Disclaimer: Law, rules and regulations, not Guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Guideline may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations.
Guideline 1: Defining the Terms for Providing Professional Services
- At the outset of service, the licensed physical therapist should discuss with the patient/client the delivery of physical therapy services by:
- Providing the client with information on what services you or your agency can provide to clients and what is required of clients receiving physical therapy services, the requirement for a referral from a qualified health care practitioner prior to treatment or, if treating without a referral, the requirement to sign a Notice of Advice Form;
- Involving the client in the mutual development and implementation of any treatment program or other intervention to the fullest extent of his/her abilities;
- Providing the client with a statement, preferably in writing, regarding all fees and relevant business procedures, participation in government programs (e.g., Medicare or Medicaid) or health insurance plans. This includes, but is not limited to, billing and payment procedures, including use of collection agencies, handling of insurance reimbursement, requirements for canceling appointments, charges for missed appointments, and the client's right to access his or her records within the law; and
- Requesting written acknowledgement by the client of the treatment plan, billing arrangements, and informed consent for treatment.
- Be sure you understand how to bill insurance companies and other third-party payers in accordance with New York State law, rules and regulations.
- If a client stops using your services against your advice and you believe this places the client at risk, develop a clear plan, preferably in writing, for re-engaging the client. The plan should be placed in the client's record and should note why you believe the termination is inappropriate, any alternative services that are available to the client, and the mechanisms for re-entry into your or your agency's care.
- If you leave an agency and/or practice, provide reasonable advance notice in writing and a clear and written plan to clients for the continuation of care. Such documents should be placed in the client's record.
Citations of Pertinent Law, Rules or Regulations:
Education Law, Section 6509(9) - "unprofessional conduct"
Education Law, Section 6509-a - "fee splitting"
Education Law, Section 6731 - "definition of practice"
Regents Rules, Part 29.1(b)(2) - "exercising undue influence"
Regents Rules, Part 29.1(b)(3) - "referral fees"
Regents Rules, Part 29.1(b)(4) - "fee splitting"
Regents Rules, Part 29.1(b)(7) - "failing to release requested records"
Regents Rules, Part 29.1(b)(11) - "patient/client authorization of services"
Regents Rules, Part 29.1(b)(12) - "advertising not in the public interest"
Regents Rules, Part 29.2(a)(1) - "abandoning a patient/client"
Regents Rules, Part 29.2(b) - "failing to provide access to records as required by Public Health Law, Section 18"