Informing Payers about the Profession of Physical Therapy
In November, 2014, the PPTA Public Policy and Advocacy Committee (PPAC) Payment Work Group, in conjunction with the Reimbursement Specialist, shared information with payers across Pennsylvania in the form of a “Payer Summit” in Harrisburg, PA. Forty two payer representatives were in attendance spanning several large commercial, auto and federal plans including Aetna/Coventry, Capital Blue Cross, Donegal, Eastern Alliance, Geisinger, Highmark, Nationwide, Novitas – Solutions, Progressive, and Safeguard Services LLC. (View the .pdf files “Payer Summit Goals and Objectives” and “Payer Summit Agenda”)
Payers were enlightened about the potential for decreasing downstream costs with direct access and early PT intervention in a presentation by Ivan Mulligan, PT, DSc, SCS, ATC, CSCS (View the .pdf file “Physical Therapy - Are the outcomes worth the cost”)
A “mock evaluation” by PPAC Payment Work Group facilitator Steve Gough, PT, DPT, OCS engaged the audience and highlighted the complexity of clinical decision making during the evaluation process that is encompassed by the CPT code 97001. The importance of performing the initial evaluation to establish an appropriate plan of care was emphasized, as many PTs experience payment policies that limit evaluations to once per calendar year.
The Payer Summit also provided an opportunity to share important elements of the PT Practice Act, medical review challenges for providers, red flags and medical necessity in documentation. (View the presentations by clicking on .pdf files “Medical Necessity and Documentation,” “Medical Review Challenges and Red Flags in Documentation” and “PA Practice Act”)
The PPAC Payment Work Group is planning to hold a Payer Summit in the fall of 2015. If you have suggestions for program content or contacts in the insurance industry who should be invited, please forward that information to Steve Gough, PT, DPT, OCS at email@example.com
Links to presentations: