Committees

Chair

Jessica To-Alemanji
Email

Communications

The Virginian E-Newsletter and other communication tools (VPTA.org, Facebook and Twitter) are often the most visible member benefit of the Virginia Physical Therapy Association. Access to information and networking opportunities are the two major reasons why people become members.

The VPTA's communication tools are the most important contributor to membership retention and recruitment at the state level. Our membership chair and communications committee work closely together to provide the best member service through different communication platforms.

News

VPTA has active Facebook and Twitter feeds reaching PTs and PTAs across Virginia.  Want to advertise your upcoming event or product? Find out more here.

 

Jessica To-Alemanji, PT, MSPT,DPT,PhD, PMP
Chelsea Laurens, SPT, ACSM EP-C
Barrett Coleman, SPT

 
 
Communications Committee Members
  • Jessica To-Alemanji, PT, MSPT,DPT,PhD, PMP
  • Chelsea Laurens, SPT, ACSM EP-C
  • Barrett Coleman, SPT
  • Kimberly Benson, PT, DPT
The Virginian

Our e-newsletter is distributed to members on the 1st Thursday of each month. To contribute to The Virginian, please write a short article and/or include 1-2 pictures, if applicable, formatted as jpeg files. Send submissions to Kimberly Hood by the 3rd Friday of each month.

Social Media

All PT/PTA professionals, students, and educators in Virginia are encouraged to share information, post photos, and engage in dialogue with others using Twitter and Facebook . To reach a larger audience on Facebook, please contact the Communications Chair and we will post for you or tweet us at @VPTA_Tweets. We want to hear from you!

Chair

Mona Fazzina, PT, DPT
Email

Education

The Education Committee serves to elevate the standard of physical therapy care delivery in the Commonwealth of Virginia through provision of evidence-based, high-quality, and cost-effective continuing education. The work of this committee has a significant impact on the financial health of the component. The committee is responsible for developing and executing—in partnership with the Executive Director and the VPTA Executive Committee—the Annual Conference, Mini-Conference at Annual Retreat, and other state-wide educational opportunities as directed.

Responsibilities:

  • General oversight of Education Committee activities such as Annual Conference, Mini-Conference, etc. (henceforth referred to as "Education")
  • Review and Select Educationconference topics and speakers in areas of importance to the profession of physical therapy and in accordance with member needs.
  • Schedule, coordinate, and execute the Education program in a way that meets members’ needs.
  • Evaluate each Education program, and implement changes as appropriate.
  • Participate in VPTA strategic planning activities related to Education
  • Act as a good steward of VPTA’s resources

Qualifications of individuals who serve on this committee:

  • Clinical expertise in one or more areas of practice
  • Excellent communication, coordination, and collaboration skills
  • Interest in elevating the standard of physical therapy care delivery in Virginia through education

News

Renewals are due on or before December 31, 2018.  For more information go to DHP online renewal or click online licensing to get started. 

Here are some key points to remember with license renewal: Depending on the status of the license, fees and requirements may vary.    

1. Pay the Fee

  1. A physical therapist and physical therapist assistant who intends to continue practicing shall renew their license biennially by December 31 in each even-numbered year. They will pay to the board the renewal fee prescribed in  18VAC112-20-27.
      1. The fee for active license renewal for a physical therapist shall be $135 and for a physical therapist assistant shall be $70 and shall be due by December 31 in each even-numbered year.
      1. The fee for an inactive license renewal for a physical therapist shall be $70 and for a physical therapist assistant shall be $35 and shall be due by December 31 in each even-numbered year.
      1. A fee of $50 for a physical therapist and $25 for a physical therapist assistant for processing a late renewal within one renewal cycle shall be paid in addition to the renewal fee.
      1. The fee for reinstatement of a license that has expired for two or more years shall be $180 for a physical therapist and $120 for a physical therapist assistant and shall be submitted with an application for licensure reinstatement.

A licensee whose licensure has not been renewed by the first day of the month following the month in which renewal is required shall pay a late fee as prescribed in 18VAC112-20-27.

2.  Provide proof of work and CEU

B.  In order to renew an active license, a licensee shall be required to Licensee shall maintain the Continued Competency Activity and Assessment Form:

1. Complete a minimum of 160 hours of active practice in the preceding two years; and

2. Comply with continuing competency requirements set forth in  18VAC112-20-131

  • You need 30 hours of continuing education (CE) within the two years immediately preceding renewal.
  • Guidance: 18VAC112-20-131. Continued Competency Requirements for Renewal of an Active License.
  • A minimum of 20 of the contact hours required for physical therapists and 15 of the contact hours required for physical therapist assistants shall be in Type 1 courses.  Examples of type 1 "course" means an organized program of study, classroom experience or similar educational experience that is directly related to the clinical practice of physical therapy and approved or provided by one of the following organizations or any of its components

a. The Virginia Physical Therapy Association;

b. The American Physical Therapy Association;

c. Local, state or federal government agencies;

d. Regionally accredited colleges and universities;

e. Health care organizations accredited by a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to assure compliance with Medicare conditions of participation;

f. The American Medical Association - Category I Continuing Medical Education course;

g. The National Athletic Trainers' Association; or

h. The Federation of State Boards of Physical Therapy.

  • No more than 10 of the contact hours required for physical therapists and 15 of the contact hours required for physical therapist assistants may be Type 2 activities or courses Type 2 activities may include consultation with colleagues, independent study, and research or writing on subjects related to practice. Up to two of Type 2 continuing education hours may be satisfied through the delivery of physical therapy services, without compensation, to low-income individuals receiving services through a local health department or a free clinic organized in whole or primarily for the delivery of health services.   
  • Be aware there are some activities that can count as continue education credits such as initial certification or recertification of specialty certification by the American Physical Therapy Association ; graduation from a transitional doctor of physical therapy program; attained at least Level 2 on the FSBPT assessment tool may receive five hours of Type 1 credit for the biennium in which the assessment tool was taken. A physical therapist who can document that he attained at least Level 3 or 4 on the FSBPT assessment tool may receive 10 hours of Type 1 credit for the biennium in which the assessment tool was taken. Continued competency credits shall only be granted for the FSBPT assessment tool once every four years.

In response to requests for interpretation on continuing education credits, the Board has adopted the following guidance and as of May 2018, amendments were made:

  • One credit hour of a college course is considered equivalent to 15 contact hours of Type 1 continuing education.
  • Courses directly related to the clinical practice of physical therapy and are sponsored by providers approved by other state licensing boards may be considered for Type 1 continuing education.
  • Research and preparation for the clinical supervision experience or teaching of workshops or courses in a classroom setting constitute Type 2 activities.
  • Classroom teaching of physical therapy topics and clinical supervision constitute Type 2 activities.
  • For every 40 hours of clinical instruction, one contact hour of Type 2 activities may be granted.

