APTA of Maryland Reimbursement Committee ReignitedCall to Action: with changes in payment and processing, it is vital that the Chapter's Reimbursement Committee be reignited. In the current environment, we need a platform to address these changes, and identify ways to enhance relationships with third-party payers through dialogue and education regarding the practice of physical therapy.
Commitment: Monthly zoom conference to discuss current payment related issues and to determine what actions should be taken to address those issues.
The Kick Off: Please take this doodle poll if you are interested in joining the committee to schedule our first call.
APTA of Maryland members benefit from expert analyses of changing payment legislation and regulations, and guidance on processing payments successfully. The APTA of Maryland and our Director for Reimbursement oversees activities or policies that can enhance the position of physical therapists in the current or in future payment environments.
The Chapter and our members work to:
- Look at trends to identify issues across insurance companies for potential legislative or regulatory action.
- Address relevant issues and trends in the current environment (internal and external) affecting payment of physical therapy.
- Identify potential changes/evolution in the payment environment and recommend techniques, positions or policies to address these changes and to promote changes that will benefit physical therapists.
- Identify and address risk management considerations of changes in payment regulation and provide advice and counsel to the Board of Directors and Chapter Office staff regarding risk management implications and changes in payment regulation.
- Expert Analysis: Members get free access to staff payment experts through the Insider Intel phone-in series, payment reform community, and other members-only resources.
- Fee Calculator: Members receive free access to the Medicare physician fee schedule and multiple procedure payment reduction (MPPR) calculators.
- ICD-10 Assistance: Members receive 15% off the Cypher ICD Logic clinical documentation tool that quickly helps you determine ICD-10 codes.
- Cash Based Practice: Resources on compliance, definitions, out of network FAQs.
- Assistance with Utilization Management: Members can access the UM toolkit that offers an overview of challenges and opportunities for physical therapists in the commercial sector, strategies to mitigate the current and future impacts of UM use, and ways to foster cooperation between providers and UM vendors so that both parties benefit.
* Support in using clinic data in contract negotiations: Using the UM toolkit and your clinic data, APTA can provide guidance with renegotiating contracted rates with commercial insurers and help you to remain in network. Guidance is provided on contracting, knowing your costs, etc. but we acknowledge this is a very challenging environment.
* APTA has also created a Video tutorial on the Managed Care Toolkit
Users can adjust the volume in the bottom toolbar of the video player, as well as on your computer.
Flash version 9,0 or greater is required
Click here to download latest version
What's New in Payment
- Never miss an APTA podcast! Subscribe on iTunes
- Glossary of Payment Terms
- Insider Intel: Live Webinar Series on Payment & Regulatory Issues
- Value Based Care
- APTA/APTAMD and American Specialty Health (Members Only)
- APTA/APTAMD and Carefirst (Members Only)
- Managed Care Contracting Toolkit - Gain useful tips for providers on knowing their costs, approaching insurers and negotiating rates
There are a number of details physical therapists should consider before contracting with payers, whether private or public. It is imperative that each contract is reviewed in its entirety with professional advice prior to signing. Terms or provisions in contracts that are often overlooked at the time of signing could significantly impact your practice in the long run.
- Rehabilitation Versus Habilitation: Modifiers 96 and 97 Replace Modifier SZ
ACA requires that non-grandfathered, fully insured health plans, offered in the individual and small-group markets, both on and off the exchanges, provide coverage of habilitative services and devices. Habilitative services and devices are among the 10 "Essential Health Benefits" (EHB) that must be covered by certain health plans.
- PT-PTA Toolkit Now Available
APTA has unveiled The Physical Therapist–Physical Therapist Assistant Team: A Toolkit, a 54-page e-publication that touches on some of the most important elements of the PT-PTA relationship, from educational requirements to work with third-party payers. Designed to serve as a resource "to share with payers, employers, patients and clients, and any other interested party," the toolkit is part primer, part compendium, with appendices that include sample appeal letters to payers, a list of minimum required skills of the PTA, and a problem-solving algorithm for the PTA. The toolkit is available free to APTA members, and joins a suite of APTA resources on PTA Patient Care and Supervision.
For additional assistance with payment and reimbursement issues, contact APTA's Payment Policy & Advocacy department at 800/999-2782, ext 8511 or firstname.lastname@example.org.