Practice Advice

As a physiotherapist, you are responsible for ensuring patients understand the fees and billing practices related to their care. Your responsibilities for communicating fees are detailed in the Funding, Fees and Billing Standard.  

You must fully explain your fees, so patients can make informed choices.    

You should make a reasonable effort to ensure that patients understand the fees and billing process. 

Steps you can take to help your patients understand your fees and billing practices include: 

• Make sure the patient has received a complete list of costs that relate to their care.

• Include easy-to-understand and honest information about billing and any possible charges, including but not limited to:  
  • Assessment and treatment fees  
  • Reports and fees for copies of patient records  
  • Equipment and any additional fees 
  • Fees and policies related to bundled physiotherapy services 
  • Cancellation or late fees and interest charges 

• Take the time to explain the fees and billing process relating to the patient’s care.

• Give the patient a clear and complete invoice or receipt, with simple explanations, so they know what they are being charged for, who gave the care, and how and when to pay.

• Identify and take reasonable steps to correct any billing errors. Document the findings, actions taken, and the outcome in the patient’s record.

Yes, but there are some considerations.  

The Advertising and Marketing Standard requires that physiotherapists only advertise free physiotherapy services, such as free consultations, assessments or trials of clinically indicated physiotherapy treatments, in a manner that:   

• Promotes general education or health awareness.  

• Informs the public about any conditions or limitations related to the physiotherapy services offered.  

• Highlights pro-bono services offered to patients experiencing financial hardship.  

The Fees, Billing and Account Standard states that physiotherapists may reduce fees (includes waiving fees). Physiotherapists must ensure invoices/receipts accurately reflect charges and discounts.  

If you are providing any physiotherapy care, including a free consultation or assessment, you must follow all standards, including having a patient record. Physiotherapists must not provide care of lesser quality because there is a promotion attached. Physiotherapists also must not provide unnecessary care. 

Physiotherapist must ensure that they have the patient’s consent to provide an assessment. Be sure to document the reasons why fees are being waived in the patient’s chart. 

All physiotherapists must comply with the Infection Control Standard. 

Hospitals and large organizations often have robust infection control measures led by an Infection Protection and Control (IPAC) team. However, it may be challenging for a solo practitioner to know what to consider.  

When providing care in a mobile physiotherapy model (such as in patients’ homes), you should create an infection control policy that applies to your situation.  

Here are some things to consider when creating your infection control policy in the context of a mobile service or when providing care in a private home: 

1. Perform a Point of Care Risk Assessment. Before each visit, evaluate potential risks by asking questions such as: 

• Does the patient (or anyone in the home) have symptoms of a respiratory virus? 

• Are there pets or other factors that could affect your infection control protocol? 

2. Prepare and use appropriate PPE. Bring necessary Personal Protective Equipment (PPE) such as masks, gloves, gown, and eye protection. 

3. Maintain hand hygiene. 

• Check if there is a sink with soap available at the site. If not, bring hand sanitizer containing at least 60% alcohol. 

• Wash or sanitize your hands before and after patient contact, and after removing PPE.  

4. Communicate your infection control procedures. Clearly explain to patients and their families the infection prevention steps you are taking to foster cooperation and understanding. 

5. Plan for safe disposal of waste. Carry an approved portable sharps disposal container for needles or other sharps. Dispose of gloves, masks, and other contaminated items safely after each visit. 

Physiotherapists who have more than one title (in healthcare or a non-healthcare field) are required to meet the requirements within the Dual Practice Standard.

This standard requires physiotherapists to clearly identify when they are providing physiotherapy care or non-physiotherapy care.

It should be clear to your patient when you are acting as their physiotherapist. Your two practices must be kept separate. This could affect a clinical day in the following ways:

1. Introductions: Be sure to introduce yourself as a physiotherapist when providing PT care. Be clear with your patient that today, they will be attending a physiotherapy appointment. Consider wearing a nametag with your protected title when providing PT care.
2. Scheduling: There must be a distinct appointment time for each service.
3. Record keeping: As a PT, you must meet the requirements of the Record Keeping Standard, as well as document chart entries using your protected title of PT or PT Resident. Record separate patient notes for each service, or separate entries in a shared patient record, that clearly identify which professional role/service was provided at each patient visit.
4. Billing: Any invoice provided to patients must clearly indicate that they received physiotherapy care when you were acting as their PT, and athletic therapy when you were providing care as an athletic therapist. The professional role/service provided should be clear on each invoice.
5. Communication: In your emails with patients, be clear about which service you are discussing in your responses to them. Use your protected title of PT when responding as a physiotherapist.
6. Conflict of Interest: If your clinical reasoning indicates that your patient would benefit from also seeing an athletic therapist, you must mitigate the potential conflict of interest by letting the patient know that they could be seen by any athletic therapist, and it would not negatively impact your patient/PT relationship. Patients should not feel that they were forced to see you as their athletic therapist. Remember, any service recommended must be clinically indicated.

Yes, a patient could continue to work with you as an out-patient in your clinic if you recognize the potential for a conflict of interest and disclose and mitigate these conflicts with your patient. 

It is your duty to act in their patient’s best interests. If a physiotherapist’s professional expertise or judgment could be affected or influenced by competing interests or relationships, they may be in a conflict of interest. Competing interests may be financial, non-financial or social in nature.  

In the recently adopted Conflict of Interest Standard, there is a performance expectation that a physiotherapist does not participate in any activity which could compromise professional judgment. An example given includes self-referring existing patients to their own services without ensuring transparent disclosure to the patient and offering alternative options. 