NEW LICENSEES BY EXAMINATION:

 If you were initially licensed by examination in Virginia and this is your first renewal, you are exempt from the requirement that you complete at least 30 hours of continuing education (CE) within the two years immediately preceding renewal. Therefore, answering “yes” to the question, "Have you completed 30 hours of continuing education activities within the two (2) years immediately preceding renewal and engaged in 160 active practice hours as a [physical therapist/physical therapist assistant] as defined in 18 VAC 112-20-130 for a period of two (2) years immediately preceding submission of this application?” will not impact the renewal process for new licensees who fall into this CE exemption, as long as the applicant has completed the 160 active practice hours.

Other FAQs may be answered at The Virginia Board of Physical Therapy Website.  

References:

§ 54.1-2400 of the Code of Virginia.

18VAC112-20-130. Biennial Renewal of License

The Virginia Board of Physical Therapy Website

18VAC112-20-131

 

 

VPTA’s Spring Education will be held during CSM’s pre-con in 2019! Be sure to register before October 24 to take advantage of early bird rates and be entered into a drawing for cool prizes.

When Your Patient is Not Improving: Using Pain Science by Craig O’Neil, PT, DMT; Brandon Ellison, PT, DPT; and David Sheer, PT,DPT

Register by October 24 For a Chance to Win Cool DC Prizes

Register by the early bird to be entered to win 1 of 2 round-trip air fares to DC from anywhere in the domestic US!* Plus 5 other cool prizes like museum passes, tour bus rides, and a DC gift basket. See complete rules (.pdf)

*No purchase necessary. Some restrictions apply. Excludes travel from or to Alaska or Hawaii. Tickets must be booked through Destination DC by November 26, 2018, for travel to CSM 2019.

Registration Register now! Best rates end on Wednesday, October 24 at midnight. Save 25% off full conference rates.

 
 

Chair

Tony Grillo, PT, DPT, OCS, FAAOMPT
Email

Ethics

Maintaining and promoting ethical principles and standards of conduct for members is a function of APTA. APTA is a voluntary organization without the legal power of licensing agencies to enforce standards of behavior; however, the Association's disciplinary process does represent a commitment of a public nature to hold its members to the ethical principles and standards of the profession.

The chapter ethics committee's function is vital to maintaining the ethical standards of an organization with which individuals want to be associated. The committee's obligation is to be fair to both the respondent and the complainant. The fact that every respondent is a member of the Association underscores the importance of the committee being fair and courteous in all its activities. The ethics committee faces the difficult task of balancing the need to be careful and thorough which tends to prolong the process against the typical respondent's desire to complete the process reasonable quickly.

The VPTA ethics committee works closely with the APTA and Ethics & Judicial Committee to ensure all cases or complaints are addressed promptly and directed to the proper channels.  While some cases may be handled through state or local committees, others are sent on directly to the APTA and their EJC.

Additional Information and Resources

APTA Ethics & Judicial Committee: http://www.apta.org/VolunteerGroups/EJC/
Contact: [email protected]
APTA Ethics & Professionalism: http://www.apta.org/EthicsProfessionalism/
Continuing Education Resources: https://www.ptcourses.com/course.php?id=168
Health Regulatory Boards: http://www.dhp.virginia.gov/
Board of PT - Guidance Documents: http://townhall.virginia.gov/L/GDocs.cfm
Virginia Regulatory Town Hall Meetings: http://townhall.virginia.gov/index.cfm
Health Professions- Filing a complaint: http://www.dhp.virginia.gov/Enforcement/complaints.htm
APTA Ethics-Resolving Disputes or Complaints: http://www.apta.org/Ethics/Disputes/
4 New Ethics Courses for 2018 AAOMPT: https://www.physiospot.com/physioplus/new-ethics-courses-coming-this-may/
Ethics in Marketing and Advertising: http://thesciencept.com/ethics-of-healthcare-advertising/
Course 109: Ethics for the PT: Real World Cases (2 hours)
Course 116: Ethics for PT Clinicians: Dealing with Child Abuse, Legally, Ethically, and with Compassion (3 hours)
Course 118: Ethics & Jurisprudence: A Practical Application 2018 (4 hours)

News

                Under Section 504 of the Rehabilitation Act of 19731, Title III of the American with Disabilities Act (ADA)2 , and the health care professional's obligations for service provision to people with Limited English Proficiency (LEP) and under court decisions that have extended protections afforded under Title VI of the Civil Rights Act of 19643, it is mandated by law that an auxiliary aide (e.g. Interpreter) or service is available and provided to patients with impairments (e.g. vision, speech and hearing deficits).  According to the ADA, if a facility faces an undue burden, one that includes financial and operational hardship, they are not required to provide an interpreter.  Unfortunately, an undue burden is not objectively defined and is subjected to regulatory and legal proceedings.   

                A qualified interpreter is one who can effectively, accurately, and impartially, both receptively and expressively convey to the patient the words of the practitioner. This can be a family member, health care professional or outsources service if they are competent.  When using an interpreter, remember to include defensible documentation when services are provided.  Defensible documentation includes but is not limited to:  the type of service provided, the delivery method, the name and qualification of the interpreter and the patient’s understanding. Documentation is often used as evidence during litigation so accurate and thorough documentation is vital.  

Reference:

  1. 1. 29 USC section 794; 45 CFR sections 84.1-84.61.
  2. 42 USC 12181.
  3. 28 CFR 36.303.
 

 Originally from upstate New York, Dr. Grillo earned his undergraduate and Master’s degrees in Physical Therapy at Nazareth College in Rochester, New York. He subsequently earned his DPT at Virginia Commonwealth University and completed an orthopedic manual therapy fellowship at Regis University in Denver, Colorado. He has over 15 years of experience, working at a private practice in Williamsburg, Virginia and in Charlottesville, VA.      

In an interview with Dr. Grillo, he discussed his new role with the VPTA as the Ethics Chair and the current climate of the Physical Therapy Industry.

Why did you want to become a PT?

Originally, I wanted to go into sports medicine or athletic training; however, a family friend who was an athletic trainer at the time talked me out of that and recommended Physical Therapy school instead. Her rationale was that Physical Therapy offers a more diverse opportunity and scope of practice. She was absolutely right!

How has the industry changed since you started practicing?

There are definitely more Universities offering Physical Therapy programs and with greater competition than when I was in school.  The scope of practice and breadth of interventions provided by PTs has grown substantially and will continue to do so as research and new treatments emerge. Overall, I believe this is reflected in the quality of education and where our profession is heading as a whole.

What does your role of Ethics Chair Entail?

