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  • Study: Home Health Physical Therapy Improves Abilities of Individuals With Dementia

    In this review: The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia
    (Health Policy and Economics, January 2020)
    Abstract

    The Message
    Physical therapy delivered at home has a role to play in improving the lives of individuals with dementia, according to authors of a study that found any physical therapy increased the probability of improvement in activities of daily living — ADLs — by 15.2%. Although those probabilities improved in relation to the number of visits received, the greatest rate of increase in ADL function seemed to occur in patients who received between six and 13 visits.

    The Study
    Researchers analyzed CMS data drawn from the 2012 Outcome and Assessment Information Set and the Home Health Research Identifiable File, focusing on patients 66 and older who had a primary diagnosis of dementia and received in-home care. A total of 1,477 patients were included in the analysis.

    The study focused on whether patients with dementia improved ADL performance during the course of their care, and whether physical therapy visits could be correlated to increased chances of improvement. ADL items assessed included grooming, upper body dressing, lower body dressing, bathing, toilet transferring, toileting hygiene, transferring to bed or chair, ambulation, feeding and eating, the ability to prepare light meals, and the ability to use a phone.

    APTA members Cherie LeDoux, PT, DPT; Jason Falvey, PT, DPT, PhD; and Jennifer Stevens-Lapsley, PT, MPT, PhD, were among the authors of the study.

    Findings

    • Patients who received no physical therapy had a 60% probability of ADL improvement; that probability jumped to 75% for patients receiving any physical therapy.
    • The probability of ADL improvement increased with the number of physical therapy visits received, with improvement probability rising to 80.3% for patients receiving six to 13 visits, and to 88.9% for patients who received 14 or more visits.
    • Among all 1,477 patients, 62% received at least one physical therapy visit, with an overall median of four physical therapy visits received.
    • Among the patients who received physical therapy, 52% received between six and 13 visits, 41.3% received one to five visits, and 6.7% received 14 or more visits.
    • Authors believe the most significant improvement rates were associated with the six to 13-visit range, writing that the improvement rates associated with 14 visits and more as statistically insignificant.

    Why It Matters
    The authors write that their study comes when changes to home health payment "may produce downward pressure on home health rehabilitation services … generally discouraging therapy use and potentially increasing avoidable functional decline for [persons with dementia]." Their findings, they assert, help to establish the role of physical therapy in a provider environment that "incentivizes functional improvement."

    "In this study, skilled PT utilization is significantly associated with greater mobility and ADL function in individuals with a primary diagnosis of dementia," the authors write, adding that "our results suggest patients [with dementia] should receive a PT evaluation at minimum as a standard of care."

    Keep in Mind …
    Authors cite limitations in their study, including an inability to correct for possible variation in treatment allocation such as patient participation levels and clinician bias. The study also has a relatively small sample size and did not account for variations in dementia types among patient data analyzed.

    [Editor's note: author Jason Falvey was awarded a 2019 Foundation for Physical Therapy Health Services Research Pipeline Grant. Author Stevens-Lapsley has also received Foundation funding, and author LeDoux is the recipient of a 2019 Foundation Promotion of Doctoral Studies grant.]

    5 Things PTs and PTAs Need to Know About Naloxone

    APTA has long supported the important role of physical therapy in providing a safe alternative to opioids for pain management. But as health care stewards in society, another way PTs and PTAs can contribute is by having the medication naloxone available in case of an overdose.

    In fact, APTA’s official position is that naloxone should be accessible where PT services are provided to be administered to reverse the effects of an opioid overdose in accordance with recommendations from the Surgeon General of the United States. A year ago, in an address to APTA leaders, the Surgeon General urged association members to learn to administer the drug.

    Here are 5 things you should know about naloxone, along with links to more information—including the Surgeon General’s recommendations.

    1. Before administering naloxone, make sure to check your State Practice Act.
    Refer to state practice acts for specifics on regulations that might be in place for the administration of naloxone. Also check insurance policies for the hospital or clinic to make sure any possible liabilities are covered.

    2. Naloxone can rapidly reverse an opioid overdose.
    Naloxone is an opioid antagonist, which means it attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. Naloxone is not a treatment for opioid use disorder—it has no effect on someone who does not have opioids in their system.

