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  • APTA Working for You: Federal Advocacy Updates, October 2018

    Advocacy for patients and the profession never stops. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of payment and care-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    Recent Advocacy Wins

    • Diagnostic services furnished by PTs: APTA staff and 3 members of the Academy of Clinical Electrophysiology and Wound Management met with the Centers for Medicare and Medicaid Services (CMS) in January to discuss Medicare Administrative Contractors’ inconsistencies between the local coverage determinations and Medicare guidelines, specifically related to reimbursement for electromyography/nerve conduction studies by qualified physical therapists (PTs). As a result of the meeting and ongoing follow-up, CMS in early October clarified its policy that PTs should be fully paid for these services.
    • Use of pulse oximetry in the home: After APTA staff met with CMS to urge the agency to clarify whether a physician’s order is required when using pulse oximetry in the home, CMS issued a clarification. An additional clarification was issued by The Joint Commission.

    APTA at the Table

    • APTA participates in a technical expert panel on postacute care
      In late September, an APTA member and staff participated in a technical expert panel (TEP) convened by CMS and consultant RTI International to discuss development of a unified postacute care prospective payment system. APTA will continue to represent the profession on future postacute care TEPs. Check out recent Medicare Payment Advisory Commission Reports to Congress on the unified postacute care payment system, including the most recent June 2018 Report to Congress.
    • APTA provides public comments at HHS Pain Management Task Force Meeting
      APTA staff provided public comments at the US Department of Health and Human Services (HHS) Pain Management Interagency Best Practices Task Force, highlighting the role of physical therapy in pain management.
    • CMS provider compliance meeting includes APTA representation
      APTA staff participated in a meeting with CMS Program Integrity staff to discuss concerns and offer recommendations on improvements to the targeted probe-and-educate program, an initiative that provides personal help to providers interested in reducing claim denials and appeals. APTA will continue to represent the physical therapy profession at future provider compliance meetings.
    • APTA maintains ongoing contact with MedPAC and the Medicaid and CHIP Payment and Access Commission (MACPAC)
      APTA staff attends MedPAC and MACPAC meetings on a monthly basis, monitoring topics that impact the physical therapy profession.

      * APTA nominee added to Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) APTA member Meghan Warren, PT, PhD, recently was appointed to MACPAC after being nominated by the association.

    Coalitions and Other Stakeholder Meetings

    • Rehabilitation providers and agencies: APTA staff attended and presented on the Merit-based Incentive Payment System (MIPS) at the National Association of Rehabilitation Providers and Agencies 2018 Fall Conference.
    • Patient-centered care: APTA staff participated in the Agency for Healthcare Research and Quality Patient-Centered Clinical Decision Support Learning Network (PCCDS-LN) conference. The conference brought together diverse stakeholders from industry, government, and academia to learn about and discuss key issues in drafting a National Opioid Action Plan. Attendees also set an agenda for developing, disseminating, and applying PCCDS in other domains.

    More Advocacy and Collaboration

    • National Institutes of Health (NIH): APTA member Julie Schwertfeger, PT, DPT, MBA, will represent APTA on the Disability Rehabilitation Research Coalition (DRRC) when it meets with NIH on October 23.
    • White House: APTA staff and members participated in a conference call with White House staff regarding the opioid epidemic and continued pain management collaboration, a follow-up to an in-person meeting held in August.
    • US Centers for Disease Control and Prevention (CDC): APTA staff participated in a conference call with the CDC to discuss ongoing collaboration on topics including the opioid crisis, traumatic brain injury, and falls prevention. Several immediate opportunities were identified.

    APTA offers a range of resources for learning more about Medicare and Medicaid reimbursement and staying connected with advocacy efforts: check out APTA Regulatory Issues: Take Action to stay on top of the federal agency comment opportunities; stay informed by visiting APTA's Medicare Payment and Reimbursement webpage and Medicaid webpage to access information and download tools including customizable appeals letters and Medicare fee schedule calculator; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Questions? Email advocacy@apta.org.

    [Editor's note: This the article has been updated from an earlier version to correct an item stating that Meghan Warren was named to MACPAC.]


    • Is anything being done so that PT's can opt out of Medicare? Currently, from what I understand, a PT can opt out, but they still need to send a HCFA to CMS or CMS representative. It is my understanding that physicians can opt out and not have to submit HCFA's to CMS for future patient visits.

      Posted by David Gross on 11/2/2018 4:14 PM

    • This rubbish about not being paid for Medicare patient's exams and ANY treatment in the same day has got to go. Who is the bureaucrat the dreamed up that mess? How would they like to go someplace for help and be treated that way? Don't they have mothers and fathers? What the heck is the matter with their heads, and hearts?

      Posted by Leon Richard on 11/16/2018 4:34 PM

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