by a qualified licensed professional (physician, physical therapist,

chiropractor), as an integral part of a treatment plan

 

Notice the first bullet point; a written physician prescribed treatment plan.

Besides BCBS of Florida, Aetna actually requires the physician sign and date

your plan of care. Please clarify rare exceptions as you can see per Medicare,

Aetna, and BCBS of Florida all require a physician plan of care or a plan of

care signed by the physician and your practice act has limited direct access for

only 21 days.

 

Rick Gawenda, PT

President

HPA

APTA

Subject: Re: Chiro's Writing PT prescriptions?

To: PTManager

Date: Monday, April 6, 2009, 7:02 PM

:

MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

I practice in FL like you. We have direct access, as you know.

Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

If your company has such policy, you need to start trying to change their

policies! ASAP!

" I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

I hope this helped.

Feel free to contact me if you want to discuss it more.

Armin Loges, P.T.

Tampa, FL

From: windyskate

Sent: Monday, April 06, 2009 12:13 PM

To: PTManager@yahoogrou ps.com

Subject: Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

Rick & Group:

True. After 21 calendar days, if the case has not been resolved we must have a

provider sign the POC.

When that happens, it becomes an excellent opportunity for us PTs to be

referring parties. I then refer " my patient " to a specialist of my choice.

However, if that same patient has ever been seen for that problem/diagnosis by

an MD/DO, the statute then does not hold the PT to 21 days anymore.

I hope that helps.

Armin

From: Rick Gawenda

Sent: Monday, April 06, 2009 8:59 PM

To: PTManager

Subject: Re: Chiro's Writing PT prescriptions?

Armin,

You do not have unlimited direct access in Florida. A practitioner of record

must sign your plan of care after 21 days.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 6, 2009, at 7:02 PM, " Armin Loges, PT "

wrote:

:

MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

I practice in FL like you. We have direct access, as you know.

Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999%).

If your company has such policy, you need to start trying to change their

policies! ASAP!

" I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

I hope this helped.

Feel free to contact me if you want to discuss it more.

Armin Loges, P.T.

Tampa, FL

From: windyskate

Sent: Monday, April 06, 2009 12:13 PM

To: PTManager

Subject: Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

Rick:

I guess you spelled out the definition of POC (plan of care) quite well.

In our experience, verifying benefits in different policies within one same

carrier, many of then will provide us information as " no physician involvement

required " .

How would you read that?

Especially with the ones we are out of network for.

In those cases we need to default to the Florida statute. So, in our practical

experience, yes I find it to be the vast majority here in Florida.

Armin Loges, PT

Tampa, FL

From: Rick Gawenda

Sent: Monday, April 06, 2009 11:56 PM

To: PTManager

Subject: Re: Chiro's Writing PT prescriptions?

Armin,

To further clarify, a plan of care that has to be signed by a physician or

non-physician practitioner for all practical purposes is a physician

order/referral/prescription or any other term that you want to use as it must

contain al the requirements of the terms I just mentioned. In addition, BCBS of

Florida requires the following:

Physical therapy modalities and procedures and physical therapy

evaluation/re-evaluation are eligible for coverage provided the services are:

rendered in accordance with a written physician prescribed treatment plan; AND

the treatment plan contains stated attainable short and long term goals; AND

the treatment plan includes specific modalities, including frequency and

duration, that are based on the individuals diagnosis and prognosis; AND

necessary to provide expected restoration of a physical function; AND

rendered by a qualified licensed professional (physician, physical therapist,

chiropractor), as an integral part of a treatment plan

Notice the first bullet point; a written physician prescribed treatment plan.

Besides BCBS of Florida, Aetna actually requires the physician sign and date

your plan of care. Please clarify rare exceptions as you can see per Medicare,

Aetna, and BCBS of Florida all require a physician plan of care or a plan of

care signed by the physician and your practice act has limited direct access for

only 21 days.

Rick Gawenda, PT

President

HPA

APTA

Subject: Re: Chiro's Writing PT prescriptions?

To: PTManager

Date: Monday, April 6, 2009, 7:02 PM

:

MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

I practice in FL like you. We have direct access, as you know.

Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

If your company has such policy, you need to start trying to change their

policies! ASAP!

" I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

I hope this helped.

Feel free to contact me if you want to discuss it more.

Armin Loges, P.T.