 The Ethic Committee provides several educational and professional resources which are available online at the VPTA website. My roles within the VPTA and this committee (as well as our duties as practicing clinicians) are to promote best practice and provide an avenue for patients and/or clinicians who want to discuss ethical concerns. This may stem from something they’ve seen, experienced, or occurred in their practice or treatment. Unfortunately, there are a number of ethical (and legal) concerns occurring in clinical practice on a daily basis and clinicians and patients should feel comfortable discussing these concerns when they realize there is a problem.

Why should people get involved with the VPTA?

It is extremely important to get involved in the VPTA and the APTA because these are our professional organizations. They are the face of our profession at the state, national, and international level.  They advocate for our profession and fight battles to protect our profession, on issues many physical therapist are not aware of.   A lot of what we do as Physical Therapist and how we treat patients on a daily basis is being altered or taken away from challenges posed by new restrictions and/or other professions. VPTA and APTA are organizations that physically and financially advocate for us so we can push forward and protect our profession. 

Unfortunately, there are a growing number of other professions who claim to offer treatments and services similar to those done by PTs.  This tends to bring ambiguity to our profession and the image we have to the public and healthcare professionals.  We need to do a better job of advocating and defending who we are and what we do. Each physical therapist owes it to themselves, their profession, and to each other to give back in some way; be it with time, their expertise, or financial contributions. 

How would you like to see the industry move forward?

I would like to see more movement with direct access and increase our role as primary provider for musculoskeletal conditions. I feel this is an area we have expertise in - far and above many other professionals who are currently providing primary level care for this condition.  The public needs to know we are musculoskeletal experts.

What do you advocate for in Physical Therapy?

I’m a big advocate for increased development and use of residency and fellowship programs. I would like to see these programs be a required portion of our education, to some extent in the future. I feel they’re an extremely valuable means of specialized education and bring the quality of practicing clinician to their highest caliber. Clinicians who have gone through residency and fellowship are easily identifiable in their commitment to practice, clinical skill, advocacy for the profession, research, and are generally a huge part of modeling the profession, that I believe, we want to be.

Why did you get involved with the VPTA?

I got involved with the VPTA for a number of reasons. First, for the opportunity to be a part of the decision making at the local and state level.  Second, I want to know firsthand the issues the profession faces and what are being done to improve them.  Finally, I want to be a part of the solution. These issues can be clinical, political, or related to scope of practice, etc.  I believe it’s extremely important to know how the healthcare landscape continues to change, what our role is as physical therapists, and what we can do to guide the profession to be what we want it to be. 

 
 

Chair

Wil Kolb, PT, DPT, FAAOMPT, OCS
Email

Finance

The component treasurer and finance committee is where the "rubber meets the road" so to speak. This committee ensures the fiscal well-being of the component as it is responsible developing and implementing the fiscal plan as directed by the yearly goals set from the VPTA BOD and EC. They are responsible for ensuring that the component fulfills its financial obligations and completes the necessary financial statements in a timely and accurate manner. Overall the finance committee members are responsible for the following:

  • Communicating with the VPTA BOD and EC
  • Assisting committee chairs develop yearly budgets
  • Develop and implementing the fiscal plan for the component

News

Note: Currently, no news to display.

Chair

Tom Bohanon, Jr, PT, DPT, OCS
Email

Legislative

The Legislative Committees is responsible for developing grassroots campaigns and for working with APTA Government and Payment Advocacy Department staff to further the legislative goals of the VPTA and APTA.

News

 Originally from upstate New York, Dr. Grillo earned his undergraduate and Master’s degrees in Physical Therapy at Nazareth College in Rochester, New York. He subsequently earned his DPT at Virginia Commonwealth University and completed an orthopedic manual therapy fellowship at Regis University in Denver, Colorado. He has over 15 years of experience, working at a private practice in Williamsburg, Virginia and in Charlottesville, VA.      

In an interview with Dr. Grillo, he discussed his new role with the VPTA as the Ethics Chair and the current climate of the Physical Therapy Industry.

Why did you want to become a PT?

Originally, I wanted to go into sports medicine or athletic training; however, a family friend who was an athletic trainer at the time talked me out of that and recommended Physical Therapy school instead. Her rationale was that Physical Therapy offers a more diverse opportunity and scope of practice. She was absolutely right!

How has the industry changed since you started practicing?

There are definitely more Universities offering Physical Therapy programs and with greater competition than when I was in school.  The scope of practice and breadth of interventions provided by PTs has grown substantially and will continue to do so as research and new treatments emerge. Overall, I believe this is reflected in the quality of education and where our profession is heading as a whole.

What does your role of Ethics Chair Entail?

 The Ethic Committee provides several educational and professional resources which are available online at the VPTA website. My roles within the VPTA and this committee (as well as our duties as practicing clinicians) are to promote best practice and provide an avenue for patients and/or clinicians who want to discuss ethical concerns. This may stem from something they’ve seen, experienced, or occurred in their practice or treatment. Unfortunately, there are a number of ethical (and legal) concerns occurring in clinical practice on a daily basis and clinicians and patients should feel comfortable discussing these concerns when they realize there is a problem.

Why should people get involved with the VPTA?

It is extremely important to get involved in the VPTA and the APTA because these are our professional organizations. They are the face of our profession at the state, national, and international level.  They advocate for our profession and fight battles to protect our profession, on issues many physical therapist are not aware of.   A lot of what we do as Physical Therapist and how we treat patients on a daily basis is being altered or taken away from challenges posed by new restrictions and/or other professions. VPTA and APTA are organizations that physically and financially advocate for us so we can push forward and protect our profession. 

Unfortunately, there are a growing number of other professions who claim to offer treatments and services similar to those done by PTs.  This tends to bring ambiguity to our profession and the image we have to the public and healthcare professionals.  We need to do a better job of advocating and defending who we are and what we do. Each physical therapist owes it to themselves, their profession, and to each other to give back in some way; be it with time, their expertise, or financial contributions. 

How would you like to see the industry move forward?

I would like to see more movement with direct access and increase our role as primary provider for musculoskeletal conditions. I feel this is an area we have expertise in - far and above many other professionals who are currently providing primary level care for this condition.  The public needs to know we are musculoskeletal experts.

What do you advocate for in Physical Therapy?

I’m a big advocate for increased development and use of residency and fellowship programs. I would like to see these programs be a required portion of our education, to some extent in the future. I feel they’re an extremely valuable means of specialized education and bring the quality of practicing clinician to their highest caliber. Clinicians who have gone through residency and fellowship are easily identifiable in their commitment to practice, clinical skill, advocacy for the profession, research, and are generally a huge part of modeling the profession, that I believe, we want to be.

Why did you get involved with the VPTA?

I got involved with the VPTA for a number of reasons. First, for the opportunity to be a part of the decision making at the local and state level.  Second, I want to know firsthand the issues the profession faces and what are being done to improve them.  Finally, I want to be a part of the solution. These issues can be clinical, political, or related to scope of practice, etc.  I believe it’s extremely important to know how the healthcare landscape continues to change, what our role is as physical therapists, and what we can do to guide the profession to be what we want it to be. 

