A new APTA Web resource can help PTs prepare for and successfully get through a Medicare claims audit. The Medicare Claims Audits Web page provides audit tools such as a form for conducting a self audit, an auditing entities chart, information on hiring an attorney, and a link to the Centers for Medicare and Medicaid Services' brochure on the appeal process. The page also links to APTA's Defensible Documentation resource; information on enrolling in Medicare; Medicare local coverage decisions; handling fraud and abuse media coverage; Medicare denials, audits, and appeals; and coding and billing information.
This week, APTA announced the new staff structure that will take effect February 1. The new staff structure is designed to ensure APTA is properly aligned to achieve its goals (as identified by the House of Delegates and the Board of Directors) by providing for more efficiency, enhancing role clarity, building more trust across the association, and making the association more effective.
Helpful information about the new staff structure is available for members on APTA's Web site, including:
During the deliberations on the staff structure reforms the following criteria were used to guide decisions:
An association should comprehensively review its staff structure on a regular basis to ensure that the association is properly aligned to achieve its goals. It has been 4 years since APTA's staff structure was comprehensively reviewed. While a staff structure review may not always lead to realignment, in this case we believed it was necessary due to significant changes in our association, the profession, and the external world.
If you have any questions about the new staff structure at APTA, contact John Barnes, chief executive officer at APTA, at firstname.lastname@example.org.
Time is running out to register for the Basic Essentials for Physical Therapist Coding and Compliance audio conference, to be held January 26, 2 pm-3:30 pm, ET.
Register by January 23, 11 pm ET, to find out the top payment challenges for physical therapy and get practical advice on how to address them to ensure you get the revenues you deserve. During the Q & A session following the presentation, participants may ask questions directly to expert rehabilitation consultant Helene Fearon, PT.
The White House Champions of Change program is seeking recommendations of individuals and organizations that are increasing access to physical activity for children and young adults. APTA members can nominate themselves or colleagues who work to increase access to physical activity for children through some/all of the following:
Submit nominations by midnight January 23 by using this form.
The White House Champions of Change program highlights the stories and examples of citizens across the country that represent President Obama's vision of out-innovating, out-educating, and out-building the rest of the world through projects and initiatives that move their communities forward. Since the 2009 launch of Let’s Move, Michelle Obama has focused on ensuring that the nation's children eat healthier and become more physically active. Last April, the White House hosted a Champions of Change event to highlight the work of chefs in improving school nutrition programs.
Of 10 major demonstration projects aimed at enhancing the quality of health care and improving the efficiency of health care delivery in Medicare's fee-for-service program, most do not reduce Medicare spending, says a new report by the Congressional Budget Office (CBO).
CBO evaluated the outcomes of 10 demonstration projects that focused on disease management and care coordination or value-based payment. In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered.
Results from demonstrations of value-based payment systems were mixed. In 1 of the 4 demonstrations examined, Medicare made bundled payments that covered all hospital and physician services for heart bypass surgeries. Medicare's spending for those services was reduced by about 10% under the demonstration. Other demonstrations of value-based payment appear to have produced little or no savings for Medicare.
The report also provides several lessons learned. Programs that collected timely data on when their patients' health problems developed or became exacerbated and where they were treated seemed better able to coordinate and manage their patients' care. Furthermore, programs that smoothed transitions (for example, by providing additional education and support to patients moving from a hospital to a nursing facility or between a primary care provider and a specialist) tended to have fewer hospital admissions.
Substantial changes to payment and health care delivery systems will probably be necessary for programs involving disease management and care coordination or value-based payment to significantly reduce spending and either maintain or improve the quality of care provided to patients, CBO says.
Many women whose bones test normal at age 65 can safely wait as long as 15 years before having a second bone density test, says a New York Times article based on a study published today in NEJM.
The researchers studied 4,957 women, 67 years of age or older, with normal bone mineral density (BMD) or osteopenia and no history of hip or clinical vertebral fracture or of treatment for osteoporosis. At 15 years, fewer than 1% of women with normal bone density when they entered the study, and fewer than 5% with osteopenia, developed osteoporosis in the following 15 years. The researchers report that osteoporosis would develop in less than 10% of older, postmenopausal women during rescreening intervals of approximately 15 years for women with normal bone density or mild osteopenia, 5 years for women with moderate osteopenia, and 1 year for women with advanced osteopenia.
According to the Times, bone density screening became popular after Fosamax, the first bisphosphonate, was approved in the mid 1990s. Physicians were "overly enthusiastic" in prescribing it for women whose bone density was "lower than normal but not in a danger zone, keeping women on the drug indefinitely." Now they are more likely to prescribe bisphosphonates for older patients and recommend against them for most younger postmenopausal women with osteopenia.
The study is expected to change the way physicians think about bone density screening, the Times says.