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Update on the Payment Front

Wednesday, November 14, 2018   (0 Comments)
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Here is some happenings in the world of payment - 

APTA partners with the American Chiropractic Association (ACA) to submit application for a dry needling CPT code
APTA and ACA staff and member experts are presenting the application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public.

Aetna's policy clarifications increase access to PT Care
Major commercial insurer Aetna recently provided clarification on policies related to payment for physical therapy, and it's good news for physical therapists (PTs) and their patients.

The clarifications help to answer questions related to the company's physical therapy policy, specifically around payment for evaluations and the ways direct access provisions can affect payment. A recent PT in Motion News story covered the highlights. 

More on the Aetna clarifications: evaluations could be eligible for payments sooner than the 180-day wait period
Although Aetna's policy reads that "physical therapy evaluations will be eligible for payment once every 180 days," Aetna representatives have informed APTA that evaluations performed within 180 days of the original evaluation may be allowed upon reconsideration or appeal, providing the evaluation is for a new or unrelated condition.

APTA attends National Business Group on Health's "Workforce Strategy" conference
As part of APTA's ongoing efforts to engage employers and better understand their challenges, APTA staff attended the "Workforce Strategy: The Future of Work, Life and Health" conference sponsored by the National Business Group on Health, (NGBH). The agenda included topics such as employee engagement, digital health, results of health-related pilot projects and emerging innovations for better health and well-being. The importance of determining centers of excellence using data was stressed. Several presenters mentioned physical therapy for low back pain in lieu of surgery and the need to assess the cost savings of avoiding the surgery. The members of the NBGH represent the human resources and health benefits interests for some the largest companies in the US, most with a global footprint. Its goal is to help employers optimize business performance through creative health improvement and health care management initiatives.

Tiered coding for PT evaluations: new APTA podcast series answers common questions
As the payment landscape for 2019 comes into focus, it's becoming clear that physical therapists (PTs) will continue coding evaluations according to a 3-tiered system based on patient complexity

In its latest efforts to help underscore the importance of continued accurate coding, APTA produced a series of free podcasts on the CPT evaluation codes. The 5-part series covers a general overview of the coding change and addresses common questions related to determining levels of stability, documenting elements, the relationship of examination time to code selection, and coding in reevaluation. With episodes ranging from 5 to 8 minutes in length, the individual podcasts are convenient for quick listens on the go or during breaks at the clinic.

APTA learning center has a new webinar on MIPS which is free for members. 

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