To avoid a conflict of interest, a physiotherapist must:  

• Disclose and discuss the situation with the patient before providing the list of services. 

• Make the patient aware of practical alternatives, if there are any. 

• Document the discussion in the patient’s record.  

A good place to begin your review of evidence-informed practice might be this summary article available on physio-pedia.com.  It includes some of the basic principles and the strengths and weaknesses of evidence-informed practice. It also includes further resources to deepen your understanding of how to critically assess the quality of the information that you are reading. You can learn about the levels and grades of evidence here. 

Remember that evidence-informed practice is not only the application of research evidence. It is a phenomenon that emerges from the interaction between research evidence, clinical experiences, and patient experience. Patient-centred communication and care should remain at the forefront of evidence-informed physiotherapy practice. 

Consider subscribing to a research summary service that will send relevant research information to your inbox to make it easier for you to stay up-to-date.  If you are a member of the Canadian Physiotherapy Association (CPA), you have access and can subscribe to research reviews such as PEDro and Ortho Evidence. 

As a PT resident with a provisional licence and a PhD in anatomy, your signature on patient charts and invoices should clearly reflect your physiotherapy qualifications. You should use the name listed on the Public Register followed by your PT protected title.

Here is an example of how to craft your signature using professional credentials in a patient-facing environment:

Smita Mehta, PT Resident

MScPT, PhD (anatomy)

A privacy breach occurs when personal health information is stolen, lost or used/disclosed without authority. Examples might include lost or stolen charts, or patient health information erroneously sent to people not involved in their care. 

When a privacy breach happens, whether intentional or not, physiotherapists should follow these steps – even if it’s just a single occurrence: 

1. Contain the breach and, if you are the agent of the health information custodian (HIC), notify your organization’s HIC and report the breach to them. 

2. Health Information Custodians must notify the affected person at the first reasonable opportunity and include mention that a complaint may be made to the Information and Privacy Commissioner of Ontario (IPC).

3. You (PT) and the HIC should determine whether your organization’s privacy policies and processes were followed.

4. Next, the HIC must determine:

• If this is a one-time occurrence or if it is part of a pattern of errors
• What the impact on the patient could be
• Whether the breach could happen again

Make note of the findings of the review.

5. The HIC must report the breach to the Information and Privacy Commissioner of Ontario (IPC) if it falls within one of the following seven categories. The categories are not mutually exclusive; more than one can apply to a single privacy breach. If at least one of the situations applies, you must report it. The following is a summary, for complete information see the regulation. 

1. Use or disclosure without authority
2. Stolen information
3. Further use or disclosure without authority after a breach
4. Pattern of similar breaches
5. Disciplinary action against a college member
6. Disciplinary action against a non-college member
7. Significant breach

Note: Not all privacy breaches need to be reported to IPC. For example, if a lost chart was a one-time occurrence, not intentional and not part of a pattern, the matter can be managed internally.

6. Debrief the issues with your team. Share the lessons learned so you can build a positive culture around privacy safeguards in your workplace.

No. You cannot use the title “Physiotherapist” or “Physiotherapy Resident” or bill for physiotherapy services using the title PT.  

The physiotherapist title is protected under the Regulated Health Professions Act to provide care to humans. The only way professionals can provide rehabilitation services to animals is under the direction and supervision of a veterinarian. 

When you’re leaving a practice and there’s no other PT available to take over your patients, it’s important to make sure they still have options for continuing their care. 

Talk to your employer about how you will let your patients know you’re leaving. Options may include providing your patients with a list of other physiotherapists in the area who can help them, or giving the patient an exercise plan to follow at home to keep up with their treatment.

Sometimes, your employment contract might have rules that stop you from telling patients where you are going next. If that’s the case, you can direct them to the College’s Public Register, where your new job will be listed. Make sure you update your information so patients can find you if they want to.

If a patient decides to keep seeing you at your new job, they can ask for a copy of their physiotherapy record from the Health Information Custodian at your previous clinic. This helps make sure you maintain the information you need to continue their care.

The Leaving a Practice Checklist outlines all of the things you’ll need to do before you leave.

The new Communication Standard guides physiotherapists to communicate professionally, clearly, effectively, and in a timely manner to support and promote quality physiotherapy services. One of the stated expectations is that the PT “documents all communications accurately, clearly, professionally, and in a timely manner.”

The College guidance regarding documenting communication has not changed. All forms of communication (for example, telephone, email or DM) that are relevant to the patient’s condition or the care provided are part of the clinical record. In the example above, a PT would not need to include a DM about what hours they are working.  However, the text message indicating a change in symptoms should be included in the patient’s record.

Yes! As a College-approved supervisor, you are an important and valued link for a PT resident to move towards their independent registration.  Not only do you act as a clinical mentor, but you also demonstrate for them how to behave as a regulated health professional.  

The College has a learning module called Supervising a Physiotherapy Resident: Everything You Need to Know as Their Supervisor. This module provides useful tips on how to manage your supervision, including keeping records of your meetings and tracking learning goals. It also introduces tools on the CPO website, such as the Identification of Learning Needs and Record Keeping Checklist.

Keeping records is key. For example:

• Track the dates and details of your check-in meetings.
• Monitor the progress of set learning goals.
• Document the results of any chart reviews.

If you have concerns about a resident’s practice or need advice on your supervision, please reach out to us at Practice Advice.