APTA recently developed an FAQ document to help association members understand the coverage and cost-sharing arrangements of various Medicare Advantage (MA) plans. The questions address billing and coding requirements, the therapy cap and KX modifier, plan of care requirements, how to appeal claim denials, reporting data under the Physician Quality Reporting System, audits, and requirements regarding face-to-face encounters, among other issues.
A summary of the 2012 Medicare Advantage final rule also is available from APTA. The final rule makes revisions to the MA program (Part C) and prescription drug benefit program (Part D) to implement provisions specified in the Patient Protection and Affordable Care Act, in addition to other changes. Some examples of pertinent changes for physical therapists include cost sharing in skilled nursing facilities, payment to non-contract providers, and revised requirements for the review of medical necessity determinations.
American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782) | 800/999-2782 | 703/683-6748 (TDD) | 703/684-7343 (fax)
Contact Us | For Advertisers & Exhibitors | For Media | Follow APTA
All contents © 2014 American Physical Therapy Association. All Rights Reserved.