Jurisprudence: The Legal Basis of Physical Therapy Practice

Jurisprudence: The Legal Basis

of Physical Therapy Practice

2018

Tennessee Physical Therapy Association Jurisprudence: The Legal Basis of Physical Therapy Practice

Table of Contents

Jurisprudence Slides ............................................................................................... 1 Physical Therapy Practice Act ................................................................................ 17 APTA Code of Ethics .............................................................................................. 33 APTA Standards of Ethical Conduct for the Physical Therapist Assistant .............. 35 Ten Tips for Protecting Your Practice ..................................................................... 37 Resources and References .................................................................................... 39

Post-test .................................................................................................................. 40

Course Objectives

Describe the purpose of the Practice Act, Rules, and Board of Physical Therapy Policy Statements

Explain the rules related to continuing competence, license renewal, and the licensure process

Describe the Practice Act and Rules related to the scope of practice and disclosures to patients

Describe offenses that may lead to disciplinary action

Explain the rules of supervision for Physical Therapist Assistants, Physical Therapy assistive personnel, and others (students, volunteers)

The Code of Ethics for the Physical Therapist and the Standards of Ethical Conduct for the Physical Therapist Assistant are reprinted with permission of the American Physical Therapy Association. This material is copyrighted, and any further reproduction or distribution is prohibited.

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JURISPRUDENCE: THE LEGAL BASIS OF PHYSICAL THERAPY

PRACTICE

Did You Know that in Tennessee…PTs & PTAs have received the following disciplinary actions on their licenses:

• Letters of reprimand

• CEU requirements from 40-50 hours in ethics, jurisprudence, documentation, supervision, & Medicare regulations

• Quarterly performance reports from their supervisor to the licensing board

Did You Know that in Tennessee…

PTs & PTAs have received the following disciplinary actions on their licenses:

• Civil penalties (fines) from $500 to $2,000

• Probation from 1-5 years

• License suspended up to 2 years

• License revoked

If You Want to Know More…

Anyone can go online and view a listing of the monthly disciplinary actions taken by health related boards at:

http://tn.gov/health/article/boards-disciplinary-actions

Licensure Verification

https://apps.health.tn.gov/Licensure/

NAMESOMEWHERE, TN 33333

Profession: Physical Therapist Rank: Physical Therapist

License Number: XXXX Status: Active Original Date: mo/da/year Expiration Date: mo/da/year

View:

Practitioner Profile

NAMESOMEWHERE ELSE, TN 22222

Profession: Physical Therapist Rank: Physical Therapist

License Number: 0000 Status: Active Original Date: mo/da/year Expiration Date: mo/da/year

View:

Practitioner Profile

Adverse Licensure Actions

Good Reasons to Study the Law

• To legally support the decisions you make associated with physical therapy practice

• To avoid finding yourself in violation of the law because “I just didn’t know!”

• Educate others about the practice of physical therapy

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The Practice Act

The Practice Act is the law that governs physical therapy practice

• Passed by the state legislature

• Defines who can practice physical therapy

• Defines the legal scope of practice

• Defines the standards of practice

The Rules

The “Rules Governing the Practice of Physical Therapy” is a companion document to the Practice Act

• The licensing board writes the rules to interpret and clarify the Practice Act

Accountability

PTs and PTAs licensed in Tennessee are accountable to both:

• Practice Act

• Rules

The purpose of the Practice Act and Rules is to protect the public

Board of Physical Therapy

• Typically, it is referred to as the “Licensing Board”

• It is an entity of the state of Tennessee

• Members are appointed by the Governor

• 3 PTs, 1 PTA, 1 member of the public

http://tn.gov/health/topic/PT-board

TPTA and the Board of Physical Therapy are NOT the same

organization.

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Board of Physical Therapy

• Regulates the practice of physical therapy according to the terms of the Practice Act and the Rules

• Reviews qualifications & issues licenses

• Interprets issues related to practice

• Takes disciplinary action

Board Administrator

• Works for the state of Tennessee

• Administers the day to day operations of the board

• Must follow procedures established by board

• Cannot make policy or interpret issues

More Accountability

In addition to the

Practice Act and Rules,

PTs and PTAs are accountable to

Board of Physical Therapy Policies


• From time to time, the Board of Physical Therapy develops policies that attempt to clarify issues regarding the practice of physical therapy.

• These policies assist in interpreting the Practice Act and Rules.

http://tn.gov/health/article/PT-policies


• Renewal for Licensees Called to Active Military Duty (4-10-03):

• Special consideration for license renewal for military personnel called to active duty

• Multidisciplinary Health Screening (9-14-98): Health screenings outside the scope of practice are unsafe to the public & may subject the licensee to disciplinary action.


• Lapsed License (3-10-16):

• If the license is not renewed, a PT or PTA may not practice legally after the expiration date

• If the license has been expired for less than 30 days, you may apply for reinstatement of your license (Regular Renewal Fee, Late Renewal Fee, & Reinstatement Fee)

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• If you keep practicing from 30 days to 6 months:

• You will receive a citation which is reported as a disciplinary action on your practitioner profile

• You may apply for reinstatement of license (Regular Renewal Fee, Late Renewal Fee, Reinstatement Fee, and a fine of $250 per month)



• If you practice more than 6 months after the expiration date, your case will go to the office of investigations as a complaint of unlicensed practice and will be handled by the Office of General Counsel


Other Consequences of a Lapsed License

• Medicare rules require that physical therapy be rendered by a licensed PT or PTA

• Healthcare facility may have to pay money back to Medicare for services the PT/PTA rendered because they were practicing without a license

• Unhappy employer - ??? Your job security ???


• Home Health Aides (2-11-05):

The monitoring of home health aides by physical therapy practitioners is not in itself a violation of the physical therapy practice act and rules if no other ethical or practice violations are present.


• Patient Referrals for Physical Therapy (2-2-01):

PTs may receive referrals from physician assistants and nurse practitioners. These practitioners can only refer per the physician’s protocol and their referrals are considered orders of the supervising physician.


• Fingerstick Techniques (8-20-10):

Performing fingerstick techniques (such as glucometer readings, coumadin readings, etc.) is within the scope of practice of a PT or PTA, so long as such activities are performed and called for during the course of the practice of physical therapy as provided under the Practice Act.

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• Continuing Competence (2-9-17) – Failure to comply with the requirement:

If a PT has at least 8 hours or a PTA has at least

8 hours:

1. Civil penalty of $100 per hour he/she is lacking and must be paid within 30 days

2. Make up the deficient hours

Board of Physical Therapy Policies• Continuing Competence (2-9-17) – Failure to comply with the requirement:

If a PT has less than 8 hours or a PTA has lessthan 8 hours:

1. Civil penalty of $100 per hour he/she is lacking and must be paid within 30 days

2. Make up the deficient hours

3. License will be suspended at least 45 days & will continue to be suspended until hours are made up

Continuing Competence

• Planned learning experiences which occur beyond the entry level educational requirement for PTs & PTAs

• Content must relate to physical therapy –intervention, examination, research, documentation, education, management

• Purpose is to assure safe & effective practice


Hours are required for the twenty-four (24) months that precede the licensure renewal month.


• PTs

• 30 hours

• At least 20 hours from Class I activities

• Only 10 hours may be acquired online

• PTAs

• 30 hours

• At least 20 hours from Class I activities

• Only 10 hours may be acquired online


• “Online” – generally refers to course accessed on the internet

• “Online” does not include courses that are:• Interactive which require answering quiz questions throughout or require successful completion of a written exam

• Real time with opportunity for interaction

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• Ethics & Jurisprudence Requirement

• PTs & PTAs – 4 hours of Ethics and Jurisprudence (counts as Class I)

• For current licensees, required every license renewal cycle

• For new licensees, within the initial period of licensure before the first renewal & then go to every license renewal cycle


• Class I Activities

• External & internal peer review

• Approved continuing education courses (APTA or its sections, TPTA, accredited PT or PTA schools)

• University credit courses

• Present continuing education courses

• Author peer reviewed research

• Adjunct teaching in PT or PTA program


• Class I Activities

• Clinical specialist certification or recertification by the American Board of Physical Therapy Specialties

• Other clinical specialist certification (McKenzie, NDT, Ola Grimsby, etc.)

• Advanced degree

• Clinical residency programGCS

Continuing Competence• Class II activities

• Self-instruction reading literature

• Attend educational sessions that do not meet Class I criteria

• Clinical instructor

• Study group participation

• Attend or present in-services

• APTA service – delegate, committee, board, task force

Continuing Competence• Unacceptable activities

• CPR, OSHA, TOSHA, & safety courses

• Meetings for policy decisions

• Non-educational sessions or entertainment activities at professional meetings

• Visiting exhibits at conferences

Continuing Competence• Documentation must be retained for 5 years after completion of requirements

• Examples of documentation may be found in Rule 1150-1-.12 (8) (d)

• You do not have to submit documentation every time you renew your license

• The Board of Physical Therapy randomly audits 5% of the renewals each month to verify compliance

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Retirement of License

• May apply to convert an active license to inactive (retired) status

• Cannot practice PT or imply that you are actively licensed in Tennessee

• Do not have to pay renewal fee

Reactivation of License

• Submit a written request

• Fees for renewal & reinstatement

• Complete the continuing competence requirements

• Board of Physical Therapy has the discretion to require additional education, supervised clinical practice, or successful passage of licensure examination

Scope of Practice

• Use of Direct Thrust

• Direct Access Provisions

• Dry Needling

Use of Direct Thrust

The scope of practice of physical therapy shall not include the performance of treatment where the PT or PTA uses direct thrust to move a joint of the patient’s spine beyond its normal range of motion without exceeding the limits of anatomical integrity.

