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Please register for our webinar: “Understanding Medicare Advantage & Multiple Procedure Payment Reductions” on Oct 23, 2013 from 12:00 PM – 1:30PM EDT :
Register using this link: https://attendee.gotowebinar.com/register/2081037215441374465
About 1 in 4 Medicare recipients are enrolled in a Medicare Advantage (MA) private health plan. Being federally funded, MA plans must meet certain federal requirements. Because they are offered by private companies, however, they mimic private insurance. Thus, as a provider accepting MA patients, you must adhere to both the terms and payment conditions of the specific MA plan and any related federal Medicare requirements. Recently, the MA private health plans have implemented the multiple procedure payment reduction (MPPR) methodology. Physical therapists must know what is expected with MA plans and how to appeal if there are debatable denials or actions by the payer. Gain insight into the MA program, find out how to comply with federal MA requirements and learn how to negotiate these private insurance company contracts through this webinar.
1. Describe the Medicare Advantage program and how it affects your patients.
2. Identify federal requirements for the Medicare Advantage program.
3. Identify problem areas in contracts with private insurers that provide Medicare Advantage plans.
4. Identify strategies in appealing MPPR reductions with private payers.
Carmen Elliott is the senior director of Payment and Practice Management at the American Physical Therapy Association. Her primary responsibilities at APTA include developing and implementing strategies to advocate for payment policies for physical therapists services and providing leadership to the private payment area. Carmen also communicates with members about payment and practice management issues, including physical therapy coverage, payment, coding, managed care contracting, and auto liability coverage.
Carmen received her BS degree from Bowie State University, Bowie, MD and a MS degree in Health Care Management from Marymount University, Arlington, VA. Prior to joining APTA in September 2006, Carmen was a Practice Administrator for a large physical therapy practice in Southern Maryland.
After registering, you will receive a confirmation email containing information about joining the webinar.
Fees: $25 per computer login, $15 for each certificate of completion toward PT & PTA Kentucky relicensure for KPTA members. $30 for each certificate of completion for non-members.
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Click here for an updated list of KPTA Candidates for Office in PDF format. All candidates were given the opportunity to submit a statement and photo.
Legislation passed in 2011 mandates that PT co-pays/co-insurance may not exceed the co-pay/co-insurance for a physician office visit. This legislation applies to ALL practice settings. Many insurers are not complying with this legislation. If you are treating patients with high co-pays/co-insurance, please follow the steps outlined below and share this information with your billing staff.
Ensure your client’s insurance is not a Medicare or self-funded plan (co-pay/co-insurance legislation does not apply to these plans). If the insurance not a Medicare or self-funded plan, then proceed with the following steps:
1. Charge the patient the co-pay\co-insurance that is in compliance with the law and make them aware their carrier is not abiding by KRS 304. 17A-177 (SB112).
2. When you bill the health insurance carrier include a copy of the law, which can be found at: http://www.lrc.ky.gov/KRS/304-17A/177.PDFand request compliance.
3. If the carrier does not comply within 1-2 weeks, you may report the noncompliance to the Ky. Department of Insurance. Print, fill out and have the patient sign the Kentucky Department of Insurance Consumer Complaintform at: http://insurance.ky.gov/Documents/ConsComplaintWithInstr022211.pdf?MenuID=16. Alternately, you may file the complaint online at: http://insurance.ky.gov/online_complaint.aspx?MenuID=15
4. Notify KPTA of your actions and results.
The investigation should take no more than 30 days. Make a note on your calendar to follow up with the patient after 30 days. Typically the Kentucky Department of Insurance has been contacting the patient and NOT the therapist with the results of the investigation.
For your information, following is the wording of KRS 304.17A-177:
304.17A-177 Limitation on amount of copayment or coinsurance charged for services rendered by occupational or physical therapist — Insurer to clearly state coverage.
(1) An insurer shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by an occupational therapist licensed under KRS Chapter 319A or a physical therapist licensed under KRS Chapter 327 that is greater than the copayment or coinsurance amount charged to the insured for the services of a physician or an osteopath licensed under KRS Chapter 311 for an office visit.