Tampa, FL

From: windyskate

Sent: Monday, April 06, 2009 12:13 PM

To: PTManager@yahoogrou ps.com

Subject: Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

You can add Kentucky to that list

Ron Barbato PT

Administrative Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Chairman, KY Board of Physical Therapy

PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

that is privileged subject to attorney-client privilege or attorney work

product, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it

and be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is

STRICTLY PROHIBITED. If you received this transmission in error, please

immediately advise me, by reply e-mail, and delete this message and any

attachments without retaining a copy in any form. Thank you.

Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL

[Guest guest]

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control

over utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

BCBS of Florida state in their PT policy that the PT must me under a physician

written treatment plan. Please provide the reference that states BCBS of Florida

does not require what I pasted below from their policy.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 8, 2009, at 10:12 PM, " "

wrote:

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control over

utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

BCBS of Florida state in their PT policy that the PT must me under a physician

written treatment plan. Please provide the reference that states BCBS of Florida

does not require what I pasted below from their policy.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 8, 2009, at 10:12 PM, " "

wrote:

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control over

utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

BCBS of Florida state in their PT policy that the PT must me under a physician

written treatment plan. Please provide the reference that states BCBS of Florida

does not require what I pasted below from their policy.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 8, 2009, at 10:12 PM, " "

wrote:

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control over

utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

For further clarification, here is the link to Florida BCBS.

 

http://mcgs.bcbsfl.com/

 

Click medicine on the left hand side and then choose the policy you want to

view.

 

Also, Aetna requires the physician sign and date the PT plan of care. Here is

the link to Aetna's PT policy.

 

http://www.aetna.com/cpb/medical/data/300_399/0325.html

 

And as you all know, Medicare requires a signed and dated plan of care.

 

With that being said, yes you may not need an order, but you need a signed and

dated plan of care for Medicare and Aetna and a written physician treatment plan

for BCBS. When you think about it, that is a referral/order/prescription as the

POC contains all the required elements of an order.

 

Is that really direct access?

 

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

Subject: Re: Chiro's Writing PT prescriptions?

To: PTManager

Date: Wednesday, April 8, 2009, 10:12 PM

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control over

utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapy Diagnosis. com

TimRichPT@PhysicalT herapyDiagnosis. com

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager@yahoogrou ps.com

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

For further clarification, here is the link to Florida BCBS.

 

http://mcgs.bcbsfl.com/

 

Click medicine on the left hand side and then choose the policy you want to

view.

 

Also, Aetna requires the physician sign and date the PT plan of care. Here is

the link to Aetna's PT policy.

 

http://www.aetna.com/cpb/medical/data/300_399/0325.html

 

And as you all know, Medicare requires a signed and dated plan of care.

 

With that being said, yes you may not need an order, but you need a signed and

dated plan of care for Medicare and Aetna and a written physician treatment plan

for BCBS. When you think about it, that is a referral/order/prescription as the

POC contains all the required elements of an order.

 

Is that really direct access?

 

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

Subject: Re: Chiro's Writing PT prescriptions?

To: PTManager

Date: Wednesday, April 8, 2009, 10:12 PM

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control over

utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapy Diagnosis. com

TimRichPT@PhysicalT herapyDiagnosis. com

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager@yahoogrou ps.com

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

For further clarification, here is the link to Florida BCBS.

 

http://mcgs.bcbsfl.com/

 

Click medicine on the left hand side and then choose the policy you want to

view.

 

Also, Aetna requires the physician sign and date the PT plan of care. Here is

the link to Aetna's PT policy.

 

http://www.aetna.com/cpb/medical/data/300_399/0325.html

 

And as you all know, Medicare requires a signed and dated plan of care.

 

With that being said, yes you may not need an order, but you need a signed and

dated plan of care for Medicare and Aetna and a written physician treatment plan

for BCBS. When you think about it, that is a referral/order/prescription as the

POC contains all the required elements of an order.

 

Is that really direct access?

 

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

Subject: Re: Chiro's Writing PT prescriptions?

To: PTManager

Date: Wednesday, April 8, 2009, 10:12 PM

Rick,

To clarify, physical therapists in Florida have 21 days of direct access to

patients NOT PREVIOUSLY DIAGNOSED by a physician of record (eg: chiropractor,

dentist, osteopath, medical doctor or podiatrist).

So, if I see a new patient with a new condition I can treat them for 21 days.

If I see a prior patient and they want me to re-initiate their plan of care

because they had a flare up, stopped doing their home-ex, need a 'tune up',

whatever then I have, statutorily, unlimited direct access.

Medicare still requires a physician signature to PAY for the physical therapy

services but payment is a separate issue from access.

