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Introduction

This chapter discusses administrative concerns as they relate to the delivery of interventions, maintaining a safe facility, and the role of medical records. Issues relating to billing and third-party reimbursement are also discussed. A series of case studies appear at the end of this chapter to help develop skill in applying the information learned in Chapters 3 and 4.

• The actual application of therapeutic modalities is only part of the rehabilitation process. Health care is bound by governmental regulations and fraught with areas of potential liability. Federal, state, and institutional regulations are meant to ensure safe, effective, and efficient patient care. Further administrative needs are required when the services provided are billed to a third party for reimbursement.

Legal Considerations in Patient Care

During therapeutic interventions, your minimum legal duty is to prevent further injury or harm to the patient by practicing in a safe and professional manner. Professional ethics and responsibility mandate that the care provided be in the best interest of the patient, be safe and effective, and progress toward meeting the patient's goals.

Before using a therapeutic modality, you must be familiar with the effects and side effects of the device or protocol being used and be able to recognize contraindications that prohibit use (see Box 3-1). Proper use also requires knowledge of the device's characteristics, maintenance requirements, and safety considerations.

This section primarily addresses legal considerations pertaining to patient intervention routines. It does not represent all aspects of liability that you may be exposed to in the daily routine of professional practice.

Scope of Practice

The legal boundaries that define the manner in which clinicians may practice, the scope of practice, are established state-by-state through regulation such as licensure, registration, or certification (Table 4-1). Professional regulation protects the public from unqualified health care providers. There are differences in the scope of practice from one profession to another and differences in the scope of practice for the same profession from state to state.137,138 The scope of practice may define the standard of care used in liability cases.

TABLE 4-1Types of Professional State Regulation

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