Reimbursement

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. This advice and counsel addresses both the appropriate reaction to payment issues, as well as the proactive planning for and promotion of appropriate methods of payment in the future. 

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.

What's New in Payment

Commercial Insurance

  • 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 New
    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 advocacy@apta.org.