In practice, if you are not seeing improvement in an expected time frame (1 day,

1 week, 1 month - you decide based on the findings) then the prudent physical

therapist should re-examine or refer their patient for more comprehensive

testing.

In fact, most commercial insurance companies (United, BCBS, Cigna, local plans,

etc.) in Florida are NOT requiring physician referrals to see physical

therapists. Most insurance companies have sufficient administrative control over

utilization - they don't need the doctor anymore.

Tim , PT

www.PhysicalTherapy Diagnosis. com

TimRichPT@PhysicalT herapyDiagnosis. com

>

>

>

> Subject: Re: Chiro's Writing PT prescriptions?

> To: PTManager@yahoogrou ps.com

> Date: Monday, April 6, 2009, 7:02 PM

>

>

>

>

>

>

> :

> MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> I practice in FL like you. We have direct access, as you know.

> Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> If your company has such policy, you need to start trying to change their

policies! ASAP!

> " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors, my

patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> I hope this helped.

> Feel free to contact me if you want to discuss it more.

>

> Armin Loges, P.T.

> Tampa, FL

>

> From: windyskate

> Sent: Monday, April 06, 2009 12:13 PM

> To: PTManager@yahoogrou ps.com

> Subject: Chiro's Writing PT prescriptions?

>

> A chiropracter in Florida told me they can write prescriptions for PT?

>

> I have never heard of this. Anyone know about this?

>

> Thanks,

>

> Yunker

> American Health

> Fort Lauderdale, FL

>

>

[Guest guest]

Rick,

I'm not disputing your scholarship or your knowledge of BCBS online

documentation guidelines but, bottom line, we treat patients in Florida without

a physician referral or signature because we call first and ask...

" Do we need a referral to see this patient? "

Would this be the first time that you have encountered insurance company

behavior that is inconsistent with their own written policies?

BCBS controls utilization with 4-units limits per day and other controls (62

days consecutive per condition per lifetime, etc.) They don't need physicians

to control utilization.

With the proliferation of POPTS in Florida most insurance companies have good

reason not to trust physicians to control utilization.

I would argue that, yes, our situation is direct access for those patients who

have had their condition diagnosed previously by a practitioner of record (MD,

DO, DC, DMD, DP).

As I said before, PTs need to bring their best game to a direct access patient

and screen for pathology that IS occasionally present. Fortunately, improved

decision-making tools and better education of PTs allows our profession to fill

this societal and market demand that should, ultimately, improve patients'

health and lower costs.

Tim

TimRichPT@...

www.PhysicalTherapyDiagnosis.com

> >

> >

> > From: Armin Loges, PT <armin@>

> > Subject: Re: Chiro's Writing PT prescriptions?

> > To: PTManager

> > Date: Monday, April 6, 2009, 7:02 PM

> >

> >

> >

> >

> >

> >

> > :

> > MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> > I practice in FL like you. We have direct access, as you know.

> > Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> > If your company has such policy, you need to start trying to change their

policies! ASAP!

> > " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors,

my patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> > I hope this helped.

> > Feel free to contact me if you want to discuss it more.

> >

> > Armin Loges, P.T.

> > Tampa, FL

> >

> > From: windyskate

> > Sent: Monday, April 06, 2009 12:13 PM

> > To: PTManager@yahoogrou ps.com

> > Subject: Chiro's Writing PT prescriptions?

> >

> > A chiropracter in Florida told me they can write prescriptions for PT?

> >

> > I have never heard of this. Anyone know about this?

> >

> > Thanks,

> >

> > Yunker

> > American Health

> > Fort Lauderdale, FL

> >

> >

[Guest guest]

Rick,

I'm not disputing your scholarship or your knowledge of BCBS online

documentation guidelines but, bottom line, we treat patients in Florida without

a physician referral or signature because we call first and ask...

" Do we need a referral to see this patient? "

Would this be the first time that you have encountered insurance company

behavior that is inconsistent with their own written policies?

BCBS controls utilization with 4-units limits per day and other controls (62

days consecutive per condition per lifetime, etc.) They don't need physicians

to control utilization.

With the proliferation of POPTS in Florida most insurance companies have good

reason not to trust physicians to control utilization.

I would argue that, yes, our situation is direct access for those patients who

have had their condition diagnosed previously by a practitioner of record (MD,

DO, DC, DMD, DP).

As I said before, PTs need to bring their best game to a direct access patient

and screen for pathology that IS occasionally present. Fortunately, improved

decision-making tools and better education of PTs allows our profession to fill

this societal and market demand that should, ultimately, improve patients'

health and lower costs.