    3. Learn about naloxone.
    Naloxone normally would fall within a drug category that requires a prescription, but in response to the opioid epidemic all 50 states have passed laws to make it easier to obtain, and most pharmacies carry it. Either the pharmacist can prescribe it on the spot when you go to a pharmacy, or a standing order can be set up that acts like a prescription anyone can fill. Find out which states make naloxone available without a prescription, or search the internet for “get naloxone in [your city].” And check out these Q&As on acquiring naloxone.

    To learn even more, view the US Substance Abuse and Mental Health Services Administration (SAMHSA) toolkit that outlines steps for first responders: Toolkit: 5 Essential Steps for First Responders.

    4. Consider training for administering naloxone — it’s easy to find.
    Most local health departments provide training and information, as does the American Red Cross.

    5. Include an emergency response plan for your hospital or clinic.
    Make sure administration of naloxone in case of opioid overdose is included in plans for medical emergencies in your facility. Refer to the SAMHSA toolkit for guidance.

    Get more information from the Surgeon General, CDC, HHS, FDA, and other sources.

    Payment Win: CMS Reverses Most of Its Damaging Coding Edits, More Details to Come

    The issue: On January 1, CMS changed some of its correct coding methodologies in ways that prevented PTs from billing an evaluation and therapeutic activity and/or group therapy services delivered on the same day, a common practice in physical therapy.

    The news: APTA and its members engaged in extensive advocacy efforts to convince CMS to rethink its decision. On January 24, CMS announced that it would do away with the most problematic changes and, for the most part, return to the coding rules PTs used in 2019.

    What it means: PTs will be able to return to billing for therapeutic activities (97530) delivered on the same day to the same patient as PT or occupational therapy evaluations billed under codes (97161, 97162, 97163, 97165, 97166, 97167). PTs (and occupational therapists) will also be allowed to return to billing the group therapy code (97150) with those evaluation codes.

    Keep in mind: There are still lots of details to be worked out, including the timeline for CMS to notify Medicare Administrative Contractors of the change, and whether it's retroactive. Additionally, a few of the January 1 restrictions remain, primarily related requirements around use of the 59 modifier/X modifier.

    The pressure paid off
    After a concerted effort by APTA, its members, and other stakeholders, CMS relented on the most detrimental parts of its changes to the edits that prohibited payment for certain activity codes if they're used on the same day as evaluation codes. The win means that PTs will be able to, for the most part, return to coding practices that were in effect prior to January 1, 2020. CMS has not yet shared details on effective date and the process for implementation of the changes.

    CMS has not yet shared details on effective date and the process for implementation of the changes.

    In a January 24 letter to APTA and other associations, Cathy Cook, MD, medical director of CMS coding contractor Capitol Bridge, wrote that "after reviewing this issue more closely, CMS has made the decision to retain the edits that were in effect prior to January 1, 2020."

    The return to the pre-January 1 coding environment reverses a CMS National Correct Coding Initiative edit that prevented PTs and OTs from billing for therapeutic activities (97530) if any of the PT or OT evaluation codes were billed the same day for the same patient. That prohibition crossed disciplines that use the same provider number, which prevented, for instance, an OT for billing for therapeutic activities with a particular patient on the same day a PT in the same practice billed for evaluation of the patient. In addition, CMS applied restrictions on billing for group therapy on the same day as PT or OT evaluations.

    With the letter from Capitol Bridge, those restrictions were undone.

    "The coding edit CMS imposed on January 1 not only ran counter to best practice in physical and occupational therapy, but was not consistent with CMS' own stated goals for care," said Kara Gainer, APTA's director of government affairs. "APTA and its members conveyed that message in large numbers, and in no uncertain terms. We're extremely pleased that CMS listened to the case we made and did the right thing for patients."

    While the reversal eliminated the most problematic parts of the January 1 edits, a few restrictions still remain: CMS will continue to require the 59 modifier/X modifier to be applied if a PT wants to receive payment for furnishing both manual therapy (97140) and an evaluation using any of the physical therapy evaluation codes (97161, 97162, 97163) on the same day for the same patient, or if billing for therapeutic activities (97530) or group therapy (97150) delivered on the same day as a physical therapy reevaluation (97164).

