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.

 

The VPTA is happy to introduce our members to a great new benefit called CEU Locker.

CEU Locker provides an easy and convenient method for tracking your CEU requirements in our state, searching for approved courses that meet state requirements, and being assured that the courses you are taking provide quality content for our specialty.

VPTA will be providing the easy-to-recognize official seal for all approved courses. As a CEU Holder, you only need to look for this seal when searching for your courses to be assured that they have been vetted and approved and that they meet state requirements. After you have completed an approved course, simply type the CEU Locker number into your online dashboard; the course information instantly will be archived for safekeeping. 

As an additional benefit to your practice, our website will begin featuring a robust, searchable listing of approved courses that meet state requirements.

Find all this here.

Usage of the CEU Locker service is an exclusive benefit of your VPTA membership. Thank you for being a member, and please let us know how much you like using CEU Locker!

 
 

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

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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

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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

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

Chelsea Lasky, PT, DPT
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

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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!

 

 

2018 Year Nominating Committee Calendar - VPTA
DESCRIPTION  
When
May
Call for Chapter and District Nominations (eblast, website, social media, etc) 3
June
Call for District & State nominations closes 17
Deadline for Candidate Pictures, Bios, Consent to Serves & Statements 25
August
Tentative Chapter & District Slate Posted  3
September
Slated by Petition Deadline 2
Bios, Pictures, Statements & Consent to Serves from Petioned Nominations Due 10
Final Slate with All Bios, Pictures, Statements Posted 19
Chapter Elections Open 19
October
Chapter Elections Close 3
Chapter Election Results Posted 5
District Elections Open 15
District Elections Close 29
District Election Results Posted to Website 31
November
Election Results Announced at Annual Meeting & Noted in Minutes 3
Chapter Elections:
Even Year Chapter: Vice President, Treasurer, PTA Caucus Rep; Delegates
Odd Year Chapter: President-Elect, Chief Delegate, Secretary, Delegtes, PTA Caucus Rep.
District Elections
Even Year Districts: Secretary: Blue Ridge, Mountain Valley Treasurer: Central, Northern, Tidewater District Directors: even year directors Nominating Committee Member: Northern, Central, Tidewater
Odd Year Districts: Secretary: Central, Northern, Tidewater Treasurer: Blue Ridge, Mountain, Valley District Directors: even year directors Nominating Committee Member: Blue Ridge, Mountain, & Valley, 
 
 

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

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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