(2) An insurer shall state clearly the availability of occupational and physical therapy coverage under its plan and all related limitations, conditions, and exclusions.
Effective: June 8, 2011
History: Created 2011 Ky. Acts ch. 92, sec. 1, effective June 8, 2011
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On January 23rd, the House of Representatives voted for a three month increase of the debt ceiling. Given the short term nature of the legislation no action was taken on larger issues including a fix for the multiple procedure payment reduction (MPPR) policy passed on January 1st as part of the year-end legislation to avoid the fiscal cliff. Without Congressional action, the MPPR policy will increase from 20% for private practice settings and 25% for facilities to 50% across all outpatient therapy settings on April 1, 2013.Contact your members of Congress TODAY using APTA’s Legislative Action Center and ask them to delay implementation of this flawed policy until January 1, 2015. This date is the scheduled start of APTA’s Alternative Payment System (APS), a new payment system for outpatient therapy that would move payment away from multiple procedures.
APS, also known as the Physical Therapy Classification and Payment System (PTCPS), will reform the current fee-for-service, procedural based payment system to a per session payment system. As part of the Balanced Budget of 1997, Congress charged CSM with developing an alternative to the Medicare therapy cap. In response to this directive, APTA began developing APS and expects to transition to the new system by January 1, 2015.
APTA estimates the application of a 50% MPPR policy will reduce aggregate payments for outpatient therapy services (physical therapy, occupational therapy, and speech language pathology) by 6-7% from the 2012 payment amounts. Please be aware these are aggregate spending numbers and there will be variation among practices with regard to the impact. To determine the impact on your individual practice, refer to both the 2012 and 2013 MPPR calculators available on APTA’s website.
You can also call the Capitol switchboard at (202) 224-3121 and ask to speak with your members of Congress. Ask your legislators to delay implementation of this provision until January 1, 2015 by inserting a fix in the next possible legislative vehicle! Don’t forget to personalize your message and tell your members of Congress how this will impact his or her patient and provider constituencies.
Tell your legislators the impact this additional cut would have on your practice or facility:
- This new reduction is in addition to the current MPPR that applied beginning in 2011 which reduced payments by 6-7%. This means that in calendar years 2011 and 2013, outpatient therapy services were subject in aggregate to a 12-14% reduction in payment overall.
- An increased MPPR would restrict patient access to vital therapy services. Particularly hard hit would be patients with multiple chronic conditions, who might benefit the most from intensive therapy treatment programs. Many therapists will be forced to choose not to treat Medicare beneficiaries.
- Patients who do not receive timely outpatient therapy services would be at increased risk for hospital readmissions, additional injuries, and other complications.
- It will be difficult for all outpatient therapy settings from small businesses to large facilities to continue caring for vulnerable Medicare patients with cuts of this magnitude.
Tell your legislators that MPPR is a flawed policy when applied to therapy for the following reasons:
- MPPR is based on the assumption that duplication exists in the practice expense portion of therapy codes billed on the same day. However, the practice expense portion of the therapy codes were already reduced when these codes were initially valued since multiple services are typically provided to a patient during a visit.
- The current MPPR policy on therapy imposes a reduction to all therapy services and is not a discipline specific policy. To spread an MPPR over the three therapies equates to reducing payment for a cardiologist because a patient saw their general practitioner earlier in the day.
To register, submit the form found at: http://kypt.org/wp-content/uploads/2013/01/FLR_Registration_Form.pdf
Webinar Description : Beginning January 1, 2013, the Centers for Medicare and Medicaid Services (CMS) will begin collection of information regarding the beneficiaries function and condition, therapy services furnished, and outcomes achieved on patient function on the claim forms. All practice settings that provide outpatient therapy services must include this information on the claim form. Specifically, the policy will apply to physical therapy(PT), occupational therapy (OT), and speech-language-pathology (SLP) services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians and nonphysician practitioners. To ensure a smooth transition, CMS sets forth a testing period from January 1, 2013, until July 1, 2013. After July 1, 2013, claims submitted without the appropriate G-codes and modifiers would be returned unpaid.
Participants will learn how to report patient functional limitation information on claims using the new nonpayable functional G-codes and with the severity modifiers on claims. In addition, the G-codes and severity modifiers used in the functional reporting are required to be documented in the patient’s medical record of therapy services.