 

Medicare Fee Schedule:

Final rule released on November 1, 2018

  • Conversion factor – giving an increase of 0.14% to Medicare payment for 2019
  • Therapy Threshold dollar amount is increased to $2040.00
  • Targeted medical review amount remains $3000.00 for PT/SLP
  • Functional limitation reporting is planned to end on January 1, 2019 for traditional Medicare plans but Medicare advantage plans have the option to continue if desired.
  • PTA modifiers must now be added to the bill if services were provided in whole or in part by a PTA.  If a PTA provides more than 10% of the service the modifier must be added to the bill.  These modifiers will be required starting January 1, 2020. 

            MIPS – Non-Institutional Settings only

  • Private practices only initially -  Beginning January 1, 2019 PTs will be included in MIPS (Merit-Based Incentive Payment system) and be required to collect and submit data for an annual score:

                        Criteria are:

    • Quality
    • Promoting Interoperability – EMR use is one example (part of meaningful use)
    • Clinical Practice Improvement activities
    • Cost

            PTs will be assessed in 2 of the 4 areas in 2019

  • Quality
  • Clinical Practice Improvement activities

            Designed to reduce variation in practice.

Need to meet 3 Criteria be required to participate:

  1. More than $90,000 in annual medicare allowed charges
  2. Treat 200 or more Part B enrolled  individuals
  3. And provide 200 covered professional services to part B enrollees (200 visits)

 

Has incentives and penalties starting in 2019 and increasing every year.

Penalties or incentives will be assessed starting in 2021 payment year. 

Practices can chose to belong to advanced payments models to avoid MIPS. 

APTA has info and a page dedicated to MIPS

http://www.apta.org/MIPS/

 

Fair Copay legislation:

            Many states have enacted Fair copay legislation.  It is The VPTA’s intent to propose legislation during the 2020 legislative season.  This Planned  legislation’s goal will be to create parity between PT’s and Primary Care Copays. 

           

Dry Needling:

            Currently the Regulation is sitting on the Governor’s desk and has passed all the requirements to be signed.  No date on signature but hopefully soon.  Currently we can perform TDN without specific regulation. 

 

Licensure Compact:

            Will allow PT’s to apply for privilege to practice in states other than their home license state through application to a compact board.  This is currently in on the Governor’s desk as well to determine if he will submit it with his legislative package this year.  If he carries it we wills support.  If not we will assist the board in putting legislation forth.  Should know something by mid December.

 

Disability placards:

            The VPTA is seeking to add PT’s to the list of individuals who can issue Disability placards for parking.  There is currently no time frame for legislative action. 

 

Medicare Fee Schedule:

Final rule released on November 1, 2018

  • Conversion factor – giving an increase of 0.14% to Medicare payment for 2019
  • Therapy Threshold dollar amount is increased to $2040.00
  • Targeted medical review amount remains $3000.00 for PT/SLP
  • Functional limitation reporting is planned to end on January 1, 2019 for traditional Medicare plans but Medicare advantage plans have the option to continue if desired.
  • PTA modifiers must now be added to the bill if services were provided in whole or in part by a PTA.  If a PTA provides more than 10% of the service the modifier must be added to the bill.  These modifiers will be required starting January 1, 2020. 

            MIPS – Non-Institutional Settings only

  • Private practices only initially -  Beginning January 1, 2019 PTs will be included in MIPS (Merit-Based Incentive Payment system) and be required to collect and submit data for an annual score:

                        Criteria are:

    • Quality
    • Promoting Interoperability – EMR use is one example (part of meaningful use)
    • Clinical Practice Improvement activities
    • Cost

            PTs will be assessed in 2 of the 4 areas in 2019

  • Quality
  • Clinical Practice Improvement activities

            Designed to reduce variation in practice.

Need to meet 3 Criteria be required to participate:

  1. More than $90,000 in annual medicare allowed charges
  2. Treat 200 or more Part B enrolled  individuals
  3. And provide 200 covered professional services to part B enrollees (200 visits)

 

Has incentives and penalties starting in 2019 and increasing every year.

Penalties or incentives will be assessed starting in 2021 payment year. 

Practices can chose to belong to advanced payments models to avoid MIPS. 

APTA has info and a page dedicated to MIPS

http://www.apta.org/MIPS/

 

Fair Copay legislation:

            Many states have enacted Fair copay legislation.  It is The VPTA’s intent to propose legislation during the 2020 legislative season.  This Planned  legislation’s goal will be to create parity between PT’s and Primary Care Copays. 

           

Dry Needling:

            Currently the Regulation is sitting on the Governor’s desk and has passed all the requirements to be signed.  No date on signature but hopefully soon.  Currently we can perform TDN without specific regulation. 

 

Licensure Compact:

            Will allow PT’s to apply for privilege to practice in states other than their home license state through application to a compact board.  This is currently in on the Governor’s desk as well to determine if he will submit it with his legislative package this year.  If he carries it we wills support.  If not we will assist the board in putting legislation forth.  Should know something by mid December.

 

Disability placards:

            The VPTA is seeking to add PT’s to the list of individuals who can issue Disability placards for parking.  There is currently no time frame for legislative action. 

 

Attention VPTA Members,

 

In an effort to keep all members informed of significant happenings in Virginia that impact clinical practice, we are contacting you to inform you that effective August 1, 2018 American Specialty Health Group (ASH) will begin utilization management services for Cigna Health Insurance company. They will take over these services from Rehab Provider Network for physical therapy utilization management and review. ASH will contract directly with individual outpatient private practice physical therapists in Virginia and letters have been sent to most practices with a fee schedule and basic contract information. Please note that this letter does not represent an actual contract. The APTA and state leaders are participating in a conference call with ASH to discuss this change and the impact it will have on clinical practice. To insure the financial health of physical therapists’ practices in Virginia and of your practice, we recommend that you request and review your contracts closely and contact the Private Practice Section of APTA and the APTA for information about contract negotiation and utilization management and review.

 

We will keep you updated as we gather information on this change. For more information, please review the ASH FAQ.

 

All and only the best,

 

Josh

 
 

Chair

Joe Speckhart
Email

Membership

The component membership committee has an important job -- membership development remains one of the highest priorities of APTA. The component membership committee is responsible for planning, implementing, and evaluating membership campaigns, including all recruitment and retention efforts.

News

Note: Currently, no news to display.

Chair

Joseph Spagnolo, PT, DPT, MTC, OCS
Email

Nominating

Serves a two (2) year term.