    The letter from Capitol Bridge also states that CMS will provide further information when it becomes available regarding impacted claims. Other details, such as how and when Medicare Administrative Contractors will be notified of the change, are unclear as of publication of this article. APTA will provide details as they become available.

    Katy Neas, APTA's executive vice president of public affairs, says that even with the remaining restrictions, the reversal from CMS is a significant one.

    "It's never easy to undo something that's been imposed by CMS and is already up and running," Neas said. "The fact that CMS changed course so quickly on so many of the most damaging parts of the coding edits is a testament to what can happen when APTA, its members, and stakeholders speak with a unified voice."

    Questions about where things stand in the wake of the CMS change? Contact advocacy@apta.org.

    What's Happening at the State Level: Hot Issues for 2020

    It's that time: Across the country, most state legislatures are either back in session or headed that way. And again this year, issues important to PTs, PTAs, and the patients they serve are on the radar in many statehouses.

    In preparation for what promises to be another busy year, we've put together a list of some of the issues that will get attention from lawmakers in the coming weeks and months. Take a look at what's coming — and then don't forget to help press for needed change by contacting your APTA chapter and the national office to sign up for action alerts, and see how you can get involved. (And check out APTA's State Advocacy webpage.)

    Direct Access
    States with potential legislation in 2020: Alabama, Kansas, Minnesota, Mississippi, Missouri, New York, Tennessee

    Background: Improving direct access to physical therapy, ideally without a physician referral, is a longstanding priority for the association and its chapters. And we've made progress: All states now have some form of direct access, but some forms are more limited than others, imposing restraints such as referral requirements and visit limits for specific interventions. Legislative energy is now being devoted to improving these more restrictive systems, bolstered by a recent APTA consponsored study that found unrestricted direct access to physical therapy for low back pain saves money and lowers utilization of services overall.

    Resources: Direct Access at the State Level webpage

    Telehealth
    States with potential legislation in 2020: Arizona, Georgia, Rhode Island

    Background: Telehealth provisions for PTs are explicitly included in laws and/or regulations in 16 states, with nine states allowing Medicaid reimbursement for telerehab and 11 more including language that opens up that possibility. The U.S. Department of Veterans Affairs allows PTs to engage in telehealth, to successful results. The states listed above want to add telehealth the PT scope of practice, allow for Medicaid reimbursement for telehealth delivered by PTs, or both.

    Resources: Telehealth webpage

    Physical Therapy Compact
    States with potential legislation in 2020: District of Columbia, Massachusetts, Michigan, Ohio, Pennsylvania, Rhode Island, South Dakota, Vermont, Wisconsin

    Background: The system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states grew to include 26 states in 2019, with five more — Arkansas, Delaware, Georgia, Maryland, and Virginia — having adopted the legislation in advance of enactment. Widespread participation in the compact is a professional game-changer, particularly as PTs' and PTAs’ ability to participate in telehealth grows.

    Resources: Physical Therapy Licensure Compact webpage

    Dry Needling
    States with potential legislation in 2020: California, Connecticut (pending a court ruling), Hawaii, New Jersey (held over from 2019)

    Background: Currently, 35 states and the District of Columbia allow PTs to perform dry needling, seven states prohibit it, and eight states are silent on the issue. Chapters from the states listed above are looking to add a specific mention of dry needling to their PT practice acts.

    Resources: Dry Needling in Physical Therapy webpage

    Fair Copays
    States with potential legislation in 2020: Georgia, New York, Ohio, Rhode Island, South Carolina, Virginia

    Background: Like direct access, the issue of fair copays has been a central advocacy focus for some time at both the state and federal levels. Many insurance provisions classify PTs as specialists and impose higher copays; it's an approach that ignores the fact that physical therapy often requires multiple visits, making seeing a PT cost prohibitive. APTA and its chapters want to change that by, at the very least, following a lead established in Kentucky in 2011 that limits physical therapy copays to no more than the copay for a visit to a primary care provider.

