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2019 APTA’s State Policy and Payment Forum Recap

Tuesday, October 8, 2019   (0 Comments)
Posted by: Matthew Nicholas
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APTA’s State Policy and Payment Forum Recap

By: Rick Rausch PT, DPT, MBA, IPTA Payment Chair

The APTA State Policy and Payment Forum was held September 14th in Arlington, VA. This annual event is designed to increase knowledge of state legislative issues that have an impact on the practice and payment of physical therapy, and to improve advocacy efforts at the state level.

Jim Milder, PT, IPT-PAC Chair and Rick Rausch, PT, IPTA Payment Chair represented the IPTA for the presentations and discussions.  Some highlights of the program included:

Federal Payment and Policy Updates included a discussion of the upcoming payment differential for services provided by Physical Therapist Assistants in 2020.  These services will be paid at 85% of the Medicare fee schedule for services provided to Medicare Part B patients.  This payment reduction is a way to pay for the cost of the Therapy Cap fix in 2017.  APTA continues to work with CMS to clarify how this payment reduction will affect payment when both a PT and PTA provide parts of a visit.  As part of the Medicare Proposed Rule that was published this past July, Medicare is also proposing a 8% reduction in all payments for physical therapy and physical therapy assistant services starting in 2021.  Medicare approved a major revision to how physician office visits are being reimbursed in 2020 that will result in significant increases in cost to the Medicare system.  Because Medicare is mandated to be a budget neutral program, all providers who do not bill under the physician office visit category will experience a reduction in payment to pay for this change. This is proposed for 2021. 

Utilization Management.  A panel of physical therapist present a variety of methods being used across the country to provide utilization management services by physical therapist, not by outside companies.  The excess administrative burden caused by outside utilization companies is significant for many providers.  No firm answer was presented, but there are success stories out there to learn from.  More information is available by contacting APTA.

Alternative Payment Models.  The consensus by many experts in our field is that our current system of fee-for-service will be reduced in the future and we will move to Alternative Payment Models (APM).  It is unclear what these models will look like, but they will likely include episode of care payments, bundled payments or case rates.  These rates will be more closely tied to outcomes.  APTA at this time is working to provide education programs regarding  APM’s, tools to determine if your practice setting is prepared to work under an APM model as well as tools to participate in discussions with payers regarding APM’s.

Payment Updates.  The new CPT codes for dry needling will be available through the Medicare Fee Schedule starting 1/1/20.  The final payment rates are not finalized yet.  Commercial payers will decide if they are going to utilize these new codes and what the reimbursement rate will be.  There will be one code for dry needling 1-2 muscles and another code for 3 or more muscles.  Also, the legislation was signed in Illinois that prohibits commercial payers from utilizing Medicare rules when paying for PT services.  That includes not using the 8 minute rule.  They must use the guidelines listed in the  CPT system.


more Calendar

Documentation for therapy Professionals, Concept to implementation (home health and PDGM focused)

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