Direct Access Provisions• PTs must practice with a referral from a doctor of:

• Medicine• Chiropractic• Dentistry• Podiatry• Osteopathy

• Except for the exemptions described on the following slides

Referred to as “doctor” on the following slides

Direct Access Provisions• Initial evaluations

• Provide assessments & instructions to asymptomatic persons

• Emergency Situations – provide treatment if absence of attention could result in:

• Health in serious jeopardy

• Serious impairment to bodily functions

• Serious dysfunction of bodily part

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Direct Access ProvisionsPatient wants PT to inform his/her doctor

• A patient comes to your clinic with low back pain & wants you to let his doctor know that he has come to PT.

• You must then inform his doctor of the initiation of PT services no later than business days after the evaluation.

• You must then consult with his doctor within the first visits or business days, whichever comes first, or no further treatment can occur.

Direct Access ProvisionsPatient wants PT to inform his/her doctor

• Consultation is defined in the Rules as:

A meeting that is conducted either face-to-face or by some other medium such as, but not limited to, telephone, facsimile, mail, or electronic means, wherein two or more health professionals discuss the diagnosis, prognosis, and treatment of a particular case.

Direct Access ProvisionsPatient does not have a doctor

• A patient comes to your clinic with a sprained ankle from slipping on ice. She tells you she just moved to town and does not have a doctor.

• You have her sign a consent form and place it in her patient record & tell her that you will not be able to treat her longer than days since she does not have a doctor.

• You provide her with a list of doctors.

Direct Access ProvisionsPatient does not want his/her doctor informed of PT

• A patient comes to your clinic with a sore neck from a motorcycle accident.

• He tells you that he does not want you to tell his doctor about PT.

• You have him sign a consent form and place it in his patient record.

• You tell him that you will not be able to treat him longer than days unless you consult with his doctor.

Direct Access ProvisionsPatient has seen a doctor for the problem within past 12 months

• A patient was seen by his doctor in January for lateral epicondylitis. He comes to PT in August with the same problem, but he has not been to his doctor for it.

• True or false: The PT must obtain the patient’s consent to inform the doctor of the patient coming to PT.

Direct Access ProvisionsPatient progress

• If no substantial progress is made in 15 calendar days or 6 visits, the PT must stop treatment & refer the patient to a doctor

• For patients previously diagnosed with chronic, neuromuscular, or developmental conditions by a doctor, this provision does not apply

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Direct Access ProvisionsSummary of maximum length of treatment

• No limit once a consultation has occurred (unless patient is not making progress) due to:

• Patient request

• Patient having seen doctor within past 12 months for the problem

• 30 day limit on treating patient if doctor has not been notified of PT services if:

• Patient does not have a doctor

• Patient does not want doctor notified

Direct Access ProvisionsPatient referral for recurring condition

• If a patient returns to PT within 90 days of treatment with the same complaint, the PT must refer to the appropriate health care provider

• For patients previously diagnosed with chronic, neuromuscular, or developmental conditions by a doctor, this provision does not apply

Direct Access Provisions

• To treat patients without a referral, a PT must meet one of the following three conditions:

1. A master’s or doctorate degree in physical therapy & one year of experience

2. Successful completion of a residency or clinical fellowship approved by the board (APTA or AAOMPT)

Direct Access Provisions

3. Three years of experience & completion of a 15 hour physical therapy screening course approved by the board & offered by an accredited university

http://tn.gov/assets/entities/health/attachments/PT_DirAccPolicy.pdf

Dry Needling

Educational Requirements:

• All instruction must be in person

• A combined 50 hours of instruction in:• Musculoskeletal and Neuromuscular systems

• Anatomical basis of pain mechanisms, chronic pain, and referred pain

• Trigger Points

• Universal Precautions

(These are generally satisfied in PT school)

Dry Needling

Educational Requirements:

• 24 hours of dry needling specific instruction in:• Dry needling technique

• Dry needling indications and contraindications

• Documentation of dry needling

• Management of adverse effects

• Practical psychomotor competency

• OSHA’s Bloodborne Pathogen Protocol

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Dry Needling

Dry Needling Courses:

• Must specify what anatomical regions are included and describe whether it offers introductory or advanced instruction

• Must be pre-approved or approved by the licensing board or its designee• If you have taken a course that is not approved by the licensing board, you may submit information for approval 30 days before the next board meeting

Dry Needling

Dry Needling Courses:• The provider must provide to the Licensing Board administrator:• Name of the course provider• Synopsis and description of the course• Copy or description of any course materials used

• PTs who obtained dry needling training in another state or country must provide this same information to the Licensing Board administrator for approval.

Dry Needling

• A newly-licensed PT may not practice dry needling for at least 1 year from the date of initial licensure, unless he/she can demonstrate compliance with the educational requirements through pre-licensure educational coursework.

Dry Needling

• Dry needling may only be performed by a PT and may not be delegated to a PTA or support personnel

• All PT patients receiving dry needling shall be provided with information that includes a definition and description of the practice of dry needling, and a description of any risks, benefits, and potential side effects of dry needling.

Conduct That May Result in Disciplinary Action


Scope of Practice• Practicing physical therapy in violation of the practice act or any rule or written order adopted by the Board

• Practicing or offering to practice beyond the scope of practice

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Patient RecordsFailure to maintain adequate records:

• Physical therapy evaluation

• Physical therapy treatment diagnosis

• Plan of care including desired outcomes

• Treatment record

• Results of interventions

• Discharge plan

• Patient identification information


Patient Records

Position Statement on PT Discharge Evaluations/Summaries

• The Board of PT recognizes that in some situations a patient’s discharge is out of control of the PT

• A discharge plan, evaluation, or summary is required for every patient record


Substandard Care

• Substandard care by a PT due to ignorance, incompetence, or a deliberate or negligent act or failure to act

• Substandard care by a PTA, which includes exceeding the authority to perform the task selected & delegated by the supervising PT


Substandard Care

• Over-utilization or underutilization

• Intervention unwarranted by the patient’s condition

• Treatment beyond the point of reasonable benefit

• Abandonment without informing of other options

• Failure to practice in accordance with standards in the “Guide to Physical Therapist Practice”


Inadequate Supervision• Inadequately supervising or delegating duties which exceed the scope of practice for support personnel• PTAs• Assistive Personnel• Students, volunteers

• Aiding or abetting a person not licensed who directly or indirectly performs activities requiring a license


Inadequate Supervision• Assistive personnel, students, and volunteers must have on-site supervision. The supervising PT or PTA must be:

• Continuously on-site and present

• Immediately available to assist

• Maintain continued involvement in appropriate aspects of each treatment session

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Inadequate Supervision• Supervision of students

• On-site supervision

• Clinical instructor must have 1 year of experience

• Volunteers

• On-site supervision

• May not provide physical therapy to patients

PTA Supervision

• A PT must perform the evaluation & develop a (written or verbal) treatment plan including goals, frequency, & time period of service.

• A PT must perform & document re-evaluations, assessments, and modifications in the treatment plan every _____ days.

PTA Supervision• For patients seen longer than 60 days, a PT must inspect the actual act of therapy services rendered by a PTA at least every _____ days.

• A PTA may see the patient for the discharge evaluation as long as the PT signs off on the note. (True or False)

• A PT may not supervise a PTA that is delivering services at a site further than _____ miles or _____ hour(s) from the PT.

PTA Supervision

• A PT may concurrently supervise no more than the equivalent of _____ full-time PTAs.

• The PT & the PTA are equally responsible & accountable for carrying out the supervision provisions in the Rules. (True or False)

PTA Supervision Case 1

• After patient evaluation in January, PT delegated treatment to a PTA

• PTA treated per original treatment plan 2-3 times weekly until October

• PTA performed assessments & status reports monthly for MD, except in April when this was done by PT

• PTA documentation was incomplete & unsigned at times

Did the Board of Physical Therapy take disciplinary action

against the PT?

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Disciplinary Action Against the PT

• 1 year probation; $2,000 fine; 50 hours of education in ethics, jurisprudence, documentation, & supervision

• The PT was disciplined for violation of:

• Inadequate supervision of assistive personnel • Failure to re-evaluate patient every 30 days &

observe PTA services every 60 days• Failure to maintain adequate patient records

Did the Board of Physical Therapy take disciplinary action against the PTA?

Disciplinary Action Against the PTA

• 1 year probation; quarterly reports from a different supervisor; 50 hours of education in ethics, jurisprudence, documentation, & supervision

• The PTA was disciplined for violation of:

• Practicing beyond the scope of practice• Engaging in substandard care by a PTA by

exceeding the authority to perform the task • Failure to maintain adequate patient records

PTA Supervision Case 2

A PTA performed

Functional Capacity Evaluations

Did the Board of Physical Therapy take disciplinary action against the

PTA?

