Insurers Frequently Asked Questions (FAQ)
Insurance companies refer to our facility frequently with the confidence that the patient's problems will be resolved in a efficacious manner. Rascal Creek PT has a reputation throughout the insurance industry of ethical, appropriate, timely, and cost effective care. Because of the level of expertise of the therapists at Rascal Creek, patients are evaluated to set up a specific treatment program designed to resolve problems quickly, without unnecessary, palliative, and time consuming treatments.
Thank for for taking the time to learn more about Rascal Creek PT. We realize the time our 3rd party payors spend on each patient account is a cost. For this reason we have posted the most common questions and their answers that 3rd party payors ask. However, if you need more information please call us immediately at (209) 722-1030.
Why should we pay for physical therapy evaluation when the physician has already evaluated the patient?
By law. physical therapists are required to perform evaluations on all patients despite the fact that they may have previously been evaluated by a physician or another physical therapist. This law is appropriate because without the evaluation, it is impossible for the physical therapist to set up a specific program that would resolve the patient's problem. Therefore, the patient would be on a more generic program which would be ineffective.
I thought all physical therapy treatments were the same. Aren't you required to follow the physician's prescription?
Physical therapists are extensively trained in evaluative procedures that lead to a physical therapy diagnosis and appropriate intervention. It is incumbent on the physical therapist set up a program that will effectuate a rapid resolution. This also would include patient education to prevent recurrence.
When a patient is first evaluated, their job duties are extensively discussed with the patient as well as anticipated return to work goals. Right from the very first day we are directing our care at return to full function or modifying the work environment so that the patient can return to work as soon as possible. To that end, we work extensively with work simulation and conditioning activities with emphasis on repetition in order to prepare the patient for his or her return to work. Additionally, we work closely coordinating with any case managers assigned to the patient's case to be sure all aspects of the patient's care is covered.
As mentioned previously, a complete evaluation is extremely important in determining the problems that exist. Goals are developed so the patient can return to their normal daily activities as soon as possible. Most importantly, at any physical therapy facility, the insurance company should be sure patients are being re-evaluated and treatment programs are being progressed as appropriate to ensure attainment of goals. If re-evaluation is not performed, and specific progress is not documented, insurance company should not be required to pay for care. It is incumbent upon the physical therapist to show progress. What is helpful in these situations are peer reviews done by a physical therapist to be sure your patient is being treated appropriately. Please see our question regarding peer reviews on this website.
Because of the level of expertise in our clinic, our physical therapists, in addition to performing subjective information and objective testing, the therapists work diligently to document any inconsistencies that may manifest themselves as a behavioral component. To this end, we also perform specific testing using validating and reliable testing tools to come up with positive signs for behavioral patients. Therefore, we are able to identify these patients, coordinate with the physician and/or case worker, in order to move the patient on to appropriate services, not keeping them in physical therapy unnecessarily.
A prudent insurance company has to be careful about sending patients to facilities that utilize a variety of equipment generically. Although equipment has its place in rehabilitation, the most important aspect of care is the therapists expertise and ability to evaluate and set up a treatment program designed to resolving the patient's problems. Treating patients generically in a "gym" type setting, whereby patients go from equipment to equipment without specific needs addressed, is inappropriate. These facilities will have very poor outcomes since their care is not directed to the specific problem at hand. At our facility, we utilize gym equipment but the patient also receives daily re-assessments and hands on care based on their particular needs. We work to keep the claims managers and claims adjustors updated through periodic reports - just let us know of your request and fax information. We also invite you to visit our facility and actually observe treatment of any patient.
Peer reviews are extremely important in containing costs in physical therapy. Unfortunately, many insurance companies utilize professionals eg: nurses or lay people to evaluate physical therapy notes in order to determine if care and/or charges are appropriate. This causes the insurance company a large disadvantage because these personnel are not trained to pick up inappropriate treatment, excessive treatment, or inappropriate charges. On request, we offer a service of internal peer review through our office or an outside review through our provider network.