    Resources: Fair Physical Therapy Copays webpage

    Imaging
    States with potential legislation in 2020: Connecticut, Illinois, Rhode Island

    Background: The importance of PTs to achieve practice authority for ordering and performing appropriate imaging studies was underscored by the APTA House of Delegates in 2016, when it directed the association to press for changes to imaging restrictions. Currently, only Colorado, Wisconsin, and Utah expressly allow PTs to order imaging under certain conditions.

    Resources: Imaging webpage

    Utilization Management
    States with potential legislation in 2020: Oregon

    Background: Used properly, utilization management can help PTs provide patient-centered and timely care to patients; too often, however, it serves as little more than a barrier to needed care and an excessive administrative burden for providers. States are looking for ways to better regulate the practice so that it doesn't get in the way of patient access to needed services.

    Resources: APTA Utilization Management Toolkit

    Practice Act Updates
    States with potential legislation in 2020: Alaska, Florida, Tennessee

    Background: Times change, and so do concepts of legal scopes of practice for PTs and scopes of work for PTAs. A large-scale revision of a state's PT and PTA regulatory language can be a major undertaking, but chapters regularly step forward to take on the challenge and ensure that PTs in their states are practicing under laws that aren't antiques.

    Resources: Jurisdictional Scope of PT Practice webpage

    Humana Adopts PTA Coding System, Anticipates Payment Differential Beginning in 2022

    Commercial health insurance giant Humana has announced that it's falling in line with rules from the Centers for Medicare and Medicaid Services designed to establish an 85% payment differential for therapy services delivered "in whole or in part" by a PTA or occupational therapy assistant. Consistent with CMS, Humana is requiring use of code modifiers in 2020, with no changes to payment until 2022.

    The new system, which establishes a code modifier ("CQ" for PTAs and "CO" for OTAs) began on January 1 for Medicare Part B payments. The new approach was triggered by federal law that mandated the creation of a way to denote the volume of physical therapy and occupational therapy services delivered by PTAs or OTAs, and then create a payment differential for those services. In its announcement, Humana states that its policy will mirror the CMS rule, "as applicable in the Federal Register and relevant CMS guidance." Like CMS, Humana also is requiring the modifier on all applicable claims submitted for services delivered beginning January 1, 2020.

    While the modifier system won't affect payment immediately, both CMS and Humana have stated that they intend to reimburse at 85% of the physician fee schedule for services delivered "in whole or part" by a PTA or OTA beginning in 2022.

    Recognizing that CMS was legally bound to establish a differential system, APTA fought initial drafts of the rule that were needlessly burdensome and seemed to ignore the realities of PT and PTA practice. The final rule included several modifications either suggested or supported by APTA, and the association continues to advocate for changes to the system.

    APTA will meet with Humana representatives to address the adoption of the modifiers and the payment differential and will work to limit the adoption of this policy by other payers.

    APTA offers a quick guide to using the PTA modifier and provides more resources on the differential at the APTA fee schedule webpage.

    APTA's Physical Therapy Outcomes Registry Again Receives QCDR Designation for MIPS Reporting, Adds New Measures

    APTA's Physical Therapy Outcomes Registry has been approved for the fourth year in a row by the U.S. Centers for Medicare and Medicaid Services as a qualified clinical data registry, or QCDR. This designation means that participating physical therapists can submit Merit-based Incentive Payment System — MIPS — reporting data to CMS directly from the registry. QCDR approval recognizes APTA's demonstrated expertise in quality measure development.

    The Physical Therapy Outcomes Registry supports 19 Quality Payment Program measures, 11 QCDR measures, and two electronic clinical quality measures. CMS requires that the electronic clinical quality measures must be reported using certified electronic health record technology, also known as CEHRT.

    As of January 2019, PTs who provide services under Medicare Part B who meet qualifying criteria must participate in either MIPS or an Advanced Alternative Payment Model (Advanced APM). PTs who participate in the Registry can meet MIPS requirements in both the Quality and Improvement Activities categories. Submitting data via a QCDR also earns "bonus" points in the Promoting Interoperability category, which is not yet required for PTs.