Duties and Responsibilities

  • Study the qualifications of eligible candidates and prepare a list of the names and qualifications of nominees consenting to serve
  • Prepare a slate of nominees for vacant VPTA offices and Nominating Committee to be presented at the Annual Chapter Business Meeting.
  • Nominate one (1) or more candidates for upcoming vacancies in the American Physical Therapy association Board of Directors and Nominating Committee.
  • Discuss with Board of Directors Annual retreat possible nominees for National APTA awards such as Lucy Blair, Mary McMillan, etc.
  • Solicit nominees and supportive narratives for all VPTA awards.

News

Congrats to those who were elected in the district elections this year!

 

 
 

Chair

Ron Masri, PT, ATC, FAAOMPT, OCS
Email

Payer & Practice Relations

The Payer and Practice Relations Committee addresses the primary elements involved in the practice of physical therapy: scope of practice, administration of practice, standards and ethics of practice, and the Guide to Physical Therapist Practice. The committee also recognizes that reimbursement/payment is likely the most confusing and frustrating part of clinical practice, so we are here to help you navigate any questions you might have.

News

                Under Section 504 of the Rehabilitation Act of 19731, Title III of the American with Disabilities Act (ADA)2 , and the health care professional's obligations for service provision to people with Limited English Proficiency (LEP) and under court decisions that have extended protections afforded under Title VI of the Civil Rights Act of 19643, it is mandated by law that an auxiliary aide (e.g. Interpreter) or service is available and provided to patients with impairments (e.g. vision, speech and hearing deficits).  According to the ADA, if a facility faces an undue burden, one that includes financial and operational hardship, they are not required to provide an interpreter.  Unfortunately, an undue burden is not objectively defined and is subjected to regulatory and legal proceedings.   

                A qualified interpreter is one who can effectively, accurately, and impartially, both receptively and expressively convey to the patient the words of the practitioner. This can be a family member, health care professional or outsources service if they are competent.  When using an interpreter, remember to include defensible documentation when services are provided.  Defensible documentation includes but is not limited to:  the type of service provided, the delivery method, the name and qualification of the interpreter and the patient’s understanding. Documentation is often used as evidence during litigation so accurate and thorough documentation is vital.  

Reference:

  1. 1. 29 USC section 794; 45 CFR sections 84.1-84.61.
  2. 42 USC 12181.
  3. 28 CFR 36.303.
 

As of January 2015 all 50 states, the District of Columbia, and the US Virgin Islands have some form of direct access with provisions to physical therapist services. Please refer to Virginia specific laws. 

Who can complete a screen or evaluation under the Virginia direct access law?

A physical therapist who has completed a doctor of physical therapy program approved by the Commission on Accreditation of Physical Therapy Education or who has obtained a certificate of authorization  to § 54.1-3482.1 2( according to 18VAC112-20-81, Requirements for Direct Access Certification.  The minimum education, training, and experience requirements for certification shall include evidence that the applicant has successfully completed (i) a transitional program in physical therapy as recognized by the Board or (ii) at least three years of active practice with evidence of continuing education relating to carrying out direct access duties under § 54.1-3482)

How do I obtain my certificate for Direct Access?

Take from 18VAC112-20-81. Requirements for Direct Access Certification.

In addition to the evidence of qualification for certification required, an applicant seeking direct access certification shall submit to the board:

 1. A completed application as provided by the board;

 2. Any additional documentation may be required by the board to determine eligibility of the applicant; and

 3. The application fee as specified in 18VAC112-20-27.4

Can I complete a community Screen without a referral?

Yes, under specific parameters.  

"The regulations shall include but not be limited to provisions for (i) the promotion of patient safety; (ii) an application process for a one-time certification to perform such procedures; and (iii) minimum education, training, and experience requirements for certification to perform such procedures.

Are there any exceptions to providing therapy without a referral (i.e. community screens)?

Yes, a licensed physical therapist may provide, without referral or supervision, physical therapy services to…

(i) a student athlete participating in a school-sponsored athletic activity while such student is at such activity in a public, private, or religious elementary, middle or high school, or public or private institution of higher education when such services are rendered by a licensed physical therapist who is certified as an athletic trainer by the National Athletic Trainers' Association Board of Certification or as a sports certified specialist by the American Board of Physical Therapy Specialties;

(ii) employees solely for the purpose of evaluation and consultation related to workplace ergonomics;

(iii) special education students who, by virtue of their individualized education plans (IEPs), need physical therapy services to fulfill the provisions of their IEPs;

(iv) the public for the purpose of wellness, fitness, and health screenings;

(v) the public for the purpose of health promotion and education; and

 (vi) the public for the purpose of prevention of impairments, functional limitations, and disabilities.

What if I screened a patient and I notice something medically is wrong?

It is vital to know when to refer to an appropriate provider.  “Upon determining that the patient's medical condition is beyond the scope of practice of a physical therapist, a physical therapist shall immediately refer such patient to an appropriate practitioner” (§ 54.1-3482, Practice of physical therapy; certain experience and referrals required; physical therapist assistants.)

Can a PT complete a Physical Therapy Evaluation and treatment under direct access?

You may evaluate and treat a patient for no more than 30 consecutive days after an initial evaluation without a referral, under the following conditions, 18VAC112-20-81

1.  The patient is not under the care of another provider for what he/she needs physical therapy services for. 

2.  The patient is under the care of another provider at the time of his presentation to the physical therapist for the symptoms giving rise to the presentation for physical therapy services and

                a. the patient identifies a provider

                b. the patient gives written consent to release medical record to the provider

                c. the physical therapist notifies the practitioner identified by the patient no later than 14 days after treatment commences and provides the practitioner with a copy of the initial evaluation along with a copy of the patient history obtained by the physical therapist

3.  Within 30 calendar days, if the PT continues to treat the patient, a referral in needed.

Things to consider: 

There may be regulations that are insurance driven.  For reimbursement please check with specific insurers on the requirement of a doctor’s prescription.

References:

  1. Statutory Authority §§ 54.1-2400 and 54.1-3482.1 of the Code of Virginia.
  2.  § 54.1-348 Practice of physical therapy; certain experience and referrals required; physical therapist assistants
  3. 18VAC112-20-81. Requirements for Direct Access Certification.
  4. 18VAC112-20-27. Fees

Historical Notes Derived from Virginia Register Volume 25, Issue 18, eff. June 10, 2009; amended, Virginia Register Volume 32, Issue 3, eff. November 4, 2015.

 

APTA and other members have added more resources regarding Carefirst. Please use the information below to assist you in finding a Carefirst rep who is able to discuss the following:

  • Any issues you may have with Carefirst payment practice
  • How it has affected you as a provider
  • How it will in turn effect your clients.

Wanda Evans at APTA spoke with a Carefirst rep who recommended that providers should contact their provider reps to discuss the impact that these reductions are having on providers’ ability to provide care to their members. I have included resources below that may be useful for you to identify your rep. APTA and VAPTA encourages you to discuss these concerns and to ask for clarification from your provider rep.

Carefirst:

Find a Provider Rep

Click here to find a Provider Rep. You can email anyone at Carefirst by using the following: first name.last [email protected].