Disciplinary Action Against the PTA

• 1 year probation; ordered to Cease & Desist from performing FCEs; continuing education related to the scope of practice of PTAs

• The PTA was disciplined for violation of:

• Practicing beyond the scope of practice• Engaging in substandard care by a PTA by

exceeding the authority to perform the task


Ethics• Failure to adhere to the standards of ethics of the physical therapy profession

• The Rules adopt the:

• APTA Code of Ethics for the Physical Therapist

• APTA Standards of Ethical Conduct for the Physical Therapist Assistant

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Competence Issues• Practicing while impaired by drugs or alcohol

• DUI Conviction• Have to report on license renewal – license may be put

on probation

• Will be put on monitoring by Tennessee Professional Assistance Program (TNPAP)

• May jeopardize credentialing by insurance companies and their willingness to reimburse for services


Competence Issues

• Having been judged mentally incompetent by a court of competent jurisdiction

• Disciplinary action taken against license held in another state

• Failure to meet the continuing competence requirement


Patient ConfidentialityFailure to maintain patient confidentiality without prior written consent or unless otherwise required by law

• Suspected child abuse must be reported to Child Protective Services (1-800-422-4453)

• Suspected abuse of dependent older adults & people with disabilities must be reported to Adult Protective Services (1-800-677-1116)


Sexual Misconduct• Engaging in or soliciting sexual relationships, whether consensual or non-consensual, while a PT/PTA relationship with a patient exists

• Making sexual advances, requesting sexual favors, & engaging in other verbal or physical conduct or physical contact of a sexual nature with patients

• Intentionally viewing a disrobed patient if not related to care


Criminal Issues

• Conviction of a felony

• Interfering with an investigation or disciplinary proceeding by willful misrepresentation of facts or by the use of threats

• Violation or assisting or conspiring to violate any provisions of the practice act, rules, or criminal statute


Fraud• Medicare & insurance regulations make fraud a federal crime

• A Tennessee PT was convicted of 26 felony counts involving fraud, extortion, & bribery

• Sentenced to 52 months in federal prison

• Ordered to pay $864,000 in restitution & fines

• PT license was revoked

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Fraud• Fraud & deceit in obtaining license or in

practice

• Requesting, receiving or participating in the dividing, transferring, assigning, rebating or refunding of an unearned fee

• Charging unreasonable or fraudulent fees for services performed or not performed


Fraud• Making misleading, deceptive, untrue or fraudulent representations

• Promoting unnecessary devices, intervention or service for financial gain

• Fee splitting for patient referral

• Payment or acceptance of commissions on fees for services or articles supplied to patients


Fraud• Law enforcement, government regulators, and

legislative bodies are strengthening resources to combat fraud

• Ten Tips for Protecting Your Practice

(From National Heritage Insurance)


False Advertising

• The Rules contain comprehensive requirements to promote “truth in advertising”

• Rule 1150-1-.13


Reporting Requirement• Failure to report any act or omission of a licensee, applicant, or any other person, which violates the provisions of the Practice Act

• Complaints are filed with the Office of Investigations

• http://tn.gov/health/article/filing-complaints-against-health-care-professionals or 1-800-852-2187


Reporting Requirement

• Issues Not Within Board Authority

• Fees and/or billing disputes (amounts charged for services, overcharges, etc.)

• Insurance matters (unless it deals with fraud by a practitioner)

• These types of complaints should go to Consumer Affairs at 1-800-342-8385

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Other Issues

• Employing illegal aliens

• Delinquency in child support payments

• Defaulting on student loans

Disclosures to Patients

• PTs must inform the patient of any financial arrangements connected to the referral process

• PTs must disclose in writing any financial interest in products they recommend or endorse to their patients

• PTs have the responsibility to ensure that the patient has knowledge of freedom of choice in services & products

PT Practice Act Puzzlers

IT’S QUESTION TIME!!

Summary

• It is in your best interest to understand the Practice Act, Rules, & Licensing Board Policies

• This knowledge will keep you from inadvertently violating the law

• If you are asked to do something illegal by an employer, knowledge of these documents arms you so that you can work with the employer to change their practice

Summary

• Understanding the Practice Act, Rules, & Licensing Board Policies helps support the decisions you make associated with physical therapy practice

POST-TEST

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Title 63 Professions Of The Healing Arts

Chapter 13

Occupational and Physical Therapy

Part Part 1 —General Provisions Part 2 —Certification of Occupational Therapists and Assistants Part 3 —Licensure of Physical Therapists and Assistants

Part 1

—General Provisions 63-13-101. Short title. —

This chapter shall be known and may be cited as the “Occupational and Physical Therapy Practice Act.” [Acts 1984, ch. 921, § 2; T.C.A., § 63-13-201; Acts 1999, ch. 528, § 2.] 63-13-102. Legislative intent. —

This chapter is enacted for the purposes of protecting the public health, safety, and welfare, and providing for state administrative control, supervision, licensure and regulation of the practice of physical therapy and occupational therapy. It is the general assembly's intent that only individuals who meet and maintain prescribed standards of competence and conduct may engage in the practice of physical therapy and occupational therapy as authorized by this chapter. This chapter is intended to promote the public interest and to accomplish the purposes stated in this section. [Acts 1984, ch. 921, § 2; T.C.A., §§ 63-13-205, 63-13-105; Acts 1999, ch. 528, § 3.] 63-13-103. Chapter definitions. — Please note - definitions related to Occupational Therapy have been deleted from this section.

As used in this chapter, unless the context otherwise requires:

(3) “Board” means:

(A) As used in part 2 of this chapter, the board of occupational therapy; and

(B) As used in part 3 of this chapter, the board of physical therapy;

(4) “Division” means the division of health related boards of the department of health;

(10) “On-site supervision” means the supervising physical therapist or physical therapist assistant must:

(A) Be continuously on-site and present in the department or facility where assistive personnel are performing services;

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(B) Be immediately available to assist the person being supervised in the services being performed; and

(C) Maintain continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel;

(11) “Physical therapist” means a person who is licensed pursuant to this chapter to practice physical therapy;

(12) “Physical therapist assistant” means a person who meets the requirements of this act for licensure as a physical therapist assistant and who performs physical therapy procedures and related tasks that have been selected and delegated only by the supervising physical therapist;

(13) “Physical therapy” means the care and services provided by or under the direction and supervision of a physical therapist who is licensed pursuant to this chapter;

(14) “Physical therapy assistive personnel”:

(A) “Other assistive personnel” means other trained or educated health care personnel not defined in subdivision (13) and (15)(B), who perform specific designated tasks related to physical therapy under the supervision of a physical therapist. At the discretion of the supervising physical therapist, and if properly credentialed and not prohibited by any other law, “other assistive personnel” or “other support personnel” may be identified by the title specific to their training or education; and

(B) “Physical therapy aide,” inclusive of the terms “aide,” “technician” and “transporter,” means a person trained by and under the direction of a physical therapist who performs designated and supervised routine physical therapy tasks;

(15) “Practice of physical therapy” means:

(A) Examining, evaluating and testing individuals with mechanical, physiological and developmental impairments, functional limitations, and disability or other health and movement-related conditions in order to determine a physical therapy treatment diagnosis, prognosis, a plan of therapeutic intervention, and to assess the ongoing effect of intervention;

(B) Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that include, but are not limited to: therapeutic exercise; functional training; manual therapy; therapeutic massage; assistive and adaptive orthotic, prosthetic, protective and supportive equipment; airway clearance techniques; debridement and wound care, physical agents or modalities, mechanical and electrotherapeutic modalities; and patient-related instruction;

(C) Reducing the risk of injury, impairments, functional limitation and disability, including the promotions and maintenance of fitness, health and quality of life in all age populations; and

(D) Engaging in administration, consultation, education and research;

(16) “Restricted physical therapist assistant license” means a license on which the committee has placed any restrictions due to action imposed by the committee;

(17) “Restricted physical therapy license” means a license on which the committee places restrictions or conditions, or both, as to scope of practice, place of practice, supervision of practice, duration of licensed status, or type of condition of patient to whom the licensee may provide services;

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(18) “Supervision” of the physical therapist assistant means the supervising physical therapist will be readily available to the physical therapist assistant being supervised. When the physical therapist assistant is practicing in an offsite setting, the supervising physical therapist will be immediately accessible by telecommunications; patient conferences will be regularly scheduled and documented and supervisory visits will be made as further outlined in the rules and regulations; and

[Acts 1984, ch. 921, § 2; T.C.A., § 63-13-202; Acts 1988, ch. 824, §§ 1-4; 1988, ch. 1023, §§ 1, 2; 1991, ch. 245, §§ 1, 2; 1993, ch. 225, § 1; T.C.A., § 63-13-102; Acts 1999, ch. 415, § 1; 1999, ch. 528, § 4; 2006, ch. 765, § 1; 2007, ch. 115, § 1.] 63-13-109. Unauthorized practice of medicine — Scope of practice. —

(a) Nothing in this chapter shall be construed as allowing physical therapists to practice medicine, osteopathy, podiatry, chiropractic, or nursing.

(b) (1) The scope of practice of physical therapy shall be under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, with exceptions as stated in § 63-13-303.

(2) The scope of practice of physical therapy shall not include the performance of treatment where the physical therapist or physical therapist assistant uses direct thrust to move a joint of the patient's spine beyond its normal range of motion without exceeding the limits of anatomical integrity. [Acts 1999, ch. 528, § 10; 2007, ch. 423, § 1.]

Part 3 —Licensure of Physical Therapists and Assistants

Sec. 63-13-301. License requirement. 63-13-302. Referrals — Ethical standards. 63-13-303. Exceptions to referral requirements. 63-13-304. Board powers. 63-13-305. Claims and practices of other licensed professionals — Exemptions from licensure. 63-13-306. Application — Examinations. 63-13-307. Qualifications of applicants — Reciprocity. 63-13-308. License renewal — Changes in name or address — Retirement — Inactive status — Exemption from continuing education requirements. 63-13-309. Reinstatement of license — Failure to renew license. 63-13-310. Unlawful use of titles or designations indicating licensure. 63-13-311. Supervision of students and assistive personnel. 63-13-312. Denial, suspension or revocation of licenses. 63-13-313. Disciplinary actions of the board. 63-13-314. Administrative procedure of disciplinary actions — Jurisdiction of board. 63-13-315. Penalties. 63-13-316. Peer assistance program — Fees. 63-13-317. Disclosures to patient — Confidentiality of information — Complaints — Display of license. 63-13-318. Board of physical therapy.

