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MI Differential Diagnosis & Med Screening > Direct Access Regs NJ/PA > Flashcards

Direct Access Regs NJ/PA Flashcards

1
Q

Direct Access aka

A

No Referral→ “Walk-In”

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2
Q

Screening for Medical Disease

WHY?

A
  • Ethical action
  • Professionally responsible action
  • Save lives OR direct pts to needed care
  • ESP important in direct-access encounters***
  • SHOULD be performed when needed in referral-generated/known-dx encounters
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3
Q

PT Direct Access Regulations

PTs shall refer any indiv…..

A
  • PTs shall refer ANY INDIV. who has failed to demo reasonable progress w/in 30d of the date of initial treatment to a licensed HC prof.
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4
Q

PT Direct Access Regs

NOT more than 30days from the start of PT, PTs shall:

A
  • Consult w/ indiv’s licensed HC provider of record regarding approp. of tx→ still do NOT need referral
  • Recommend that the indiv consult w/ licensed HC prof of their choice
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5
Q

PT Direct Access Regs

Instances when you are required to refer (right away after exam)

A
  • Failure to refer a pt shall be considered unlawful practice of PT if a PT does not immediately refer an indiv to a HC prof if the PT has reasonable cause to believe that:
    • PT is contraindicated**
    • Sx’s or cond’s are present, including, but NOT limtd to: non-muscular and non-skeletal sx’s/conditions or cond’s of the CNS, that require services outside the scope of a PTs practice
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6
Q

Ex. You see a pt via direct access in NJ. The pt is NOT making progress. You are req’d by law to refer the pt to a physician or other licensed prof after ____ days

A

30 days

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7
Q

In NJ, you must refer a patient to a physician or other licensed medical prof IMMEDIATELY if the pt has____________

A
  • Sx’s of CNS disorder, GI disorder, CV disorder, infected wound, psychiatric disorder******

ANY OF THE ABOVE!!!!

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8
Q

NJ: Seeing a pt thru Direct Access

Plain Language Summary

IMPORTANT!!! MEMORIZE ALL OF THIS!!!!

A
  • IF pt is NOT making progress→ refer to licensed HC prof w/in 30d of initial tx
  • IMMEDIATELY REFER if pt has nonmuscular/nonskeletal sx’s, cond’s of CNS that req. services outside scope of PTs practice
  • IF pt IS making progress→ communicate PT POC to pts licensed HC prof w/in 30d of initial PT tx→ DOCUMENT!
    • If pt has no HC prof→ recommend that indiv consult w/ licensed HC prof of their choice
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9
Q

PT Practice w/out referral in PA

What is required for practice without referral?

A

“Certificate of Authorization”

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10
Q

PT Practice w/out Referral in PA requires “Certificate of Authorization”

Requirements for this?

A
  • Current PT License
  • Passed NPTE after Jan 1, 1990 OR passed NPTE prior to Jan 1, 1990 and completed (in prior 2 yrs) a Board approved course of at least 10hrs on evaluative and screening procedures to determine the need for further exam or consultation by physician, dentist, or podiatrist prior to initiating tx w/out referral
  • 2 yrs continous experience* immediately preceding the application (w/ proof) (*MIN 200hrs/year)
  • Prof Liability Insurance
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11
Q

PT Practice w/out referral in PA

Renewal of certificate

A
  • Renewal of Certificate to practice w/out referral→ requires biennium* minimum of 30 contact hrs of Board approved PT continuing Ed. related to advancements and new developments in the practice of PT
    • At least 10 of the 30 contact hrs shall be in evaluative procedures to treat a person w/out referral***
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12
Q

PT Practice w/out referral in PA

Certificate Holders (those who DO have cert):

A
  • Display certificate in conspicuous manner to public
  • Shall NOT delegate care to a PT who is NOT a Cert holder
  • Shall refer pts to a licensed phys. or HC practitioner:
    • when sx’s are present for which PT is a contraindication
    • cases for which Tx is outside scope of PT
    • cases for which Tx is beyond the edu, expertise, or experience of the PT
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13
Q

PT Practice w/out referral in PA

Certificate holders may treat indivs w/out referral for up to _________ from 1st date of treatment

A

30 calendar days from 1st date of treatment

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14
Q

PT Practice w/out referral in PA

Cert Holders may treat indivs w/out referral for up to 30 calendar days from 1st date of treatment*

May NOT treat beyond 30 days unless pt has obtained a referral from:

A
  • Licensed physician, Licensed PA, Registered NP, Licensed dentist, Licensed podiatrist
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15
Q

PT Practice w/out referral in PA

Treating conds that are NOT non-neuro, non-muscular, non-skeletal, or acute cardiac or pulm conds

A

PTs may NOT treat condition which is non-neuro, non-muscular/skeletal, OR indiv who has acute cardiac/pulm conditions UNLESS Cert holder has consulted w/ the indivs licensed physician, dentist, or podiatrist regarding the indivs condition and the PT treatment plan, OR has referred the indiv to a licensed phys, dentist, or podiatrist for dx and referral***

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16
Q

Pennsylvania PT Practice w/out Referral

Plan Language Summary

IMPORTANT!!! MEMORIZE ALL OF IT!!!

A
  • ***Certificate of Authorization REQUIRED!
  • MAY TREAT w/out referral for up to 30 calendar days from 1st day of treatment
  • May NOT treat→ beyond 30d unless indiv has a referral from licensed HC practitioner
  • May NOT treat→ if pt has a non-neuro, non-muscular, non-skeletal, acute cardiac/pulm condition UNLESS PT has consulted w/ the indiv’s licensed phys, dentist, or podiatrist regarding indiv’s condition and the PT Tx plan, OR has referred the indiv to a licensed physician, dentist or podiatrist for dx and referral
17
Q

Pennsylvania PT Practice w/out Referral

Plan Language Summary

More…

A

ALWAYS refer patient to licensed HC practitioner if:

  • Sx’s are present for which PT is a contraindication
  • Tx is outside scope of PT practice
  • Needed Tx is beyond edu, expertise, or experience of the PT
18
Q

Just because its legal*, doesn’t mean you’ll get reimbursed for care provided w/out a referral

A

Insurance carriers may still req. referral in order for you to submit a claim and get reimbursed*

Medicare has it’s own set of direct access rules regarding direct access and reimbursement for PT care under direct access*

19
Q

Medicare’s Direct Access rules:

A
  • In gen, Medicare does NOT require a physician Rx for PT, but it DOES require physician involvement
  • PT must develop a written POC and the physician (or non-phys practitioner) must certify POC w/in 30days of initial visit
    • POC includes (@min):
      • Dx, LTGs
      • Type, Quantity, Duration/Freq of PT
  • For the POC to be “certified”→ Physician must sign/date.
    • If verbal certification→ physician must provide sig/date on POC w/in 14 dates of verbal notice
  • *POCs must be re-certified w/in 90 calendar days from initial tx, OR if there is a revision of LTGs, whichever occurs first

MI Differential Diagnosis & Med Screening (12 decks)

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