The representatives below are available for inquiries from our network providers. To find contact information for the Provider Relations Representative in your area, download the appropriate PDF. If you are a provider that has a question regarding claim issues, contact the designated Provider Service area found on the Provider Quick Reference Guide.

Member inquiries should be directed to the phone number on the back of the Member’s ID card.

 

You can find information regarding Direct Access here. 

 

Attention all VPTA members.

 

It has come to our attention that CareFirst has implemented a multiple procedure reduction with little notice to the providers and with a lack of transparency on the process and methodology for payment reductions.  We want you to know that VPTA and APTA have online members only resource with templates, tools, and resources to assist with payment related issues.

 

a) APTA: Know your cost

b) APTA Private Practice Section

c) Managed Care Contracting Tool Kit Video

d) Managed Care Contracting Tool Kit

 

Furthermore, it is crucial for you to understand your cost of doing business.  You must

compare the practice contracted rate and cost per visit calculation. Is the practice contracted for rate less than the cost to provide a visit? If the answer is yes, you will need to make an educated business decision. There may be reasons the practice chooses to sign or not sign a contract with a payer, but it should always be based on knowledge of the numbers and a sound business decision.

 

 Cost per Visit:

In the current environment of the Health Care it is more important than ever to know the cost of doing business when making contracting decisions.

Knowing your expense per visit for each encounter versus revenue per visit paid by each payer insures that your services will continue to be financially viable. If you sign contracts at a lower rate than your cost per visit you will lose money on those visits.

Sample Calculation: Annual expenses $500,000/# 5,800 Visits/year= $86.21/Visit

Contracts that pay lower than $86.21 on average would be loss leaders!

 

VPTA and APTA continues to monitor and advocate on behalf of our members.  We are also talking with other Chapters to discuss these concerns and have been sharing information of best course of action. Here is an update on recent discussions with providers, chapters, and APTA as well as next steps.

 

What we learned:

  • There is not a clear algorithm for these reductions. The lead for provider representatives that APTA contacted indicated that they have asked the executives within CareFirst for clarification but to date, this has not been provided.

 

 

Concerns shared with CareFirst:

  • Providers should have access to information that will provide them with a clear understanding of how much they will be payed for services they are providing. Providers need to understand costs and payment on a regular basis. Therefore, if there is not a clear understanding of the reduction methodology then they cannot calculate costs or determine the impact.
  • A reduction in reimbursement could create an unintended effect on access to care.
  • If providers do not have the algorithm for the reductions then implementation should be delayed to allow for provider education.
  • What mechanisms are available for providers to understand if the claim is accurately processed?

Questions for Providers

  • Has anyone received written or oral notification of certain percentage decrease in payment for multiple procedure codes? The Chapter has received several calls and emails noting no specific methodology for processing claims but we are asking if anyone has formal documentation and to contact the VPTA at Ron Masri, Practice Chair VPTA. [email protected]

Please see the Payer Relations Section of the VPTA website for specific guidance and links to resources that you may find helpful.

 

Respectfully,

Ron Masri, Practice Chair, VPTA

 

Contact your provider rep: https://provider.carefirst.com/carefirst-resources/provider/pdf/professional-provider-representatives-cut0512.pdf (To find anyone at Carefirst, email address: first name.last [email protected])
Let them know the impact on your practice. Ask them for assistance and guidance with claims processing.

 

http://www.apta.org/UMToolkit/

http://www.apta.org/UMToolkit/ChapterStrategies/

Utilization Management Toolkit: Templates and Calculation Tools

Templates

Calculation Tools

Audits, Denials & Appeals

APTA Template Letters: Appeals

http://www.apta.org/UMToolkit/ProviderStrategies/

Utilization Management Toolkit: Member and Provider Strategies to Address UM Issues

The insurance commissioner's job is to protect consumers and ensure their access to appropriate care, It isn't within their scope to address the burden on providers or reduced payment resulting from the use of a UM vendor. Providers should think in terms of how the UM vendor policies are impeding patient access to medically necessary services. Essential to that effort is data collection, which is described below.

Note: Government regulation of health plans is complex. The OIC generally has jurisdiction over only private "insured" health plans in which the buyer is required to pay a premium. Depending on the state or municipality, the OIC may have jurisdiction over some or all aspects of workers' compensation, health maintenance organizations (HMOs), and preferred provider organizations (PPOs). However, state insurance entities never have jurisdiction over Medicare, Medicaid, federal workers compensation, or the military health system TRICARE. It may be difficult to determine if a health plan is subject to state jurisdiction. Providers who are uncertain still may file a complaint, but it may be deemed invalid.

Self- insured employers are covered by ERISA and are not required to follow state law. Issues for these payers must be brought to the attention of the Social Security Administration rather than the OIC.

Utilization Management Toolkit: Chapter Checklist

APTA chapters can use this checklist to see how informed and prepared they are on issues related to UM.

□ Alert members to pending UM vendor contracts.

□ Track reported issues and identify trends.

□ Collect data via UM survey.

□ Educate members on UM and strategies.

□ Educate members on careful assessment of TPA contracts (see APTA’s Managed Care Contracting Toolkit).

□ Alert members to availability and encourage completion of the UM Feedback Form.

□ In concert with APTA, educate members on strategies to avoid denied authorization approvals.

□ Collaborate with payer and UM vendor.

□ Reach out to other provider groups with similar UM issues.

□ Assess legislative options (see this example of what Washington state did to address UM issues).

□ If appropriate, conduct grassroots efforts to facilitate provider and consumer outcry.

□ Build coalitions with other stakeholders.

 

Utilization Management Toolkit: Tips for Successful Provider and Chapter Collaboration With Payers and UM Vendors

For providers and APTA chapters that are seeking collaboration opportunities with payers and UM vendors, these tips can help make interactions successful.

  • Establish positive relationships with payer and UM vendor representatives.
  • Seek an audience with payer and UM vendor representatives who have the decision-making authority.
  • Consider issues from the payer and UM vendor perspective.
  • Seek collaborative solutions or compromises on both sides that may be viewed as a positive outcome for both.
  • To facilitate change, collect meaningful data that objectively demonstrates and quantifies the issue, rather than providing anecdotes that may not be actionable.
  • Keep the conversation targeted on the main objective.
  • Restate any agreed-to changes to be sure there is a mutual understanding.
  • Be respectful.
  • Use active listening to show you are trying to understand the other points of view.
  • Maintain good communication at all times.
  • Avoid irritation.

http://www.apta.org/WorkArea/edit.aspx

  • Remain calm and separate the people from the problem.
  • Keep sight of the big picture.
  • Look at your objectives and focus on your goals.
  • In speaking, use "we," not "you."

http://www.apta.org/UMToolkit/AddressIssues/

Utilization Management Toolkit: APTA Strategies to Address UM Issues

APTA is committed to supporting its members on issues related to UM. Following are some of the association's strategies for resolving issues as well as for providing education and encouraging a positive environment that can avoid issue in the first place.