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63-13-301. License requirement. —

(a) A physical therapist licensed under this chapter is fully authorized to practice physical therapy as defined in this chapter.

(b) No person shall practice, or in any manner claim to be engaging in the practice of physical therapy or designate as being a physical therapist unless duly licensed as a physical therapist in accordance with this chapter. [Acts 1999, ch. 528, § 12.] 63-13-302. Referrals — Ethical standards. —

(a) A physical therapist shall refer persons under the physical therapist's care to appropriate health care practitioners, after consultation with the referring practitioner, if the physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice or when physical therapy treatment is contraindicated.

(b) Physical therapists shall adhere to the recognized standards of ethics of the physical therapy profession and as further established by rule. [Acts 1999, ch. 528, § 13.] 63-13-303. Exceptions to referral requirements. —

(a) The practice of physical therapy shall be under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, except a licensed physical therapist may:

(1) Conduct an initial evaluation of a patient without referral;

(2) Provide physical assessments or instructions, including a recommendation of exercise to an asymptomatic person, without the referral of a referring practitioner;

(3) (A) In emergency circumstances, including minor emergencies, provide assistance to a person to the best of a therapist's ability without the referral of a referring practitioner. Except as provided in subdivision (a)(4), the physical therapist shall refer the person to the appropriate health care practitioner, as indicated, immediately after providing assistance;

(B) For the purposes of subdivision (a)(3)(A):

(i) “Emergency circumstances” means instances where emergency medical care is required; and

(ii) “Emergency medical care” means bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:

(a) Placing the patient's health in serious jeopardy;

(b) Serious impairment to bodily functions; or

(c) Serious dysfunction of any bodily organ or part; and

(4) Treat a patient without a referral when all of the following apply:

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(A) When a patient provides the name of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy and expressly wants the physical therapist to inform that physician, the physical therapist shall inform the patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy no later than five (5) business days after the evaluation. A consultation shall occur between the physical therapist and the patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within the first six (6) visits or fifteen (15) business days, whichever comes first, of the findings of the patient's initial visit for physical therapy and any subsequent visits. Should that consultation not take place, no further therapy beyond the six (6) visits or fifteen (15) days, whichever comes first, shall be delivered;

(B) When a patient does not provide the name of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy or expressly states to the therapist that the patient does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of the initiation of therapy services, the therapist shall have the patient sign a consent form that confirms the patient either does not have a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy or does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of the initiation of therapy treatment. The consent form shall be maintained in the patient's record;

(C) If the patient presents to the physical therapist for a problem for which the patient has been seen by a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within the past twelve (12) months, the consent of the patient is not necessary to inform that licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy of the presentation for the physical therapy treatment. If the patient has no licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, then the physical therapist shall make a suggestion from the list of available providers and shall inform the patient of the thirty-day limitation in subdivision (a)(4)(E);

(D) If the physical therapist determines, based on reasonable evidence, that no substantial progress has been made with respect to that patient within fifteen (15) calendar days or six (6) visits, whichever occurs first, immediately following the date of the patient's initial visit with the physical therapist, the physical therapist shall not provide any additional physical therapy services and shall refer the patient to a licensed physician, doctor of chiropractic, dentist, podiatrist or osteopath. If the patient previously was diagnosed with chronic, neuromuscular, or developmental conditions by a physician, doctor of chiropractic, dentist, podiatrist or osteopath and the evaluation, treatment or services are being provided for problems or symptoms associated with one (1) or more of those previously diagnosed conditions, then this subdivision (a)(4)(D) shall not apply. If a patient returns to the physical therapist within ninety (90) days of treatment with the same complaint, then the physical therapist shall make an immediate referral to the appropriate health care provider;

(E) When a patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy has not been notified of the physical therapy services, under no circumstances should therapy services continue beyond thirty (30) days immediately following the date of the patient's first visit;

(F) (i) It shall be considered unprofessional conduct for the purposes of § 63-13-312 for a physical therapist to knowingly initiate services for the same complaint for which a patient:

(a) Has started therapy services but another therapist did not inform a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within five (5) business days of the initial evaluation in accordance with subdivision (a)(4)(A);

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(b) Has reached the fifteen (15) day and six (6) visit limit imposed by subdivision (a)(4)(D) where no substantial progress has been made from another physical therapist; or

(c) Has reached the thirty-day limit imposed by subdivision (a)(4)(E);

(ii) This subdivision (a)(4)(F) does not apply if a referral from a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy is made; and

(G) If, at any time, the physical therapist has reason to believe that the patient has symptoms or conditions that require treatment or services beyond the scope of practice of a physical therapist, the physical therapist shall refer the patient to a licensed health care practitioner acting within the practitioner's scope of practice.

(b) No person shall practice physical therapy other than upon the referral of a patient by a person who is licensed in this or another state to practice medicine, chiropractic, dentistry, osteopathic medicine, or podiatric medicine, within the scope of those practices, and whose license is in good standing and who holds a CPR certificate, or its equivalent, unless one of the following conditions is met:

(1) The person holds a master's or doctorate degree from a professional physical therapy program that is accredited by a national accreditation agency recognized by the United States department of education and by the board of physical therapy and the person has completed at least one (1) year of experience as a licensed physical therapist;

(2) The person has successfully completed a residency or clinical fellowship in physical therapy at a program approved by the board; or

(3) (A) The person has completed at least three (3) years of experience as a licensed physical therapist; and

(B) The person has completed a course approved by the board of physical therapy and offered by an accredited university of at least fifteen (15) hours, designed to enable the physical therapist to identify signs and symptoms of systemic disease, particularly those that can mimic cardiological, neurological, oncological, or musculoskeletal disorders, and to recognize conditions that require timely referral to a physician, dentist, osteopath, podiatrist or chiropractor. [Acts 1999, ch. 528, § 14; 2007, ch. 115, § 10; 2007, ch. 423, § 2.] 63-13-304. Board powers. —

The board of physical therapy has the power and authority to:

(1) Evaluate the qualifications of applicants for licensure and provide for the examination of physical therapists and physical therapist assistants;

(2) Adopt passing scores for examination;

(3) Issue licenses to those who qualify under this chapter;

(4) Regulate the practice of physical therapy by interpreting and enforcing the provisions of this statute, including disciplinary action;

(5) Adopt and revise rules, as it deems necessary and appropriate, consistent with this law, for the discharge of its obligation under this section. Such rules, when lawfully adopted, shall have the effect of law;

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(6) Establish requirements for assessing continuing competence of licensees; and

(7) Assess all license and registration fees.[Acts 1999, ch. 528, § 15; 2007, ch. 115, § 10.]

63-13-305. Claims and practices of other licensed professionals — Exemptions from licensure. —

(a) Nothing in this chapter shall be construed as restricting a person licensed or certified under any other law of this state from engaging in the profession or practice for which the person is licensed or certified; provided, that the person does not claim to be a physical therapist, a physical therapist assistant or a provider of physical therapy.

(b) The following persons shall be exempt from licensure as a physical therapist or physical therapist assistant under this chapter:

(1) A person who is pursuing a course of study leading to a degree as a physical therapist or physical therapist assistant in a professional education program approved by the board and is satisfying supervised clinical education requirements related to physical therapy education;

(2) A physical therapist or physical therapist assistant while practicing in the United States armed services, United States public health service or veterans administration as based on requirements under federal regulations for state licensure of health care providers;

(3) A physical therapist or physical therapist assistant licensed in another United States jurisdiction, or a foreign-educated physical therapist credentialed in another country, performing physical therapy as part of teaching or participating in an educational seminar of no more than sixty (60) days in a calendar year; and

(4) A physical therapist or physical therapist assistant licensed in another United States jurisdiction who is temporarily performing physical therapy for members of established athletic teams, athletic corporations, or performing arts companies that are training, competing, or performing in Tennessee; provided, however, that a person performing physical therapy in this state pursuant to this subdivision (b)(4) shall agree to use the secretary of state for service of process pursuant to title 20, chapter 2, part 2.

(c) Nothing in this chapter shall be construed as restricting persons licensed under any other law of this state from performing physical agent modalities for which they have received education and training. [Acts 1999, ch. 528, § 16; 2003, ch. 8, § 1; 2007, ch. 115, § 10.] 63-13-306. Application — Examinations. —

(a) An applicant for licensure as a physical therapist or physical therapist assistant shall file an application as required by the board. A non-refundable application fee and the cost of the examination shall accompany the completed written application. Fees shall be established by the rules promulgated by the board.

(b) After the application process has been completed, an applicant shall take the examination for physical therapist licensure that covers current physical therapy practice.

(c) After the application process has been completed, an applicant shall take the examination for physical therapist assistant licensure that covers current technical application of physical therapy services.

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(d) Examinations shall be available within the state at such time and place as the board shall determine. The board shall determine the passing score.

(e) Applicants who do not pass the examination after the first attempt may retake the examination one (1) additional time without re-application for licensure. This must occur with six (6) months of initial board approval to take the examination. Prior to being approved by the board for subsequent testing beyond two (2) attempts, individuals shall submit a new application with all applicable fees and demonstrate evidence satisfactory to the board of having successfully completed additional clinical training and/or course work as determined by the board and defined in the rules. [Acts 1999, ch. 528, § 17; 2007, ch. 115, § 10.] 63-13-307. Qualifications of applicants — Reciprocity. —

(a) An applicant for licensure as a physical therapist shall have the following qualifications:

(1) Must be at least eighteen (18) years of age;

(2) Be of good moral character;

(3) Have completed the application process;

(4) Be a graduate of a professional physical therapy education program accredited by an accreditation agency approved by the board; and

(5) Have successfully passed an examination approved by the board.

