Currently, 50 states and the District of Columbia (DC) allow physical therapists to evaluate patients without a prior physician’s referral and 48 states and DC improve accessibility further by allowing physical therapists to evaluate and treat, under certain conditions, patients without a referral from a physician. Since 2005, important gains have been made under Medicare for patients to see their physical therapist without a referral. This page will be updated with information and resources on additional federal efforts relating to direct access in the 113th Congress. If you’d like additional updates on this and other legislative issues, join PTeam today!
Medicare Direct Data Entry (DDE)
Say good-bye to modems, password re-sets, and disconnects. Manage your own MAC credentials, get support for multiple submitter IDs, and benefit from complete visibility to Medicare claim submissions and eligibility verification, with built-in EDI tracking capability.
Direct Graduate Medical Education (DGME)
Prior to July 1, 2010, under section 1886(h)(4)(E) of the Act, a hospital could count residents training in nonprovider settings for direct GME purposes (and under section 1886(d)(5)(B)(iv) of the Act, for IME purposes), if the residents spent their time in patient care activities and if “. . . the hospital incurs all, or substantially all, of the costs for the training program in that setting.” The implementing regulations, first at §413.86(f)(3), effective July 1, 1987, and later at §413.86(f)(4) (redesignated as §413.78(d)) , effective January 1, 1999, required that, in addition to incurring all or substantially all of the costs of the program at the nonprovider setting, there must have been a written agreement between the hospital and the nonprovider site (in place prior to the time the hospital began to count the residents training in the non-provider site) stating that the hospital would incur all or substantially all of the costs of training in the nonprovider setting. The regulations further specified that the written agreement must have indicated the amount of compensation provided by the hospital to the nonprovider site for supervisory teaching activities. Effective October 1, 2004, the hospital must have either had a written agreement with the nonprovider setting, or, as described in the regulations at §413.78(e), paid for all or substantially all of the costs, concurrent with the training in the nonprovider setting. Effective for cost reporting periods beginning on or after July 1, 2007 and before July 1, 2010, “all or substantially all of the costs for the training program” in the nonprovider setting is defined as at least 90 percent of the total of the costs of the residents’ salaries and fringe benefits (including travel and lodging where applicable) and the portion of the cost of teaching physician’s salaries attributable to nonpatient care direct GME activities.