Communicate Medical Necessity of PT to Utilization Managers

Learning Center

Course Type: Webinar

Author(s): Karen Jost, PT, MS; Beth Rohrer, PT, DPT, OCS; and Victoria Rupakus, PT

Price: $99 APTA Member | $169 Nonmember

CEU: 0.2 CEUs (2 contact hours/CCUs)

Description: Utilization management companies (UMs) typically are independent agents contracted by payers to manage utilization of services. Agents review and respond to information, documentation, and request forms submitted by physical therapists (PTs) and other providers.

Here's where confusion and frustration can come in. Without sufficient information from you, UM reviewers—even those who are PTs—cannot determine the medical necessity of your services.

Most PTs are excellent at providing care but are far less adept at "telling the story" in a way that clearly shows the value of their services, and helps UM reviewers determine medical necessity.

Physical therapists, physical therapist assistants, and administrators who are responsible for billing and coding need to attend this course to learn the best ways to respond to current and changing payment policy in the out-patient setting.

Upon completion of this seminar, you'll be able to:

  • Describe the role of physical therapy utilization management companies, their relationship(s) to third-party payers/insurers, and the value of working collaboratively with the UM company
  • Identify 3 or more sources of evidence to support clinical decision making
  • Document medical necessity of services to advocate for appropriate physical therapy benefits
  • Employ effective communication strategies with peer reviewers and referring providers

Learn more and register via APTA's Learning Center.

Please note: An audio bridge is NOT provided to call into for this series of webinars. Audio for these webinars will be streamed through your computer speakers. Please ensure your plugins are up-to-date in order to have an optimal listening and viewing experience.

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