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Our next district meeting is scheduled for Saturday, September 29th. Please plan ahead to join us for a night out with your professional colleagues. Directly following our meeting we will be going to the Barter Theatre (Stage II) to enjoy "Bridges of Madison County." The district has reserved a select number of seats (14 seats) at a discounted price ($21/person) to those who RSVP with the Mountain District. We encourage you to bring your significant other and/or family for a "Date Night." (Please be advised due to the content of the play this show may not be appropriate for children). No worries if you miss out on the discounted group price, tickets can still be reserved through the Barter ticket office. Be sure to ask about discounts such as Student, Military, Employer (i.e. Ballad Health), etc. Please act fast, tickets can sell out quickly!
Mountain District Meeting Details
Location: Ballad Health Rehabilitation at Johnston Memorial Hospital
445 Porterfield Highway, Suite B
Abingdon, VA 24210
Schedule of Events:
6:00 PM - Social
6:30 PM - Business Meeting
7:30 PM - Arrive at Barter Theatre (Stage II)
8:00 PM - Showtime "Bridges of Madison County"
RSVP to Barret Blevins, VPTA Mountain District Chair
by September 21st, 2018
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.
continue due diligence with the payer
Review your contract annually. Provide outcome measures or rationale annually for why you feel that your payment should be increased.
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
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.
Resubmit claims with an explanation
Begin filing appeals.
Review documentation standards with in their clinic to ensure that your documentation clearly reflects treatment rendered
Audits, Denials & Appeals
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@example.com.
Please feel free to contact me at firstname.lastname@example.org
With great appreciation and enthusiasm,
Rony Masri, PT, DPT
VPTA Practice and Payor Chair
VPTA’s upcoming Fall Summit will be held at South University in Glen Allen, VA on November 3, 2018. Virginia cordially invites you to participate in this event as a sponsor or exhibitor! You don't want to miss this year's fall summit!
We have some exciting sponsorship packages, all of which include an exhibit booth and your linked logo on our homepage for 6 months! The sponsorship packages give you the most bang for your buck and each level provides unique opportunities to reach not only those who are in attendance but even those who decided to stay home. Some of the sponsorship packages will even allow you to reach non-members through our social media!
Not interested in sponsoring? We have booths too!
Please take some time to look through our Sponsor & Exhibitor Prospectus.
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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.
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!
By now, most physical therapists (PTs) have heard the news: the final 2018 Medicare Physician Fee Schedule (PFS) released in early November by the US Centers for Medicare and Medicaid Services (CMS) included some significant variations from the PFS proposed in July. Instead of finalizing CPT code values that were the same as—and occasionally larger than—current values, CMS opted to offer up a more complicated combination of cuts and increases that could affect PTs in different ways, depending on their case-mix and billing patterns.
So Here are APTA's top 4 suggestions.
- Know the design process for the fee schedule. It's important to understand what led to the changes to provide context, a slight sense of relief, and a reminder of why payment needs to move toward value-based models and away from fee-for-service.
The PFS now set to debut January 1, 2018, is the CMS response to an American Medical Association (AMA) committee's recommendation on potentially "misvalued" codes associated with a wide range of professions, not just physical therapy. When the process began in early 2016, many predicted that the final outcome would be deep cuts to nearly all valuations—as much as 10% or more overall. APTA and its members fought hard to substantiate the validity of the current valuations, and even the need for increases in some areas. The end result was a significant improvement from where things were headed at the start of the process.
That's not to say it's been an entirely satisfying process from start to finish. This recent PT in Motion News story goes into more detail about the sometimes-frustrating journey from points A to B.
2. Understand what's being changed. Just about everything that happens at CMS is complicated, and the process that led to the new CPT code valuations is no exception. Still, a working knowledge of how CPT codes are valued is helpful in understanding why the PFS contains such a mix of positives and negatives.
One important thing to understand is that code valuation is actually a stew of 3 separate elements, known as relative value units (RVUs). These are estimations of the labor, expense, and possible professional liability involved in performing any given treatment or evaluation task associated with a CPT code. The 3 types of RVUs are known as "work," "practice expense" (PE), and "professional liability." The coding valuation differences between the proposed and final PFS were due to changes to the PE RVUs only.
This wasn't part of the proposed rule. While the AMA Relative Value Scale Update Committee Health Care Professions Advisory Committee did recommend changes to PE RVUs, CMS initially opted to not adopt those suggestions. When the final rule was released 3 months later, CMS—without seeking input from APTA or any other stakeholders—did an about-face and adopted the changes to PE RVUs.
So what? The answer is twofold: first, the tweaks to PE RVUs mean it's difficult to make many sweeping generalizations about how the new PFS will affect individual practices and clinics; second, it's worth noting that individual work RVUs either remained unchanged or increased.
A more detailed explanation of how the codes were affected is available in an APTA fact sheet on the 2018 PFS (listed under "APTA Summaries and Fact Sheets"). For a more complete explanation of RVUs and the differences between the 3 types, check out this APTA podcast on the CPT valuation process.
3. Get a sense of how you might be affected. A sense of history and understanding of detail are all well and good, but the bottom line is your bottom line.
Here's the complication with the 2018 PFS: because of the wide variation in upward and downward adjustments, it's hard to make statements about how PTs in general will be affected. CMS estimates the overall impact at a 1%-2% reduction, but a lot depends on the types of patients a PT or clinic typically sees and what interventions are commonly used. Some providers could see increases.
In an effort to clear up some of the uncertainty, APTA offers a calculator than can help you see how your typical case-mix would fare in the new PFS. The calculator, offered in Microsoft Excel, allows you to enter different codes to see what changes to expect, given your Medicare service area.
4. Keep learning. There's much more to understand about the PFS—not just in terms of the details of how the new rule will work, but in terms of APTA's work to safeguard CPT codes throughout the misvalued codes review process.
One great way to learn more about what to expect is coming up in December, when the association hosts a free webinar on Medicare changes for 2018 on December 6 from 1:00 pm to 2:00 pm ET. The webinar will be presented in a "flipped" format, meaning that when you register, you'll be provided with a prerecorded presentation to listen to in advance. That way, more of the actual session can be devoted to live interaction with the presenters. Be sure to sign up—and listen up—soon.
Another opportunity is available December 13, when APTA hosts an "Insider Intel" phone-in session that will cover many of the same topics, albeit in a pared-down 30-minute session, from 2:00 pm to 2:30 pm ET. Instructions for signing up for this session are on APTA's Insider Intel webpage.
To view the news story, please see: http://www.apta.org/PTinMotion/News/2017/11/21/PFSTipsNovember2017/