A self-referred patient walks into a PT clinic. Is this the start of a joke or a story with a happy ending? Well, that’s up to you. Your direct access marketing efforts will inspire patients to pick up the phone and dial your clinic. But then what? Your front office team is your direct access front line, and if they’re not prepared to interact with self-referred patients (i.e., those with no referral from another healthcare provider), then they probably won’t win these business opportunities for your practice.

Let’s say you’ve done your due diligence and thoroughly trained your staff on your state’s practice act and direct access laws. Now, it’s time to ensure your staff effectively uses that knowledge.

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Negotiating with Payers

Before I leap into a discussion of self-referred patient interaction tactics for your direct access front line, let’s talk payers, because—as this What to Look for in a Front Office Staff article points out—“Billing starts in the front office...Your front office team should verify each patient’s insurance and benefits before you begin treatment...any front office staffer worth his or her salt should be able to complete this task in a timely and efficient manner.” When it comes to direct access and your payers, the APTA recommends these steps:

  1. Review your third-party payer contracts to determine which require physician referrals as a condition of payment.
  2. Negotiate with these payers to try to get the language removed from the contracts, collaborating “with other providers of PT services in your area if necessary.”
  3. Develop a system for obtaining required referrals and POC signatures via phone, fax, or electronic transmission, and do your best to make sure that system doesn’t create a patient access barrier.
  4. Ensure that system includes verifying insurance benefits for all patients, no matter their referral status.

Interacting with the Self-Referred Patient

In our research at WebPT, we’ve identified the following common phone call interaction pattern:

  1. Patient calls practice.
  2. Front office person asks if the patient has a referral.
  3. Patient says, “No” or “Do I need one?” or “I thought that wasn’t necessary.”
  4. Front office person says, “Oh, well, we prefer a referral.”
  5. Patient says, “Okay, bye.”
  6. Practice loses a potential patient and his or her business.

This exact interaction happened not once, not twice, but three times for a WebPT employee who wanted to obtain PT for her back. This occurred in Arizona, no less, a state that has had unrestricted direct access to PT for more than 15 years. With the fourth clinic she tried, she had a much better phone interaction, similar to the one I’ve outlined below, and as a result, that clinic gained her 12 visits and plenty of positive word-of-mouth marketing, including referrals.

  1. Patient calls practice to book an appointment.
  2. Front office person asks if the patient has a referral.
  3. Patient says, “No” or “Do I need one?” or “I thought that wasn’t necessary.”
  4. Front office person says, “You might not need one. [Succinctly explain direct access laws for your state.] Let me verify your insurance and get the name of your primary care physician.”
  5. Patient provides insurance information and name of primary care physician.
  6. Front office person gets patient scheduled for an appointment—simply to get him or her on the books for the preferred date and time.
  7. Immediately following phone call, front office person verifies patient’s benefits.
    1. If a referral is needed, the front office person contacts the physician to get a referral, then contacts the patient to confirm appointment. At this point, the front office person should also review any copayment or coinsurance required for the visit, which means your front office staffs needs to know how to confidently review patient benefits.
    2. If a referral is needed and the physician wants to see the patient, the front office person should see if the physician is available at or around the same time as the tentatively booked PT appointment, because the front office person already knows that date and time is convenient for the patient. That way if that time slot is open at the physician’s office, the front office person can suggest that appointment when he or she calls the patient back. Even better, the front office person could offer to connect the patient to the physician’s office, so the patient can book the physician appointment sooner rather than later. That in turn allows the patient to begin PT sooner as well. Situations such as this require your practice, especially your front office staff, to develop relationships with your referring physicians’ front office teams. As WebPT founder and COO Heidi Jannenga, DPT, explains, “It’s much more empowering to say, ‘let me call over to your doctor s office and get you right in.’ Patients may get the run around if they go through the scheduling channels on their own, which delays their PT treatment. This won’t happen, though, if your front office has a direct line to the physician’s calendar.”
    3. If the referral is not needed, front office person contacts patient to confirm appointment. Again, the front office person should review patient benefits.
    4. If benefits do not cover PT, front office person contacts patient to explain a self-pay option. This means that your front office staff needs to be well-versed in your cash services fee schedule. If patients are going to go the self-pay route, they need to clearly understand your clinic’s pricing.
  8. Patient attends appointment, giving the practice more business.

Sure, this alternative is tied up with quite the desirable bow, and there is plenty of potential for interactions to fall outside of this example. That being said, if a practice:

  1. establishes a direct access policy,
  2. trains and educates its staff on said policy, and
  3. empowers front office staff to interact with patients in a way that informs them, gets them on the schedule, and doesn’t discourage proactive verification of benefits,

Then your practice will gain self-referred patients—and what practice doesn’t want more patients?

Measuring Your Efforts

Let’s say your practice has officially embraced direct access. You know how to market; you’re well-trained; you’ve expanded into some cash-pay only services. Now it’s time to measure your efforts. The APTA recommends collecting data on the following:

  • Number of direct access patients
  • Number of visits
  • Cost of episodes of care for direct access patients
  • Clinical outcomes
  • Patient satisfaction

Your front office staff can assist with a lot of this data collection. They can track self-referred status during patient intake, track number of visits within the EMR or scheduling software, and administer patient satisfaction surveys.


Now that your front office is well-equipped to serve on your practice’s direct access front lines, it’s time to win all those business opportunities. How are the efforts going at your practice? What intel do you need to succeed? What winning strategies do you have to share with your PT allies? Post in the comments below.

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