2017 Spring PPTA Reimbursement & Regulations Updates

2017 Spring PPTA Reimbursement and Regulations Update Webinar 



Preliminary List of Topics will be addressed:


  • Payment Trends in Pennsylvania

    • 2017 Evaluation/Re-evaluation codes

      • Problematic payers and provider options

    • Commercial payers

      • Trends/denial issues

      • Delayed Payment? PA Prompt Payment Act – Filing a complaint

      • Payer policy updates

        • Unit restrictions; ICD-10 requirements; copays; authorizations, and more!

      • Act 146 – limitation on payback requests

    • PA Motor vehicle

      • Communicating with claims managers – Act 6… know the law!

        • Peer review of physician referral

        •  Workers’ Compensation

  • PA WC Fee schedule – PPTA petition
    • Network issues – contract language that should send up a red flag

    • Fee Reviews

    • Important questions for intake

    • Utilization Reviews – Act 44 – important time frames… know the law!

  • PPTA initiatives to address payment/practice issues

    •   Pending legislative issues
      • Telehealth/Licensure Compact update

        Impact of Federal Legislation
  • MACRA (Medicare Access and CHIP Reauthorization Act)
    • How is MIPS (Merit Based Incentive Payment System) different from PQRS (Physician Quality Reporting System)?
      • How and why would I continue to participate in PQRS in 2017?

      • Advanced Alternative Payment Models

      • Value based payment initiatives

      • Manual Medical Review
    • Medicare Part B

      • PT Comparative Billing Report (CBR) – Action needed?

      • Skilled maintenance (Latest on Jimmo v. Sebelius)

        • Documenting to support skilled maintenance

      • Medically Unlikely Edits (MUE) unit restrictions

      • Correct Coding Initiative (NCCI edits)/ Modifier -59

      • Local Coverage Determination L35036

      • Novitas – Solutions (Medicare Administrative Contractor for PA)

        •  Local Coverage Determination (LCD 35036) ICD-10 requirements; PTA supervision requirements; Documentation requirements; Keeping Novitasphere active; Provider Enrollment Status Inquiry Tool; CERT
    • Tricare Issues

      • Consolidation into East/West regions

      • Exclusions (PTAs; Vestibular Rehab)

    • HIPAA – resources for compliance
    • APTA Initiatives/Federal Health Care Legislation

      • Cures Act of 2016/ Locum Tenens

      • Final rule on Emergency Preparedness

      • Electronic Health Records

    • Special Topic: 2017 PT evaluation codes

      • Clinical Decision Making and Complexity – not new concepts, but your thought process needs to be reflected in your documentation!

      • Understanding the importance of ICF language

    • Target Audience

      The primary focus of this webinar is to provide an update on payment trends and regulatory changes related to outpatient physical therapy services provided in various settings (Hospitals, Private Practice, CORFs, Rehab Agencies, Skilled Nursing Facilities, and Home Health).  

      Physical Therapists, Physical Therapist Assistants, PT facility managers, PT compliance officers, and PT payment/reimbursement personnel employed by/consulting with PT facilities interested in remaining up to date with changes in payment and compliance with payer and regulatory requirements in the delivery of physical therapy services are invited to register.


      Course participants will

      1. Identify state/federal regulatory and policy trends in 2017 that will impact payment/reimbursement.

      2. Recognize methods and develop strategies to minimize denials and facilitate efficient reimbursement from private and federal payers.

      3. Increase awareness of CMS Manual guidance regarding documentation to support coverage of skilled maintenance physical therapy services.

      4. Increase familiarity with documentation strategies that will support the level of complexity in a PT evaluation.

      5. Recognize the resources available for obtaining information

      **If your schedule does not permit your participation on the April 27th Webinar, register now and  you will have access to the handouts and webinar recording.



      Carole S. Galletta, PT, MPH   
      Carole is the Payment Specialist for the Pennsylvania Physical Therapy Association. In this role she serves as a payment/reimbursement resource for PPTA members, Pennsylvania regulators and payers.   She is a member of the Private Practice, Geriatric, Women’s Health and Health Care Policy and Administration Sections of the APTA. She is a partner in Galletta McCuen Rehab Compliance Consultants, providing consultation and audit services to rehab providers, auditing firms and provider legal counsel in the areas of regulatory compliance for rehab services, corrective action plan development/implementation, and client education in documentation and coding. Carole is an Assistant Professor in the Graduate School of Physical Therapy at Slippery Rock University and lectures in the areas of Health Care Systems and Policy, Legal and Ethical issues, Business Practices and Compliance and Reimbursement.



      **If your schedule does not permit your participation on the April 27th Webinar, register now and  you will have access to the handouts and webinar recording.