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.

Billing - Regular BannerBilling - Small Banner

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.

  • Common Questions from Our Patient Sticker Shock Webinar Image

    articleMar 31, 2017 | 33 min. read

    Common Questions from Our Patient Sticker Shock Webinar

    From copays and deductibles to payer contracts and benefits verification, understanding all the nuances of third-party insurances is tough enough for healthcare providers—let alone their patients. In WebPT’s most recent webinar— Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans —co-hosts Heidi Jannenga, PT, DPT, ATC/L, the cofounder and president of WebPT, and WebPT CEO Nancy Ham provided a lot of great advice on how to have productive conversations about healthcare costs with your patients—without …

  • Common Questions from Our 2018 State of Rehab Therapy Webinar Image

    articleJul 13, 2018 | 21 min. read

    Common Questions from Our 2018 State of Rehab Therapy Webinar

    Earlier this year, we surveyed nearly 7,000 PT, OT, and SLP professionals on the current state of the rehab therapy industry, asking questions on everything from salary and student loan debt to payer mix and patient dropout. We then compiled their responses into our comprehensive State of Rehab Therapy in 2018 report and hosted webinar during which Dr. Heidi Jannenga, PT, DPT, ATC/L, president and co-founder of WebPT, and Nancy Ham, WebPT CEO, offered their take on …

  • What is Concierge PT—and Why is it Getting So Popular? Image

    articleJan 30, 2019 | 8 min. read

    What is Concierge PT—and Why is it Getting So Popular?

    It’s no secret that our healthcare model is a bit, well, broken—for lack of a better term. Patients often have to wait weeks or months to gain access to providers—long enough for conditions to move from acute to chronic. The good news is that there are plenty of alternative practice models clinicians are adopting in order to meet patients’ demands for high-quality, convenient care. Concierge medicine is one of those models; it’s becoming very popular in the …

  • Therapy Heroes, Assemble! How to Fight the Top 3 Threats Facing PTs, OTs, and SLPs Image

    articleOct 25, 2017 | 7 min. read

    Therapy Heroes, Assemble! How to Fight the Top 3 Threats Facing PTs, OTs, and SLPs

    Earlier this year, WebPT conducted a survey to gain a better understanding of the state of the rehab therapy industry—and we were thrilled to receive more than 5,200 complete responses from rehab therapy professionals across the country. With this type of large-scale data collection and analysis, we’ve been able to produce a comprehensive snapshot of the rehab therapy industry’s demographics, trends, frustrations, and motivations, all of which shape the industry’s future outlook and potential for success in …

  • FAQ: The Data-Driven Practice: 10 Stats to Track in Your Therapy Organization Image

    articleFeb 8, 2019 | 18 min. read

    FAQ: The Data-Driven Practice: 10 Stats to Track in Your Therapy Organization

    Earlier this week, WebPT President and Co-Founder Dr. Heidi Jannenga, PT, DT, ATC, teamed up with WebPT Vice President of Innovation and Product Management, Russell Olsen, to discuss the ten trackable metrics that can help you turbo-boost your practice past the competition. They tackled as many audience questions as they could during the post-webinar Q&A, but there just wasn’t enough time to get to all of them. So, we’ve compiled—and answered—the most frequently asked ones and posted …

  • Common Questions from Our Cash-Based Physical Therapy Webinar Image

    articleAug 30, 2017 | 19 min. read

    Common Questions from Our Cash-Based Physical Therapy Webinar

    Earlier this week, WebPT’s president and co-founder, Dr. Heidi Jannenga, PT, DPT, ATC/L, teamed up with cash-based physical therapy guru Dr. Jarod Carter, PT, DPT, MTC, to host a webinar covering all things cash pay —from insurance contracting considerations and Medicare rules to self-referral marketing and service pricing. Thousands of rehab therapy professionals registered to attend, which means we received a ton of questions—so many, in fact, that there was no way we could answer all of …

  • 5 Things PTs Must Do to Take Over the World (as Told at the 9th Annual Graham Sessions) Image

    articleJan 19, 2016 | 12 min. read

    5 Things PTs Must Do to Take Over the World (as Told at the 9th Annual Graham Sessions)

    To most people, Graham Sessions probably sound like something that would take place next to a crackling campfire—with a bag of jumbo Jet-Puffed marshmallows, a bar of creamy Hershey’s milk chocolate, and a box of crisp Honey Maids. When I attended my first Graham Sessions last year , I was initially disappointed to discover that this beloved annual event had nothing to do with s’mores. What I soon realized, though, is that this forum—often touted as a …

  • Think Big, Think Differently: 6 Bits of Inspiration from Ascend 2017 Image

    articleOct 5, 2017 | 11 min. read

    Think Big, Think Differently: 6 Bits of Inspiration from Ascend 2017

    The overarching theme of Ascend 2017 —the fourth-annual installment of rehab therapy’s premier business summit—was, quite simply, “Think big.” But, based on what we learned from our esteemed group of speakers over the course of two inspiration-filled days in Washington, DC, a more accurate tagline for this year’s conference might have been, “Think differently.” After all, in a field as complex as health care, grand aspirations are not enough. To solve the problems plaguing this industry, we …

  • The State of Rehab Therapy in 2018 Image

    downloadJun 28, 2018

    The State of Rehab Therapy in 2018

    To say that the healthcare industry is complex would be an understatement. While the advent of technology has made care more precise, efficient, and collaborative than ever before, it has also put greater pressure on providers to deliver high-value care at scale. After all, big data makes it possible to not only develop the most effective, evidence-based best practices for individual diagnoses, but also form evidence-based strategies for managing the health of populations. In the spirit of …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.