Tim

TimRichPT@...

www.PhysicalTherapyDiagnosis.com

> >

> >

> > From: Armin Loges, PT <armin@>

> > Subject: Re: Chiro's Writing PT prescriptions?

> > To: PTManager

> > Date: Monday, April 6, 2009, 7:02 PM

> >

> >

> >

> >

> >

> >

> > :

> > MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> > I practice in FL like you. We have direct access, as you know.

> > Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> > If your company has such policy, you need to start trying to change their

policies! ASAP!

> > " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors,

my patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> > I hope this helped.

> > Feel free to contact me if you want to discuss it more.

> >

> > Armin Loges, P.T.

> > Tampa, FL

> >

> > From: windyskate

> > Sent: Monday, April 06, 2009 12:13 PM

> > To: PTManager@yahoogrou ps.com

> > Subject: Chiro's Writing PT prescriptions?

> >

> > A chiropracter in Florida told me they can write prescriptions for PT?

> >

> > I have never heard of this. Anyone know about this?

> >

> > Thanks,

> >

> > Yunker

> > American Health

> > Fort Lauderdale, FL

> >

> >

[Guest guest]

I would also question the people you are talking to and do they know the

policies? These people are not in the medical review department of BCBS. Also,

they may not view a referral the same as a treatment plan as you have the

referral to start treatment and the treatment plan is signed by the physician

after the evaluation by the PT. You may very well be right, but that is not what

their policy states. The question is " Upon medical review, what would happen

without a signed physician treatment plan " ?

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 9, 2009, at 12:20 PM, " "

wrote:

Rick,

I'm not disputing your scholarship or your knowledge of BCBS online

documentation guidelines but, bottom line, we treat patients in Florida without

a physician referral or signature because we call first and ask...

" Do we need a referral to see this patient? "

Would this be the first time that you have encountered insurance company

behavior that is inconsistent with their own written policies?

BCBS controls utilization with 4-units limits per day and other controls (62

days consecutive per condition per lifetime, etc.) They don't need physicians

to control utilization.

With the proliferation of POPTS in Florida most insurance companies have good

reason not to trust physicians to control utilization.

I would argue that, yes, our situation is direct access for those patients who

have had their condition diagnosed previously by a practitioner of record (MD,

DO, DC, DMD, DP).

As I said before, PTs need to bring their best game to a direct access patient

and screen for pathology that IS occasionally present. Fortunately, improved

decision-making tools and better education of PTs allows our profession to fill

this societal and market demand that should, ultimately, improve patients'

health and lower costs.

Tim

TimRichPT@...

www.PhysicalTherapyDiagnosis.com

> >

> >

> > From: Armin Loges, PT <armin@>

> > Subject: Re: Chiro's Writing PT prescriptions?

> > To: PTManager

> > Date: Monday, April 6, 2009, 7:02 PM

> >

> >

> >

> >

> >

> >

> > :

> > MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> > I practice in FL like you. We have direct access, as you know.

> > Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> > If your company has such policy, you need to start trying to change their

policies! ASAP!

> > " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors,

my patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> > I hope this helped.

> > Feel free to contact me if you want to discuss it more.

> >

> > Armin Loges, P.T.

> > Tampa, FL

> >

> > From: windyskate

> > Sent: Monday, April 06, 2009 12:13 PM

> > To: PTManager@yahoogrou ps.com

> > Subject: Chiro's Writing PT prescriptions?

> >

> > A chiropracter in Florida told me they can write prescriptions for PT?

> >

> > I have never heard of this. Anyone know about this?

> >

> > Thanks,

> >

> > Yunker

> > American Health

> > Fort Lauderdale, FL

> >

> >

[Guest guest]

Rick:

The truth of the matter is direct access to physical therapists in all 50 states

is a laughable joke. Not much to brag about.

Here in Florida, to be able to see a previously undiagnosed patient for 21 days

(not 22, or 32 or whatever - go figure what clinical rationale went into this

" lawful decision making " !) is not really direct access. It is crumbs. And this

would make a lovely discussion, with arguments such as " massage therapists do

have true direct access, and DPTs don't " etc etc.

In all cases, we need consultants such as yourself to show us the loopholes that

are there; to have a " can do " mentality and find the ways that are there. We,

mere clinicians, can too copy and paste from BCBS. We need your brains to beat

the system. Not to be beaten by it.