  • Educate members on evaluating contracts (see APTA's Managed Care Contracting Toolkit).
  • Educate members on effective communication with payers and UM vendors (see APTA's Managed Care Contracting Toolkit and "Utilization Management Review Essentials" in PT in Motion magazine).
  • Educate members on appropriate documentation, outcomes data collection, and billing.
  • Educate members on determining the cost of service delivery (see APTA's Managed Care Contracting Toolkit).
  • Educate members on fee determination and knowing costs (see Fee Determination and Know Your Costs on APTA.org).
  • Educate members on determining and conveying the value of their services (See "Measuring By Value, Not Volume" in PT in Motion magazine).
  • Educate payers on the value of physical therapist services (see APTA Policy Center webpage The Value of Physical Therapy).
  • Track and trend data collected from APTA-developed UM Feedback Form (see UM feedback form in this toolkit).
  • Identify chapters experiencing issues with the same payer and/or UM vendor to identify issues and find solutions.
  • Facilitate sharing of APTA and chapter resources and updates among chapters and individual members.
  • Develop a UM map indicating vendor activity in each state and across the country.
  • Collaborate with chapters, payers, and UM vendors to identify and address issues with mutually satisfactory solutions.
  • Help chapters with appropriate messaging to providers on the local level.
  • Help members with appropriate messaging to patients.
  • Submit comment letters to payers.
  • Conduct in-person and virtual meetings with payers and UM vendors.
  • Communicate meeting findings to chapters and individual members.
  • Collaborate with other health care disciplines and their associations that face similar challenges.
  • Explore legislative, regulatory, and legal remedies.

http://www.apta.org/Payment/PrivateInsurance/ManagedCareContractingToolkit/Video/

Video: Managed Care Contracting Toolkit

December 19, 2012: As of 2009, there were more than 169 million enrollees in private health insurance plans and over 91 million enrollees in government plans such as Medicare, Medicaid, and military plans. To ensure adequate coverage of their enrollees, managed care plans are constantly reaching out to providers to join their networks. While most physical therapists consider joining a provider network at some point, the decision should be based on sound business strategy.

http://www.apta.org/Payment/PrivateInsurance/ManagedCareContractingToolkit/

Joining A Managed CARE Plan: doing The Math

If you’ve never gone through the process of joining a managed care plan, the financial considerations can be daunting. This chapter will help you “do the math” to decide what fee schedules, patient populations, and payment methodologies are best suited to your practice.

Calculate Your Costs

The crucial first step is to define your costs of providing services. Knowing your costs will help determine whether a contract is financially feasible for your practice to manage. For a simple analysis, use the table below to fill in your overall cost of business. Once you have added up your costs, divide the total by either 12 or 52 to get your monthly or weekly overall costs. Knowing how much to charge for your services, or whether a contract offered by a payer is fiscally acceptable, depends on an understanding of your costs.

There are 2 types of costs: direct and indirect.

Direct costs are the expenses for clinical services, such as salaries, equipment, supplies, etc. Indirect costs are often referred to as overhead costs, that is, nonclinical expenses, such as rent or mortgage payments, electricity, heat/

cooling, and janitorial services. Some costs, such as the rent or mortgage, are fixed. This means that your practice will incur the same cost whether you treat 10 patients or 200 patients. Other costs like staff salaries or utilities are semi-fixed. If your staff must work overtime, then salary costs increase.

Variable costs include items like disposable supplies. These costs can increase depending on patient volume. All costs, including fixed costs, need to be reevaluated at least annually. Lease agreements generally have an annual fixed rate increase that has to be accounted for when calculating expenses and forecasting budgets. Lease costs should not exceed about 10% of your overall budget. Labor costs are a key area for a service business like physical therapy and can make or break your practice. The key is combining appropriate wages with adequate productivity. Labor costs should also include owner or key employee benefits and outsourced service costs. It is recommended that labor costs for PTs should equal between 28% and 40% of their gross collections. Higher salaries are usually awarded to more productive staff with fewer cancellations, better patient retention, and higher customer service scores.

Developing FEE schedules

Now that you know your costs of care, you can look at each insurance fee schedule and see how many patients you will need to treat in that time frame to produce a profit. To be realistic, don’t count on more than a 90% collection rate, depending on your market, allowing a margin of error for uncollectible or delayed payments. Also, remember to always maintain about 3 months of operational cash flow, or at least allow 90 days in the billing cycle to receive all of the payments that were billed.

The next step is to estimate the annual gross total income you need to make a profit.

Gross income includes all payments received, before taxes and expenses are deducted, such as insurance reimbursement, self-pay and copay, as well as income from other services like fitness, massage, functional capacity evaluations, etc. Your gross total income must exceed your calculated expenses in order for the business to remain profit-able.

The difference is called net ordinary income(NOI).

Net Ordinary Income (NOI) = Gross Total Income –Total Expenses Divide your NOI by weekly, monthly, or annual hourly net income (before interest, taxes, depreciation, and amortization) to assess your potential income based on the above assumptions and numbers. A reasonable starting target profit margin would be 10%. As growth and efficiencies develop, that can increase. For example, if you add a staff PT, the fixed costs such as rent are now spread among 2 providers instead of 1.

https://provider.carefirst.com/carefirst-resources/provider/newsletters/bluelink-2017-jun.pdf

Staggered Deployment of Clinical Auditing Tool ClaimsXten

Beginning this fall, CareFirst will move from our current clinical auditing tool, ClaimCheck, to an enhanced tool, ClaimsXten. ClaimsXten is a comprehensive auditing tool that will allow us to manage the unique requirements of our claims processing platforms. Deployment will be staggered across multiple claims processing platforms over the next year.

What will change?

With these deployments, CareFirst’s claim adjudication will be updated. This update may affect the outcome of some clinical edits, including the four outlined below.

• Add On Without Base Code:

Audits claim lines containing the add on codes when the base code cannot be found for the same member for the same date of service.

•Diagnosis Age Validation:

Identifies claim lines containing diagnosis codes that are inconsistent with the patient’s age.

•Durable Medical Equipment (DME) Own Rule:

Audits claim lines containing a DME item submitted as new or new when rented or used, when the same DME item is member owned.

•Lifetime Event:

Audits claim lines that contains a procedure code that has been submitted more than once or twice across dates of service because it has been identified as a procedure that can only

be performed once or twice in a lifetime, reported for the same member.

What does this mean to you?

There will be no change to your process for submitting claims to CareFirst. There will also not be any changes to CareFirst Medical Policy due to this implementation.