(b) An applicant for license as a physical therapist assistant shall meet the following requirements:




(4) Be a graduate of a physical therapist assistant education program accredited by an accreditation agency approved by the board; and

(5) Have successfully passed an examination approved by the board.

(c) The board shall issue a license to a physical therapist or physical therapist assistant who has a valid unrestricted license from another United States jurisdiction in which such person, when granted such license, previously met all requirements as specified in subsections (a) and (b), and as further established by rules promulgated by the board.

(d) An applicant for licensure as a physical therapist who has been educated outside the United States shall meet the following qualifications:




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(4) Provide satisfactory evidence that the applicant's education is substantially equivalent to the requirements of physical therapists educated in accredited educational programs as determined by the board. If the board determines that a foreign-educated applicant's education is not substantially equivalent, it may require completion of additional course work before proceeding with the application process;

(5) Provide written proof that the school of physical therapy education is recognized by its own ministry of education;

(6) Provide written proof of authorization to practice as a physical therapist without limitations in the country where the professional education occurred;

(7) Provide proof of legal authorization to reside and seek employment in the United States or its territories;

(8) Have the applicant's educational credentials evaluated by a board-approved credential evaluation agency;

(9) Have passed the board approved English proficiency examinations, if the applicant's native language is not English;

(10) Have participated in and completed an interim supervised clinical practice period prior to licensure; and

(11) Have successfully passed the examination approved by the board.

(e) Notwithstanding the provisions of this section, if the foreign-educated physical therapist applicant is a graduate of a professional physical therapy education program accredited by an agency approved by the board, the requirements in subdivisions (d)(4), (5), (8), and (10) may be waived.

(f) In determining the qualifications of an applicant for licensure as a physical therapist or as a physical therapist assistant, only a majority vote of the board of physical therapy shall be required. [Acts 1999, ch. 528, § 18; 2007, ch. 115, § 10.] 63-13-308. License renewal — Changes in name or address — Retirement — Inactive status — Exemption from continuing education requirements. —

(a) A physical therapist or physical therapist assistant licensed under the provisions of this part shall renew such person's license as specified in the rules. An individual, who fails to renew the license by the date of expiration, shall not practice physical therapy or function as a physical therapist assistant in the state of Tennessee.

(b) Each licensee shall report to the division a name change and changes in business and home address within thirty (30) days of the change.

(c) Any person licensed by the board to practice in this state, who has retired or may retire from such practice in this state, is not required to register as required by this part, if such person files with the board an affidavit on a form to be furnished by the board, which affidavit states the date on which the person retired from such practice and any other facts, as the board considers necessary, that tends to verify such retirement. If such person thereafter reengages in practice in this state, such person shall apply for licensure with the board as provided by this part, and shall meet such continuing education requirements that are established by the board, except for good and sufficient reasons as determined by the board.

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(d) Any person licensed by the board may place their license on inactive status by filing the proper forms with the board, and by paying a biennial fee in accordance with rules. If such person thereafter reengages in active practice in this state, such person shall apply for relicensure with the board as provided by this part, and shall meet such continuing education requirements as are established by the board, except for good and sufficient reasons as determined by the board.

(e) A licensee who has been continuously licensed in this state since 1960 and who is at least seventy-one (71) years of age shall be exempt from any continuing education requirements imposed by the board under this chapter. [Acts 1999, ch. 528, § 19; 2005, ch. 51, § 1; 2007, ch. 115, § 10.] 63-13-309. Reinstatement of license — Failure to renew license. —

(a) Reinstatement of a lapsed license following a renewal deadline requires payment of a renewal fee, a late renewal penalty fee and a reinstatement fee, in accordance with rules promulgated by the board.

(b) Reinstatement of a license that has lapsed for more than three (3) consecutive years requires reapplying for a license and payment of fees in accordance with board rules. The individual shall successfully demonstrate to the board competency in the practice of physical therapy or shall serve an internship under a restricted license or take remedial courses as determined by the board, or any combination of the preceding, at the board's discretion. The board may also require the applicant to take an examination.

(c) When any license holder fails to renew and pay the biennial renewal fee within sixty (60) days after renewal becomes due, as provided in this section, the license of such person shall be administratively revoked at the expiration of the sixty (60) days after the renewal was required, without further notice or hearing. Any person whose license is administratively revoked, as provided in this subsection (c), may make application in writing to the board for the reinstatement of such license and, upon good cause being shown, the board, in its discretion, may reinstate such license upon payment of all required fees. [Acts 1999, ch. 528, § 20; 2007, ch. 115, § 10.] 63-13-310. Unlawful use of titles or designations indicating licensure. —

(a) A physical therapist shall use the letters “PT” in connection with their name or place of business to denote licensure under this part.

(b) It is unlawful for any person, or for any business entity, its employees, agents or representatives to use in connection with such person's name, or the name or activity of the business, the words, “physical therapy,” “physical therapist,” “physiotherapy,” “physiotherapist,” “registered physical therapist,” “licensed physical therapist,” or the letters “PT,” “LPT,” “RPT,” or any other words, abbreviations or insignia indicating or implying directly or indirectly that physical therapy is provided or supplied, including the billing of services labeled as physical therapy, unless such services are provided by or under the direction of a physical therapist licensed in accordance with this part.

(c) Nothing in this chapter shall be construed as restricting a person licensed or certified under any other law of this state from engaging in the profession or practice for which the person is licensed or certified; provided, that the person does not claim to be a physical therapist, a physical therapist assistant or a provider of physical therapy.

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(d) A physical therapist assistant shall use the letters “PTA” in connection with their name to denote licensure.

(e) No person shall use the title “physical therapist assistant” and use the letters “PTA” in connection with the person's name, or any other words, abbreviations or insignia indicating or implying, directly or indirectly, that the person is a physical therapist assistant unless the person is licensed as a physical therapist assistant in accordance with this part. [Acts 1999, ch. 528, § 21.] 63-13-311. Supervision of students and assistive personnel. —

(a) Physical therapists are responsible for the patient care given by physical therapist assistants, assistive personnel, and students on clinical affiliations under their supervision. The physical therapist may delegate to the physical therapist assistant, assistive personnel, and clinical students selected acts, tasks or procedures that fall within the scope of their education or training.

(b) Physical therapist assistants shall at all times be under the supervision of a licensed physical therapist as defined in § 63-13-103 and as further set forth in the rules promulgated by the board.

(c) Physical therapy aides, other assistive personnel, and clinical students shall at all times perform patient care activities under the on-site supervision of a licensed physical therapist or physical therapist assistant as defined in § 63-13-103.

(d) Physical therapist students and physical therapist assistant students shall at all times be under the supervision of a physical therapist as further set forth in the rules promulgated by the board. [Acts 1999, ch. 528, § 22.] 63-13-312. Denial, suspension or revocation of licenses. —

The board has the power, and it shall be its duty, to deny, suspend, revoke the license of, or to otherwise lawfully discipline, a licensee who is guilty of violating any of the provisions of this part or is guilty of the following acts or offenses:

(1) Practicing physical therapy in violation of the provisions of this chapter or any rule or written order adopted by the board;

(2) Practicing or offering to practice beyond the scope of physical therapy practice as defined in this chapter;

(3) Making false or misleading statements or representations, being guilty of fraud or deceit in obtaining admission to practice, or being guilty of fraud or deceit in the licensee's practice;

(4) Engaging in the performance of substandard care by a physical therapist due to ignorance, incompetence, or a deliberate or negligent act or failure to act regardless of whether actual injury to the patient is established;

(5) Engaging in the performance of substandard care by a physical therapist assistant, which includes exceeding the authority to perform the task selected and delegated by the supervising physical therapist regardless of whether actual injury to the patient is established;

(6) Inadequately supervising or delegating duties that exceed the scope of practice for assistive personnel in accordance with the chapter and rules adopted by the board;

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(7) Conviction of a felony or any offense involving moral turpitude in the courts of this state or any other state, territory or country. “Conviction,” as used in this subdivision (7), includes a finding or verdict of guilt, or a plea of nolo contendere;

(8) Practicing as a physical therapist or working as a physical therapist assistant when physical or mental abilities are impaired by the use of controlled substances, other habit-forming drugs, chemicals or alcohol;

(9) Disciplinary action against a person licensed to practice as a physical therapist or physical therapist assistant by another state or territory of the United States for any acts or omissions that would constitute grounds for discipline of a person licensed in this state. A certified copy of the initial or final order or other equivalent document shall constitute prima facie evidence of a violation of this section and be sufficient grounds upon which to deny, restrict or condition licensure or renewal and/or discipline a person licensed in this state;

(10) Engaging in sexual misconduct. “Sexual misconduct,” for the purpose of this section, includes:

(A) Engaging in or soliciting sexual relationships, whether consensual or non-consensual, while a physical therapist or physical therapist assistant/patient relationship exists;

(B) Making sexual advances, requesting sexual favors, and engaging in other verbal conduct or physical conduct or physical contact of a sexual nature with patients; and

(C) Intentionally viewing a completely or partially disrobed patient in the course of treatment, if the viewing is not related to patient diagnosis or treatment under current practice standards;