At least for us - " out-of-network folks " - who are not entered into contract

with these 3rd party payers, it makes us nonetheless PT providers and obligated

to abide to no more than to the statutes that regulate our profession. But that

is my opinion and not the one of a PT consultant, off course. As for for a

medical review I couldn't care less. For that matter, why not a physical

therapist's review? I would be much more interested in finding out (and perhaps

we will) how it would stand in the court of law.

Armin Loges, PT

Tampa, FL

From: Rick Gawenda

Sent: Thursday, April 09, 2009 10:03 PM

To: PTManager

Subject: Re: Re: Chiro's Writing PT prescriptions?

I would also question the people you are talking to and do they know the

policies? These people are not in the medical review department of BCBS. Also,

they may not view a referral the same as a treatment plan as you have the

referral to start treatment and the treatment plan is signed by the physician

after the evaluation by the PT. You may very well be right, but that is not what

their policy states. The question is " Upon medical review, what would happen

without a signed physician treatment plan " ?

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

On Apr 9, 2009, at 12:20 PM, " "

wrote:

Rick,

I'm not disputing your scholarship or your knowledge of BCBS online

documentation guidelines but, bottom line, we treat patients in Florida without

a physician referral or signature because we call first and ask...

" Do we need a referral to see this patient? "

Would this be the first time that you have encountered insurance company

behavior that is inconsistent with their own written policies?

BCBS controls utilization with 4-units limits per day and other controls (62

days consecutive per condition per lifetime, etc.) They don't need physicians to

control utilization.

With the proliferation of POPTS in Florida most insurance companies have good

reason not to trust physicians to control utilization.

I would argue that, yes, our situation is direct access for those patients who

have had their condition diagnosed previously by a practitioner of record (MD,

DO, DC, DMD, DP).

As I said before, PTs need to bring their best game to a direct access patient

and screen for pathology that IS occasionally present. Fortunately, improved

decision-making tools and better education of PTs allows our profession to fill

this societal and market demand that should, ultimately, improve patients'

health and lower costs.

Tim

TimRichPT@...

www.PhysicalTherapyDiagnosis.com

> >

> >

> > From: Armin Loges, PT <armin@>

> > Subject: Re: Chiro's Writing PT prescriptions?

> > To: PTManager

> > Date: Monday, April 6, 2009, 7:02 PM

> >

> >

> >

> >

> >

> >

> > :

> > MCR does not consider Chiros referring providers to PTs. But no one needs a

" prescription " to see a MCR patient. What PTs need is and MD or DO to sign their

POC! A bit different.

> > I practice in FL like you. We have direct access, as you know.

> > Private insurances don't require us to get referrals (with extreme rare

exceptions, which you find out by verifying benefits) and its typically from an

MD/DO (99.999999999% ).

> > If your company has such policy, you need to start trying to change their

policies! ASAP!

> > " I take referrals from anyone: MDs, friends, Chiros, Nurses, my neighbors,

my patients and anyone that wants to send me a patient! But I take prescriptions

from NO ONE, being I am not a pharmacist. "

> > I hope this helped.

> > Feel free to contact me if you want to discuss it more.

> >

> > Armin Loges, P.T.

> > Tampa, FL

> >

> > From: windyskate

> > Sent: Monday, April 06, 2009 12:13 PM

> > To: PTManager@yahoogrou ps.com

> > Subject: Chiro's Writing PT prescriptions?

> >

> > A chiropracter in Florida told me they can write prescriptions for PT?

> >

> > I have never heard of this. Anyone know about this?

> >

> > Thanks,

> >

> > Yunker

> > American Health

> > Fort Lauderdale, FL

> >

> >

[Guest guest]

In the same line of thought...we in Calif are dying to get Direct Access, is it

all just a hype or is it true direct access? I would like to know the truth!

Hiten Dave' PT 

Chiro's Writing PT prescriptions?

> >

> > A chiropracter in Florida told me they can write prescriptions for PT?

> >

> > I have never heard of this. Anyone know about this?

> >

> > Thanks,

> >

> > Yunker

> > American Health

> > Fort Lauderdale, FL

> >

> >

[Guest guest]

In FL it may depend on the insurance co.?? Medicare does not recognize

chiropractors as physicians, so they can not write scripts for PT, but other

insurers may allow it.

Amy McBreen-Babb, PT

FL

Chiro's Writing PT prescriptions?

A chiropracter in Florida told me they can write prescriptions for PT?

I have never heard of this. Anyone know about this?

Thanks,

Yunker

American Health

Fort Lauderdale, FL