Since this change will be deployed across multiple CareFirst platforms at different times, beginning in fall 2017 and continuing through 2018, you may notice different outcomes for similar claims during this time, depending on which claims platform the patient’s policy operates on.

What’s next?

We will continue to keep you updated as this tool is deployed on our platforms. There is no further action needed on your part. If you have any questions, please contact Provider Service at 877-228-7268.

https://provider.carefirst.com/providers/news/clinical-auditing-tool-claimsxten-to-be-deployed-on-facets-system-on-dec-1.page?

Professional Providers: Clinical auditing tool ClaimsXten™ to be deployed on Facets system on Dec. 1

November 21, 2017 -

On Dec. 1, we will continue the process of moving from our current clinical auditing tool, ClaimCheck™ to an enhanced tool, ClaimsXten, which will allow us to manage unique requirements of our claims processing platforms.

Facets will be the second claims processing platform to have the tool deployed. It was successfully deployed on FEP Bridge in September, and will be deployed on additional platforms over the next year.

What does this mean for you?

Since ClaimsXten is being deployed to our systems over time, you may notice different outcomes for similar claims in the coming year, depending on which claims platform the patient's policy operates on. Please note: There will be no change to your process for submitting claims or to CareFirst Medical Policy as a result of this implementation. This only affects Professional providers at this time.

Questions? Please contact Provider Service at 877-228-7268 Stay Connected: Update your email preferences by visiting carefirst.com/stayconnected.

 

 

Open http://www.apta.org/PTinMotion/News/2018/09/17/PFSComments/?_zs=837fV1&_zl=SKAA5 in a new window

 

VPTA has come to realize that some commercial payors are implementing the MPPR (multiple procedure payment reduction) esp in DC and certain part of Northern VA. Because commercial payers are privately run entities it is challenging to get them to make sweeping changes from a legislative perspective. As you know there is no federal or state legislative body that has jurisdiction over how a commercial payer mandates their policies. APTA and we suggest beginning with local advocacy efforts with the commercial payer reps if you happen to have those connections. Furthermore here are some things that can be done on an individual clinician level and

 

Here are some suggestions and resources that may be useful for further research.

Individual clinicians:

  1. continue due diligence with the payer

  2. Review your contract annually. Provide outcome measures or rationale annually for why you feel that your payment should be increased.

  3. set up a mechanism within your clinic to review the newsletters/notices/letters that come from the payer to remain informed about proposed changes. This was fwrd to the VPTA from APTA and is a notification in a newsletter in April 2018 from Carefirst about upcoming changes to billing procedures

     

    https://provider.carefirst.com/carefirst-resources/provider/newsletters/bluelink-2018-apr.pdf

    BlueLink Provider Newsletter April 2018 Volume 20 Issue 2 Pg 10 ClaimsXten™ Implementation Update We continue the transition from our current clinical auditing tool, ClaimCheck™, to an enhanced tool, ClaimsXten across all of our claims processing platforms. ClaimsXten is a comprehensive auditing tool that allows us to manage the unique requirements of our claims processing platforms.

     

    Clinical Edit Description Pay Percent – Therapy Professional

    Recommends an adjustment in the pay percent when multiple therapy procedures are submitted on the same date on certain therapy procedures. There will be no change to the process for submitting claims to CareFirst regarding these clinical edits. Please note that you may see different outcomes for similar claims dependent upon the aligned platform. What’s Next? We will continue to keep you updated as the ClaimsXten solution is deployed on our platforms. If you have any questions, please contact Provider Service at 877-228-7268. What’s Changing? With each of the recent deployments, CareFirst’s claim adjudication is being updated. In addition to the four clinical edits announced in 2017, and six clinical edits that are being implemented this Spring, we will be implementing one additional clinical edit this summer.

     

  4. Resubmit claims with an explanation

  5. Begin filing appeals.

  6. Review documentation standards with in their clinic to ensure that your documentation clearly reflects treatment rendered

     

    Additional resources:

    http://www.apta.org/Payment/PrivateInsurance/

    Audits, Denials & Appeals

  1. Appeal Letter Outline (.pdf)

  2. FAQ: Audits

  3. FAQ: Claim Denials

     

     

    http://www.apta.org/MPPR/PrivateInsurersList/

    Nonfederal Payers That Implement MPPR

    The following payers have implemented the multiple procedure payment reduction (MPPR) according to the time frames listed. As shown under the Policy heading, implementation and the extent of the reduction vary by payer.

    If you are aware of any additional payers implementing the MPPR, please contact APTA at [email protected].

     

     

    Please feel free to contact me at [email protected]

     

     

With great appreciation and enthusiasm,

 

Rony Masri, PT, DPT

VPTA Practice and Payor Chair

 

 

Attention VPTA Members,

 

In an effort to keep all members informed of significant happenings in Virginia that impact clinical practice, we are contacting you to inform you that effective August 1, 2018 American Specialty Health Group (ASH) will begin utilization management services for Cigna Health Insurance company. They will take over these services from Rehab Provider Network for physical therapy utilization management and review. ASH will contract directly with individual outpatient private practice physical therapists in Virginia and letters have been sent to most practices with a fee schedule and basic contract information. Please note that this letter does not represent an actual contract. The APTA and state leaders are participating in a conference call with ASH to discuss this change and the impact it will have on clinical practice. To insure the financial health of physical therapists’ practices in Virginia and of your practice, we recommend that you request and review your contracts closely and contact the Private Practice Section of APTA and the APTA for information about contract negotiation and utilization management and review.

 

We will keep you updated as we gather information on this change. For more information, please review the ASH FAQ.

 

All and only the best,

 

Josh

 
 

Chair

Amanda Miller Avila, PT, DPT, WCS
Email

Research

The primary purpose of this section of the website is to provide a source of information for consumers of research as well as for clinical researchers.  A secondary purpose is to provide a forum for clinicians, academicians, and students to share ideas and to develop collaborative research projects.  Please let us know if you have an interesting link you would like to share.

Validating clinical practice by documenting outcomes and the efficacy of physical therapy are vital to our future as a profession.  Clinicians and academicians can combine efforts to answer questions of interest to our profession and the scientific community.  If you are interested in clinical research, or have an idea for a clinical research project contact any of the educational institutions in your area.  Many PT programs require a research project and you may be able to find students and faculty that are interested in assisting you.  If further assistance is needed in finding collaborators for clinical research please contact the Research Committee Chair.

News

Co-Chair

Brandon Smith
Email

Co-Chair

Megan McIntyre, PT, DPT
Email

Student Relations

The VPTA Student Relations Committee (SRC) serves to facilitate the engagement of student-related activities as they pertain to the VPTA, Student Special Interest Group (SSIG), and associated gatherings throughout the calendar year. The SRC plays a key role in mentoring and preparing student for future chapter leadership and encouraging involvement in current national and chapter student opportunities in leadership. These activities include:

Sponsorship to attend these programs and others

News

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