(11) Directly or indirectly requesting, receiving, or participating in the dividing, transferring, assigning, rebating or refunding of an unearned fee, or profiting by means of a credit or other valuable consideration, such as an unearned commission, discount, or gratuity in connection with the furnishing of physical therapy services. Nothing in this subdivision (11) prohibits the members of any regularly and properly organized business entity recognized by law and comprised of physical therapists from dividing fees received for professional services among themselves as they determine necessary to defray their joint operating expense. Physical therapists employed by or contracting with a physician, physician group, as defined in accordance with the federal Physician Self-Referral Law, codified in 42 U.S.C. § 1395nn, or entity primarily owned by physicians, and receiving wages or other compensation and/or benefits pursuant to the employment or contract, shall not be deemed to be in violation of any provision under this chaptersolely by virtue of the employment or contract, and shall not be subject to licensure denial, suspension, revocation, or any other disciplinary action or other penalty described under this chapter solely by virtue of the employment or contract. This subdivision (11) shall not be interpreted in such a way as to create a prohibition on the corporate practice of any health care professional where no such prohibition previously existed;

(12) Failing to adhere to standards of ethics of the physical therapy profession;

(13) Charging unreasonable or fraudulent fees for services performed or not performed;

(14) Making misleading, deceptive, untrue or fraudulent representations in violation of this act, or otherwise, in practice of the profession;

(15) Being under a current judgment of mental incompetency rendered by a court of competent jurisdiction;

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(16) Aiding or abetting a person not licensed in this state who directly or indirectly performs activities requiring a license;

(17) Failing to report to the board any act or omission of a licensee, applicant, or any other person, which violates the provisions of this chapter;

(18) Interfering with, or refusing to cooperate in, an investigation or disciplinary proceeding, including willful misrepresentation of facts or by the use of threats or harassment against any patient or witness to prevent the patient or witness from providing evidence in a disciplinary proceeding or any legal action;

(19) Failing to maintain patient confidentiality without prior written consent or unless otherwise required by law;

(20) Failing to maintain adequate patient records that contain a minimum of an evaluation of objective finding, a physical therapy treatment diagnosis, the plan of care including desired outcomes, the treatment record, a discharge plan including results of intervention, and sufficient information to identify the patient;

(21) Promoting unnecessary devices, treatment intervention or service for the financial gain of the practitioner or of a third party;

(22) Providing treatment intervention unwarranted by the condition of the patient, nor shall the licensee continue treatment beyond the point of reasonable benefit;

(23) A violation or attempted violation, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate, any provisions of this chapter or any lawful order of the board issued pursuant thereto, or any criminal statute of the state of Tennessee;

(24) Division of fees or agreeing to split fees or divide fees received for professional services with any person for bringing or referring a patient, outside the scope of § 63-13-315; or

(25) Payment or acceptance of commissions, in any form or manner, on fees for professional services, references, consultations, pathological reports, prescriptions, or on other services or articles supplied to patients. [Acts 1999, ch. 528, § 23; 2006, ch. 875, § 3; 2007, ch. 115, § 10.] 63-13-313. Disciplinary actions of the board. —

The board may, upon proof of the violation of any provision of this chapter, take the following disciplinary actions singly or in combination:

(1) Deny an application for a license to any applicant who applies for the same through reciprocity or otherwise;

(2) Permanently or temporarily withhold issuance of a license;

(3) Suspend, limit or restrict a previously issued license for such time and in such manner as the board may determine;

(4) Issue a letter of reprimand;

(5) Reprimand or take such action in relation to disciplining an applicant or licensee including, but not limited to, informal settlements and letters of warning as the board, in its discretion, may deem proper;

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(6) Revoke a license;

(7) Refuse to issue or renew a license; or

(8) Impose civil penalties for violation of this chapter pursuant to § 63-1-134. In addition, the board may, in its discretion, assess and collect the reasonable costs incurred in a disciplinary hearing, when action is taken against a person's license. [Acts 1999, ch. 528, § 25; 2007, ch. 115, § 10.] 63-13-314. Administrative procedure of disciplinary actions — Jurisdiction of board. —

(a) All proceedings for disciplinary action against a licensee shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

(b) The board retains jurisdiction to modify or refuse to modify, upon request of any party, any of its orders issued pursuant to this section. [Acts 1999, ch. 528, § 26; 2007, ch. 115, § 10.] 63-13-315. Penalties. —

(a) A person commits a Class B misdemeanor if the person engages in an activity requiring a license issued according to this chapter and who fails to obtain the required license, who violates any other provision of this chapter or who uses any word, title, or representation implying that the person is licensed to engage in the practice of physical therapy. A person claims to be a physical therapist when using a title, letters, or any description of services that incorporates one (1) or more of the terms, designations or abbreviations specifically restricted under §§ 63-13-103 and 63-13-310.

(b) The board may authorize an investigation of any person to the extent necessary to determine if the person is engaged in the unlawful practice of physical therapy.

(c) The board may, through the office of the attorney general and reporter, apply for injunctive relief in any court of competent jurisdiction to enjoin any person from committing an act in violation of this chapter. Injunctive proceedings are in addition to, and not in lieu of, all penalties and other remedies prescribed in this chapter.

(d) A person who aids or requires another person to directly or indirectly violate this chapter or rules, who permits the person's license or a license issued by this board to be used by any person other than the licensee, or who acts with the intent to violate or evade this chapter or rules is subject to a civil penalty of not more than one thousand dollars ($1,000) for each violation. [Acts 1999, ch. 528, § 27.] 63-13-316. Peer assistance program — Fees. —

(a) In lieu of a disciplinary proceeding as set forth in this chapter, the board may permit a licensee pursuant to this part to actively participate in a board approved peer assistance program under the following conditions:

(1) The board has evidence that the licensee is impaired;

(2) The licensee has not been convicted of a felony relating to a controlled substance in a court of law of the United States or any other territory or country;

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(3) The licensee enters into a written agreement with the board for a restricted license and complies with all the terms of the agreement, including making satisfactory progress in the program and adhering to any limitations on the licensee's practice imposed by the board to protect the public. Failure to enter into such an agreement shall activate an immediate investigation and disciplinary proceeding by the board; and

(4) As part of the agreement established between the licensee and the board, the licensee shall sign a waiver allowing the peer assistance program to release information to the board if the licensee does not comply with the requirements of this section or is unable to practice with reasonable skill or safety.

(b) The board shall establish fees for all licensees to effect the purposes of this section.[Acts 1999, ch. 528, § 28; 2007, ch. 115, § 10.] 63-13-317. Disclosures to patient — Confidentiality of information — Complaints — Display of license. —

(a) Physical therapists shall inform the patient of any financial arrangements connected to the referral process.

(b) Physical therapists shall disclose in writing any financial interest in products they endorse and recommend to their patients.

(c) The licensee has the responsibility to ensure that the patient has knowledge of freedom of choice in services and products.

(d) Information relating to the physical therapist-patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient. The physical therapist-patient confidentiality does not extend to cases in which the physical therapist has a duty to report information as required by law.

(e) Any person may submit a complaint regarding any licensee or any other person potentially in violation of this chapter. Confidentiality shall be maintained subject to law.

(f) The department shall keep all information relating to the receiving and investigation of complaints filed against licensees confidential until the information becomes public record as required by law.

(g) Each licensee shall display a copy of the licensee's license or current renewal verification in a location accessible to public view at the licensee's place of employment. [Acts 1999, ch. 528, § 29.] 63-13-318. Board of physical therapy. —

(a) There is created a board of physical therapy, which shall perform the same functions and have the same duties and responsibilities that were performed by the committee of physical therapy prior to July 1, 2007.

(b) The board shall consist of five (5) members appointed by the governor, each of whom shall be a resident of this state. Three (3) members of the board shall be licensed physical therapists who have had at least five (5) years of experience in the actual practice or teaching of physical therapy immediately preceding their appointment. One (1) member of the board shall be a licensed physical therapist assistant who has had at least five (5) years of experience in the

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actual performance of physical therapy procedures and related tasks or teaching of a physical therapist assistant curriculum immediately preceding the appointment. One (1) member of the board shall be a person who is not engaged in the practice of physical therapy and who is not professionally or commercially associated with the health care industry.

(c) The Tennessee Physical Therapy Association may submit to the governor a list of at least three (3) nominees for each appointment or vacancy to be filled pursuant to this section. The governor may make the appointment from the list.

(d) The physical therapists and the physical therapist assistant who are serving on the committee of physical therapy on July 1, 2007, shall continue to serve as members of the board until the expiration of their terms.

(e) The board shall organize annually and select a chair and a secretary. Meetings shall be held as frequently as may be required.

(f) A quorum of the board shall consist of at least three (3) members.

(g) The division shall provide administrative, investigatory, and clerical services to the board.

(h) Each member of the board shall be reimbursed for actual expenses incurred in the performance of official duties on the board and shall be entitled to a per diem of one hundred dollars ($100) for each day of service in conducting the business of the board. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter.

(i) All regular appointments to the board shall be for terms of three (3) years each. Each member shall serve until a successor is appointed. Vacancies shall be filled by appointment of the governor for the remainder of the unexpired term.

(j) The governor may, at the request of the board, remove any member of the board for misconduct, incompetence, or neglect of duty.

(k) In making appointments to the board, the governor shall strive to ensure that at least one (1) member is sixty (60) years of age or older, that at least one (1) member is a racial minority, and that the gender balance of the board reflects the gender balance of the state's population.