Specifically, this call will include an overview of the new functional reporting requirement, including effective dates, and information on:
· nonpayable G-codes used to report functional limitations
· modifiers used to report the severity of functional limitations
· reporting frequency
· documentation requirements
Presenter: Heather Smith, PT, MPH : Heather Smith currently serves as the Program Director of Quality for APTA. Heather previously worked for New York Presbyterian Hospital as the Manager of Core Measures, with responsibility for all publically reported core measure sets and quality improvement projects associated with these measures. In addition, she worked on a variety of other quality initiatives as well as regulatory preparedness for multiple campuses within New York Presbyterian’s 2,300 bed hospital system. Prior to her role at New York Presbyterian, she worked at the University of Pennsylvania Health System where she also served in a quality improvement position for over two years. Her transition into quality was facilitated in part by the acquisition of her Masters in Public Health from Drexel University. Previous to her role in quality improvement, she was a practicing clinician for over ten years with the majority of her focus on orthopedics in the outpatient setting.
It is with great sadness that we share with you the passing of David Pariser, PT, PhD.
Dave served as KPTA’s Legislative Chair, during which the landmark SB112 was passed – the copay bill. Since then numerous states have introduced and passed similar legislation, based on our model. He was a current member of the APTA Board of Directors; and a Past President of the Louisiana Physical Therapy Association.
Dave was a respected member of the Bellarmine faculty. He came to Bellarmine from the LSU Health Sciences Center in 2005, after being named Physical Therapist of the Year in Louisiana and being inducted into the Louisiana Physical Therapy Association Hall of Fame for career achievement. At Bellarmine he quickly became a fully contributing member not only of our Physical Therapy Department and the Lansing School, but of the entire University community. In addition to his exceptional teaching, generous service and extensive published research, he participated in pro bono physical screening exams for the Bellarmine University Athletic Department from 2006-2009, served as a faculty search committee chair in 2008 and received the Presidential Merit Award here at Bellarmine in the same year.
Dave earned his B.S. in physical therapy at West Virginia University, and his M.Ed in physical education and Ph.D. in education curriculum & instruction at the University of New Orleans.
He was one of few men to possess a brilliant mind, yet a humble heart. He was greatly loved and will be greatly missed.
Dave was married to Gina Pariser, PT, PhD; and was the proud father of Ada and Kayla. Our thoughts and prayers go out to Gina and the girls.
Congress has less than 30 days to extend the Medicare therapy cap exceptions process. In order to ensure your voice is heard on Capitol Hill, APTA is working with the Therapy Cap Coalition to promote awareness of the December 31st deadline. TODAY every member of the coalition is activating its grassroots network, and asking its members to email or call their legislators. You can help by emailing your members of Congress using APTA’s Legislative Action Center and asking them to extend the exceptions process through 2013. You can also call your legislators using the phone number provided below. Without Congressional action, a hard cap of $1,900 will take effect January 1, 2013.
It is vital that PROVIDERS AND PATIENTS take action! Flood Congress with emails and telephone calls TODAY!
CALL YOUR LEGISLATORS:
Call the Capitol switchboard at (202) 224-3121 and ask to speak with your members of Congress.
Ask your legislators to extend the Medicare therapy cap exceptions process through 2013.
- Emphasize the patient impact of letting a hard cap of $1,900 take effect in 2013.
- Tell Congress that a hard therapy cap disproportionately impacts those patients who need treatment the most.
- Beneficiaries who experience more than one episode of illness or injury per year often exceed the cap.
- Beneficiaries will be forced to delay necessary care, assume higher out-of-pocket expenses, or forgo care altogether if a hard cap is implemented in 2013.
Don’t forget to ask your patients to email or call their members of Congress using the Patient Action Center. All they have to do is enter their zip code and click “Go!”
APTA is working diligently with Congressional offices on Capitol Hill to develop a solution before year’s end but TIME IS RUNNING OUT! Please take five minutes and contact your legislators NOW. You can make a difference and help prevent a hard Medicare therapy cap of $1,900 from being implemented in 2013.
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