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.

 

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

 

 

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.

 

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

 

Marymount University Department of Physical Therapy wishes to recognize and congratulate our faculty and alumni on the prestigious awards they received in 2018:

 

  • Becky Leonard - an adjunct faculty member, received the Henry O. and Florence P. Kendall Practice Award, which honors a physical therapy professional who embodies a commitment to developing physical therapy as a caring profession.
  • Secili DeStefano- An alumna, Dr. Secili DeStefano, ’01, ’07, who earned her master’s degree and doctorate from Marymount, received the Lucy Blair Service Award, which honors members whose contributions to APTA are of exceptional quality or value.
  • Diana Venskus- received the Humanitarian Award. The recognition honors individuals who exemplify the compassionate nature of the profession and actively demonstrate a commitment to humanity and selflessness in addressing health concerns.
 

As physical therapy students, our focus is pretty regularly zoomed in on the foundational details of physical therapy. Attending the NEXT Conference & Exposition this summer allowed us to zoom out a bit, inspiring and challenging us to broaden our vision of what it means to be a successful physical therapist. We were exposed to the issues, successes, current knowledge, and research surrounding physical therapy, heard the perspectives of both new and veteran physical therapists, and began to recognize and appreciate the tireless work that the American Physical Therapy Association (APTA) does on behalf of our profession.

 

In short, the Conference was overwhelming in the best possible sense of the word. We chose from a large selection of eye-opening and thought-provoking lectures and workshops each day. We had the chance to interact with students from other schools, and converse with physical therapists from all over the country. We heard an inspiring speech by the APTA president, Sharon Dunn, about how physical therapists fit into society (past, present, and future), and saw Marymount faculty receive prestigious awards. We participated in a successful Go Baby Go build and education session with the University of Central Florida. We spent a lot of time in the exposition area meeting with different vendors and getting a ton of physical therapy swag! Finally, we found some creative ways to participate in the famous Oxford Debate on whether or not nutrition should fall under the scope of physical therapy.

 

As we reflect back, most of us went into the Conference expecting a lot of information to go straight over our heads. We were surprised to realize just how much we already knew and understood during discussions and lectures only one year into our program. But really, the best part of it all was it allowed us the great opportunity to bond with our fellow Marymount classmates!

 

By: Katie O’Donohue, Bryce Downen, Alex Turner, and Gaby Zacuto

 

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

 

 

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!

 

The Northern District holds monthly meetings, networking events, and participates in charity events,  between September and May.  Meetings consist of social networking time, a business meeting to update members on Virginia Physical Therapy news, and an educational presentation.  They are held at clinics in the Northern District.  Meeting notifications are sent out to Northern members APTA listed emails.