(l) After July 1, 2007, the board shall assume and fulfill all powers and duties previously assigned to the committee of physical therapy, and the rules adopted by the committee of physical therapy shall become the rules of the board without further action by the board. [Acts 2007, ch. 115, § 11.]s

Code of Ethics for the Physical TherapistHOD S06-09-07-12 [Amended HOD S06-00-12-23 ; HOD 06-91-05-05;HOD 06-87-11-17; HOD 06-81-06-18; HOD 06-78-06-08; HOD 06-78-06-07; HOD 06-77-18-30; HOD 06-77-17-27; Initial HOD 06-73-13-24] [Standard]

Preamble The Code of Ethics for the Physical Therapist (Code of Ethics) delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association (APTA). The purposes of this Code of Ethics are to: 1. Define the ethical principles that form the foundation of physical therapist practice in patient/client management, consultation, edu-

cation, research, and administration. 2. Provide standards of behavior and performance that form the basis of professional accountability to the public. 3. Provide guidance for physical therapists facing ethical challenges, regardless of their professional roles and responsibilities. 4. Educate physical therapists, students, other health care professionals, regulators, and the public regarding the core values, ethical prin-

ciples, and standards that guide the professional conduct of the physical therapist. 5. Establish the standards by which the American Physical Therapy Association can determine if a physical therapist has engaged in

unethical conduct. No code of ethics is exhaustive nor can it address every situation. Physical therapists are encouraged to seek additional advice or consulta-tion in instances where the guidance of the Code of Ethics may not be definitive. This Code of Ethics is built upon the five roles of the physical therapist (management of patients/clients, consultation, education, research, and administration), the core values of the profession, and the multiple realms of ethical action (individual, organizational, and societal). Physical therapist practice is guided by a set of seven core values: accountability, altruism, compassion/caring, excellence, integrity, profes-sional duty, and social responsibility. Throughout the document the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life.

PrinciplesPrinciple #1: Physical therapists shall respect the

inherent dignity and rights of all individuals. (Core Values: Compassion, Integrity)

1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, reli-gion, ethnicity, social or economic status, sexual orientation, health condition, or disability.

1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist prac-tice, consultation, education, research, and administration.

Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients.

(Core Values: Altruism, Compassion, Professional Duty)

2A. Physical therapists shall adhere to the core values of the pro-fession and shall act in the best interests of patients/clients over the interests of the physical therapist.

2B. Physical therapists shall provide physical therapy services with compassionate and caring behaviors that incorporate the individual and cultural differences of patients/clients.

2C. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed deci-sions about physical therapy care or participation in clinical research.

2D. Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care.

2E. Physical therapists shall protect confidential patient/client information and may disclose confidential informa-tion to appropriate authorities only when allowed or as required by law.

Principle #3: Physical therapists shall be accountable for making sound professional judgments.

(Core Values: Excellence, Integrity)

3A. Physical therapists shall demonstrate independent and objec-tive professional judgment in the patient’s/client’s best interest in all practice settings.

3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient/client values.

3C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care profes-sionals when necessary.

3D. Physical therapists shall not engage in conflicts of interest that interfere with professional judgment.

3E. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel.

EFFECTIVE JULY 1, 2010. For more information, go to www.apta.org/ethics.

Principle #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research partici-pants, other healthcare providers, employers, payers, and the public.

(Core Value: Integrity)

4A. Physical therapists shall provide truthful, accurate, and rel-evant information and shall not make misleading represen-tations.

4B. Physical therapists shall not exploit persons over whom they have supervisory, evaluative or other authority (eg, patients/clients, students, supervisees, research participants, or employees).

4C. Physical therapists shall discourage misconduct by health-care professionals and report illegal or unethical acts to the relevant authority, when appropriate.

4D. Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law.

4E. Physical therapists shall not engage in any sexual relation-ship with any of their patients/clients, supervisees, or students.

4F. Physical therapists shall not harass anyone verbally, physi-cally, emotionally, or sexually.

Principle #5: Physical therapists shall fulfill their legal and professional obligations.

(Core Values: Professional Duty, Accountability)

5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations.

5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel.

5C. Physical therapists involved in research shall abide by ac-cepted standards governing protection of research partici-pants.

5D. Physical therapists shall encourage colleagues with physical, psychological, or substance related impairments that may adversely impact their professional responsibilities to seek assistance or counsel.

5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority.

5F. Physical therapists shall provide notice and information about alternatives for obtaining care in the event the physi-cal therapist terminates the provider relationship while the patient/client continues to need physical therapy services.

Principle #6: Physical therapists shall enhance their expertise through the lifelong acquisition and re-finement of knowledge, skills, abilities, and professional behaviors.

(Core Value: Excellence)

6A. Physical therapists shall achieve and maintain professional competence.

6B. Physical therapists shall take responsibility for their profes-sional development based on critical self-assessment and reflection on changes in physical therapist practice, educa-tion, healthcare delivery, and technology.

6C. Physical therapists shall evaluate the strength of evidence and applicability of content presented during professional development activities before integrating the content or techniques into practice.

6D. Physical therapists shall cultivate practice environments that support professional development, life-long learning, and excellence.

Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society.

(Core Values: Integrity, Accountability)

7A. Physical therapists shall promote practice environments that support autonomous and accountable professional judgments.

7B. Physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services.

7C. Physical therapists shall not accept gifts or other consider-ations that influence or give an appearance of influencing their professional judgment.

7D. Physical therapists shall fully disclose any financial interest they have in products or services that they recommend to patients/clients.

7E. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy ser-vices accurately reflect the nature and extent of the services provided.

7F. Physical therapists shall refrain from employment arrange-ments, or other arrangements, that prevent physical thera-pists from fulfilling professional obligations to patients/clients.

Principle #8: Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally.

(Core Values: Social Responsibility)

8A. Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, unin-sured, and underinsured.

8B. Physical therapists shall advocate to reduce health dispari-ties and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people.

8C. Physical therapists shall be responsible stewards of health care resources and shall avoid over-utilization or under-utilization of physical therapy services.

8D. Physical therapists shall educate members of the public about the benefits of physical therapy and the unique role of the physical therapist.

Proviso: The Code of Ethics as substituted will take effect July 1, 2010, to allow for education of APTA members and

non-members.

Standards of Ethical Conduct for the Physical Therapist AssistantHOD S06-09-20-18 [Amended HOD S06-00-13-24; HOD 06-91-06-07; Initial HOD 06-82-04-08] [Standard]

Preamble The Standards of Ethical Conduct for the Physical Therapist Assistant (Standards of Ethical Conduct) delineate the ethical obligations of all physical therapist assistants as determined by the House of Delegates of the American Physical Therapy Association (APTA). The Standards of Ethical Conduct provide a foundation for conduct to which all physical therapist assistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients/clients to achieve greater indepen-dence, health and wellness, and enhanced quality of life.

No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive.

Standards Standard #1: Physical therapist assistants shall

respect the inherent dignity, and rights, of all individuals.

1A. Physical therapist assistants shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orienta-tion, health condition, or disability.

1B. Physical therapist assistants shall recognize their personal bi-ases and shall not discriminate against others in the provision of physical therapy services.

Standard #2: Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients.

2A. Physical therapist assistants shall act in the best interests of patients/clients over the interests of the physical therapist as-sistant.

2B. Physical therapist assistants shall provide physical therapy interventions with compassionate and caring behaviors that incorporate the individual and cultural differences of pa-tients/clients.

2C. Physical therapist assistants shall provide patients/clients with information regarding the interventions they provide.

2D. Physical therapist assistants shall protect confidential patient/client information and, in collaboration with the physical therapist, may disclose confidential information to appropri-ate authorities only when allowed or as required by law.

Standard #3: Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations.

3A. Physical therapist assistants shall make objective decisions in the patient’s/client’s best interest in all practice settings.

3B. Physical therapist assistants shall be guided by information about best practice regarding physical therapy interventions.

3C. Physical therapist assistants shall make decisions based upon their level of competence and consistent with patient/client values.

3D. Physical therapist assistants shall not engage in conflicts of interest that interfere with making sound decisions.

3E. Physical therapist assistants shall provide physical therapy ser-vices under the direction and supervision of a physical thera-pist and shall communicate with the physical therapist when patient/client status requires modifications to the established plan of care.

Standard #4: Physical therapist assistants shall dem-onstrate integrity in their relationships with patients/clients, families, colleagues, students, other health care providers, employers, payers, and the public.

4A. Physical therapist assistants shall provide truthful, accurate, and relevant information and shall not make misleading representations.

4B. Physical therapist assistants shall not exploit persons over whom they have supervisory, evaluative or other authority (eg, patients/clients, students, supervisees, research partici-pants, or employees).

4C. Physical therapist assistants shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate.

4D. Physical therapist assistants shall report suspected cases of abuse involving children or vulnerable adults to the su-pervising physical therapist and the appropriate authority, subject to law.

4E. Physical therapist assistants shall not engage in any sexual relationship with any of their patients/clients, supervisees, or students.

4F. Physical therapist assistants shall not harass anyone verbally, physically, emotionally, or sexually.

Standard #5: Physical therapist assistants shall fulfill their legal and ethical obligations.

5A. Physical therapist assistants shall comply with applicable local, state, and federal laws and regulations.

5B. Physical therapist assistants shall support the supervisory role of the physical therapist to ensure quality care and promote patient/client safety.

5C. Physical therapist assistants involved in research shall abide by accepted standards governing protection of research partici-pants.

5D. Physical therapist assistants shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel.

5E. Physical therapist assistants who have knowledge that a col-league is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority.

Standard #6: Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities.

6A. Physical therapist assistants shall achieve and maintain clinical competence.

6B. Physical therapist assistants shall engage in lifelong learning consistent with changes in their roles and responsibilities and advances in the practice of physical therapy.

6C. Physical therapist assistants shall support practice environ-ments that support career development and lifelong learning.

Standard #7: Physical therapist assistants shall sup-port organizational behaviors and business prac-tices that benefit patients/clients and society.

7A. Physical therapist assistants shall promote work environments that support ethical and accountable decision-making.

7B. Physical therapist assistants shall not accept gifts or other con-siderations that influence or give an appearance of influencing their decisions.

