Referrals, Prescriptions, and Certifications: What Are They, and How are They Different?

Rehab therapy professionals have a lot to keep track of when initiating patient treatment—everything from verifying patient insurance information to building rapport with patients. And that’s in addition to ensuring that if a patient comes in via a physician—or has an insurance plan that requires the oversight of an MD—you’ve covered all things paperwork and signatures. 

While referrals, prescriptions, and certifications are all part of the rehab therapy landscape, you won’t need all of these for every patient. Here are the similarities—and differences—as well as what you’ll need to do to obtain each:

Referrals

A referral simply means that someone—a physician, a fellow therapist, a current patient, or another provider—referred a patient to you. For many in the industry, referrals serve as a major source of new patient volume, which means they’re essential to track. 

That way, you can identify your top referral sources—and then focus on nurturing those relationships. It can also shed light on relationships that you may be investing a lot of time and effort into—but that aren’t actually generating new patients. In that case, you may want to change up your game—perhaps make a stronger push to highlight your value via outcomes data or switch gears to prioritize other referral sources and paths.

How to Track Referrals

Regardless, ensure you have a method for tracking your referral sources (like the WebPT Referral Report). Typically, that means asking every patient how she or he heard of you. While some patients may be forthcoming with that info, others may not know how valuable it is to the success of your practice. And definitely don’t overlook the importance of word-of-mouth referrals. Social proof from peers can go a long way toward encouraging a new patient to book an initial appointment. 

Prescriptions

A prescription (a.k.a. an order) is a directive from a physician as to the therapy services a particular patient should receive for a specific condition or diagnosis. Some insurance plans—specifically those that do not allow for direct access—may require that a patient receive a prescription from an MD prior to obtaining specialist services. Typically, prescriptions or orders contain the number of sessions and/or frequency of treatment recommended for a patient, although that is certainly something therapists can suggest changing following an initial evaluation and based on their clinical expertise. 

While physician prescriptions were once commonplace in rehab therapy, direct access has definitely made them less prevalent. With that in mind, if you practice in a state that allows for unrestricted direct access—and a patient’s insurance company does not require a prescription to cover your services—then continuing to require that patients obtain a script before starting therapy isn’t ideal. Instead, it’s time to update your practice’s internal policies to take full advantage of the law—and make the path to accessing rehab therapy easier for patients.

How to Track Prescriptions

Within your EMR, you should be able to enter prescription information into the patient record or upload a digital copy of the paperwork directly—and then create alerts to notify you when a patient’s prescription is about to expire. That way,  you can renew the prescription with the patient’s physician before it runs out, and thus ensure there’s no gap in treatment. As an example, WebPT’s Prescription Report—which is an analysis-grid-style report—also enables therapists to glean actionable information about prescribed visits across clinics.

Certifications

Some insurances—Medicare, for example—do not require that patients obtain a prescription or order to seek out therapy services. Instead, beneficiaries are free to initiate rehab therapy on their own accord via direct access. However, Medicare does require that a physician be involved in the oversight of every patient’s care, which means therapists must obtain a physician signature on their plans of care within 30 days of the initial evaluation. This process is known as obtaining certification. 

As explained in this blog post, Medicare does not require that patients see their physician in order to obtain certification, although some physicians do require an office visit before they will certify a plan of care. Medicare also does not stipulate that the certifying MD be the patient’s primary care physician, which means you may be able to obtain certification from a rehab-therapy friendly MD in your network who is already familiar with the value you provide to your patients—no office visit required. Either way, though, we advise starting the certification process early—like as soon as you determine that rehab therapy is medically necessary for a patient—because delayed certification can trigger Medicare to deny payment for your claims.

How to Track Certifications

Similar to prescriptions, your EMR should help you keep tabs on patient certifications and alert you when a cert is nearing the end of its duration. Medicare, in particular, requires that therapists renew certifications every 90 days, assuming there is no change to the patient’s condition that would necessitate a new certification prior to the 90-day mark.

There you have it: the similarities—and differences—of referrals, prescriptions, and certifications. Still have questions about what you need to obtain—and when? Drop them in the comment section. We’ll be sure to point you in the right direction.