Upcoming Webinars 

Disclaimer

The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Menu
Log in


Log in

New Jersey Physical Therapy Financial Arrangements

Financial Arrangements

Prior to the initiation of physical therapy, the PT or the PT’s designee shall explain to the patient in an understandable manner the financial arrangements. The information provided to the patient shall include, but not be limited to:

    • The fee for services or the basis for determining the fee to be charged;
    • Whether the licensee will accept installment payments or assignment of benefits from a third party payor;
    • That insurance coverage may not be available in all circumstances; and
    • The financial consequences, if any, of missed sessions.

Prohibited Fees

The PT shall not require a patient or a third party payor to pay:

    • A fee for preparing an insurance claim form;
    • Interest on an unpaid account unless the patient has been notified of this policy, in writing, prior to the initiation of physical therapy treatment;
    • A full or partial fee for unkept appointments unless the patient has been notified of this policy, in writing, prior to the initiation of physical therapy treatment;
    • A fee for any physical therapy examination, evaluation, intervention or other services not documented in a patient's permanent record; or
    • A fee for any free services offered pursuant to N.J.A.C. 13:39A-7.2.

The PT shall provide a copy of a written fee schedule to any interested person upon request.

The PT shall include on all bills submitted to a patient or third party payor the licensee's license number.

Excessive Fees

A licensee shall not charge an excessive fee for services. A price is excessive when, after review of the facts, a licensee of ordinary prudence would be left with a definite and firm conviction that the price is so high as to be manifestly unconscionable or overreaching under the circumstances.

Factors which may be considered in determining whether a price is excessive include, but are not limited to, the following:

    • The time and effort required;
    • The novelty and difficulty of the professional intervention;
    • The skill required to perform the intervention properly;
    • Any requirements or conditions imposed by the patient or by the circumstances;
    • The nature and length of the professional relationship with the patient;
    • The nature and circumstances under which the services were provided (for example, emergency, home visit).

A PT shall not provide intervention or conduct testing which in light of the patient's history and findings are unwarranted and unnecessary.

A PT shall not charge a fee to a patient or a third party payor for an intervention or other physical therapy which is unwarranted and unnecessary.

Citation

N.J.A.C ยง 13:39A-3.4


Powered by Wild Apricot Membership Software