7C. Physical therapist assistants shall fully disclose any financial in-terest they have in products or services that they recommend to patients/clients.

7D. Physical therapist assistants shall ensure that documenta-tion for their interventions accurately reflects the nature and extent of the services provided.

7E. Physical therapist assistants shall refrain from employment arrangements, or other arrangements, that prevent physi-cal therapist assistants from fulfilling ethical obligations to patients/clients

Standard #8: Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally.

8A. Physical therapist assistants shall support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured.

8B. Physical therapist assistants shall advocate for people with impairments, activity limitations, participation restrictions, and disabilities in order to promote their participation in community and society.

8C. Physical therapist assistants shall be responsible stewards of health care resources by collaborating with physical therapists in order to avoid overutilization or underutiliza-tion of physical therapy services.

8D. Physical therapist assistants shall educate members of the public about the benefits of physical therapy.

TEN TIPS FOR PROTECTING YOUR PRACTICE (National Heritage Insurance*)

1. PROTECT YOUR PROVIDER IDENTIFICATION NUMBER (PIN)

Do not let anyone bill under your PIN.

If you relocate or retire, notify Provider Enrollment to de-activate your PIN. 2. ASSIGN PROCEDURE CODES YOURSELF

You (the provider) are responsible for accurate billing under your PIN.

Never use a code because a supplier OR manufacturer suggests it.

If you delegate this responsibility, conduct periodic checks to ensure accuracy.

Refer to American Medical Association’s Physician’s Current Procedural Terminology (CPT) book.

Use the Healthcare Common Procedure Coding System (HCPCS) guide.

Consult your professional associations and societies for guidance. 3. DOCUMENT ALL SERVICES RENDERED

An important element contributing to the high quality of care to the patient is medical record documentation.

If the service is not documented – it was not done.

Make sure your medical notes are legible.

Make sure every entry is signed and dated.

Remember: Your medical records may serve as a legal document to verify the care provided.

4. USE CAUTION WHEN SIGNING CERTIFICATES OF MEDICAL NECESSITY (CMN)

Never sign blank or incomplete forms.

Never certify supplies for patients you have not seen or examined.

Question a supplier who tries to coerce you to sign CMNs that you do not professionally agree with or have not examined carefully.

Certificates of Medical Necessity are required for the prescription of certain medical equipment, devices, and supplies.

5. MINIMIZE RISK FROM YOUR EMPLOYEES

Screen new employees carefully.

Take caution; attempt to hire competent and ethical employees.

Develop procedures to safeguard your practice.

Carefully delegate signing authority.

Conduct periodic checks of sensitive operational procedures.

Establish an internal compliance plan. A compliance plan is proactive way to protect your practice from the inside out.

6. DEVELOP WISE BUSINESS RELATIONSHIPS

Be suspicious if anyone offers you deep discounts for free services or cash incentives for referrals or orders.

Never allow yourself to be coerced into any questionable fiscal or financial arrangement.

Do not order tests performed by entities in which you have a financial interest. 7. USE BILLING SERVICES WISELY

Check references.

Instruct the service not to change your codes – procedure and diagnostic as well as other information furnished by you and your office.

Avoid paying on a percentage basis.

Get copies of all correspondence between the service and Medicare.

Pay attention to your billing service’s practices.

Make sure they keep accurate, complete administrative records of the claims it submits to Medicare on your behalf.

Make sure that if you are a Participating Provider, that your billing service or collectors are not requesting payments above the Medicare Fee Schedule amount.

If you are a Non-participating Provider, your billing and collecting staff should not bill more than the Medicare Limiting Charge.

Make sure that your billing staff is aware of Medicare Secondary Payer situations. 8. KEEP UP WITH MEDICARE

Attend billing workshops conducted by Medicare’s Education and Training Department.

Implement changes in billing procedures.

Read, refer to, and retain copies of the Medicare B Resource.

Periodically check the Electronic Data Interchange (EDI) System – Medicare’s computer library of information that you can access using a computer and a modem.

Take note of Remittance Notice reminders and Automated Response Unit (ARU) messages for important information.

Check out Medicare’s publications to determine if a guide is available for your specialty.

Check our website at http://www.medicarenhic.com 9. COMMUNICATE WITH YOUR PATIENTS

Don’t be a victim. Medicare receives hundreds of calls and letters from beneficiaries who have lost their Medicare cards. Some beneficiaries impersonate others and benefit from the use of their Medicare cards as the cost of health care is rising. As a result here are some suggestions to help reduce being prey to such schemes:

Photocopy your patient’s Medicare, Driver’s License and/or Senior Identification cards. o Beware of receiving false, fake, or fabricated cards. o Keep your patient’s address and telephone numbers current. o The Provider is responsible for verifying the identity of each patient. o Misunderstandings between you and your patient may cause complaints to the

Fraud o or Abuse Unit.

Avoid unnecessary complaints. Take a few minutes to talk to your patient.

Do tell your patients about: o Changes in your office name or mergers. o When other providers may bill Medicare (labs, EKGs, x-rays, consultations).

Don’t tell your patients: o “Don’t worry, its not your money.” o “Nothing will come out of your pocket.” o “I have to bil it this way in order to get paid.”

10. RESPOND TO MEDICARE’S INQUIRIES

Do not ignore requests for information.

Respond in a timely manner.

Call Medicare Customer Service if you have any questions. * National Heritage Insurance – www.medicarenhic.com/providers/pubs/fraud_aug2005.pdf

http://www.medicarenhic.com/

Resources and References - Jurisprudence Board of Physical Therapy

http://tn.gov/health/topic/PT-board ; 1-800-778-4123 Online License Renewal

https://apps.tn.gov/hlrs/ Peer Assistance Program

http://tn.gov/health/article/PT-peer ; 1-888-776-0786 Health Professional Boards (to file a complaint)

http://tn.gov/health/article/filing-complaints-against-health-care-professionals ; 1-800-852-2187 American Physical Therapy Association

http://www.apta.org The website has many useful links to government and regulatory websites, particularly under the

“Payment” and “Advocacy” tabs. Ethics and legal information may be found under the “Practice and Patient Care” tab.

Tennessee Physical Therapy Association

http://www.tptatn.org/ ; 1-615-269-5312 Federation of State Boards of Physical Therapy

http://www.fsbpt.org/ HIPAA

http://www.hhs.gov/ocr/privacy/ Health Ethics Trust (formerly The Council on Corporate Ethics)

http://www.corporateethics.com

http://tn.gov/health/topic/PT-board

https://apps.tn.gov/hlrs/

http://tn.gov/health/article/PT-peer

http://tn.gov/health/article/filing-complaints-against-health-care-professionals

http://www.apta.org/

http://www.tptatn.org/

http://www.hhs.gov/ocr/privacy/

http://www.corporateethics.com/

Tennessee Physical Therapy Association Jurisprudence – The Legal Basis of Physical Therapy

Post-test True or False: True False 1. A physical therapist must have 2 years of experience and a Master’s or Doctorate degree before treating a patient without a referral. True False 2. There is a grace period after the date that a license expires in which a

PT/PTA can still legally practice while taking care of the paperwork. True False 3. A PT may delegate specific tasks to an ATC or massage therapist as long as

the PT cosigns the documentation in the patient record. True False 4. Probation, civil penalties, and license revocation are types of

disciplinary action that may be taken by the licensing board. True False 5. A PT or PTA may concurrently supervise no more than the equivalent of 2

physical therapy aides. True False 6. Volunteers may perform modalities such as hotpacks and ultrasound as long

as they have on-site supervision. True False 7. The correct title that a physical therapist must use to denote licensure is “PT”. True False 8. The correct title that a physical therapist assistant must use to denote

licensure is “LPTA”. True False 9. The monitoring of home health aides by physical therapists is a violation of

the practice act. True False 10. The practice act requires physical therapists to inform patients of any financial

arrangements connected to the referral process. Multiple Choice – Circle all answers that are correct for each question. 1. Which of the following are correct descriptions of legal PT supervision of PTAs?

a. The supervising PT must be no more than 60 miles or 1 hour away from the PTA. b. A PT may concurrently supervise no more than the equivalent of 3 PTAs. c. A PTA may see the patient for the discharge visit as long as the PT signs off on the

note. d. The supervising PT must perform and document re-evaluations, assessments, and

modifications in the treatment every 30 days. e. The supervising PT must inspect the actual act of therapy services rendered by a PTA

every 60 days. f. The PT has the sole responsibility for carrying out the provisions of supervision.

2. What is the purpose of the Practice Act?

a. Defines who can practice physical therapy b. Defines the legal scope of practice c. Promotes the interests of the PT profession d. Defines standards of practice e. Protects the public

3. All of the following interventions are included in the definition of physical therapy practice

except:

a. Functional training b. Airway clearance techniques c. Manual therapy d. Animal rehabilitation e. Health promotion

4. Which of the following require on-site supervision?

a. Students b. Volunteers c. Aides d. Other assistive personnel such as ATCs and massage therapists

5. All of the following are listed in the Practice Act as offenses that may lead to disciplinary

action except:

a. Malpractice b. Sexual misconduct c. Inadequate supervision of support personnel d. Failure to maintain adequate records

6. Which of the following are correct descriptions of the continuing competence requirement for

licensure?

a. Hours are required in the 2 calendar years prior to the year of license renewal b. Hours are required in the 24 months prior to the month of license renewal c. PTs and PTAs are required to have 30 hours in each license renewal cycle d. Serving as a clinical instructor is allowed to count as a Class II activity e. Ethics and Jurisprudence must be taken during every 2 year renewal cycle

Documents

Jurisprudence: The Legal Basis of Physical Therapy Practice