    Whether or not PTs participate in MIPS, according to Heather Smith, PT, MPH, APTA's director of quality, APTA’s registry is a valuable tool for optimizing patient outcomes.

    "Participants have found that registry data has opened their eyes to areas for improvement, and even informed changes to the way they deliver care," Smith said. "Registry analytics allow therapists to objectively understand how their practice patterns and interventions are impacting patient outcomes."

    Registry users can access nonproprietary outcomes measures supported by CMS, as well as specific measures shared from other QCDRs.

    By directly integrating with EHRs, the registry enables PTs — whether or not they participate in MIPS — to leverage their existing EHR data to track and benchmark outcomes, apply dashboard insights to improve quality of care, and demonstrate the value of physical therapist services to payers and providers. For more information about the Physical Therapy Outcomes Registry, visit www.ptoutcomes.com.

    Headed to the APTA Combined Sections Meeting in February? Visit the APTA Pavilion in the Exhibit Hall to learn more about how the registry can benefit your practice. Related education sessions include "Demonstrating Value: Using Clinical Data and Databases to Improve Outcomes for Patients and the Population" and "Through the Looking Glass: What Are the Emerging Payment and Quality Issues?"

    2020 Federal Advocacy Forum Coming March 29; Registration Open Through March 16

    While 2019 saw some real advocacy achievements for the physical therapy profession, the year also brought challenges to tackle in 2020 — not the least of which is the proposal by Medicare to cut reimbursement to physical therapy in 2021. And with APTA's fight against the cut already in motion, the 2020 Federal Advocacy Forum, set for March 29-31, couldn't come at a better time.

    Registration is now open for the annual event, which brings PTs, PTAs, and students together in Washington, DC, for a three-day conference that provides the latest on regulatory and legislative issues affecting the profession, and ends with an opportunity for attendees to apply what they've learned by making in-person visits to Senate and House offices. Registration deadline is March 16.

    The forum's keynote speaker will be Paul Begala, political analyst and commentator at CNN. An affiliated professor of public policy at Georgetown University, Begala served as counselor to President Bill Clinton.

    Begala's participation is in keeping with the forum's tradition of offering a variety of speakers with diverse perspectives. Past keynote speakers include political commentator Fred Barnes, FOX News host Tucker Carlson, and political strategist Donna Brazile.

    Other forum activities will include an evening reception and breakout sessions on advocacy-related topics.

    "The proposed 8% cut will be one of the issues the profession will share with their elected officials, and APTA will continue to educate Congress about the essential role that physical therapists play in the delivery of quality health care for patients of all ages across the country," said Michael Matlack, APTA's director of congressional affairs. "Now, more than ever, the voice of the physical therapy profession is critical to the health and well-being of our patients and our industry. "

    Want to get a feel for what the Federal Advocacy Forum is all about? Check out the video recap of the 2019 forum on the Federal Advocacy Forum webpage.

    NCCI Code Edits: Your Questions Answered

    Background: A surprise coding change issued by the Centers for Medicare and Medicaid Services (CMS) caused an uproar in the physical therapy community earlier in January, and for good reason: The new requirements state that CMS won't reimburse for certain activity and evaluation codes if they're used in the same day. APTA argues that accepted physical therapist practice often includes the startup of care on the same day as evaluation (and continued care on the same day as reevaluation), and that the prohibition runs counter to CMS' own aims for care.

    Reaction: Since the announcement, Capitol Bridge, LLC, CMS' National Correct Coding Initiative (NCCI) contractor, has been inundated with comments from PTs, PTAs, and other stakeholders slamming the decision and requesting that the change be reversed. And it's not too late to add your voice to the effort. APTA is communicating with representatives from Capitol Bridge, CMS, and the American Medical Association, which plays a significant role in coding development.

    Where things stand: As of the date of this report, no changes have been made. That leaves PTs and PTAs to deal with the current prohibition, as problematic as it may be.

    To help you navigate the system as it is, here are answers to some of the most common questions we've been receiving on the NCCI coding change.

    1. What are NCCI Procedure-to-Procedure (PTP) code pair edits?
    NCCI PTP edits are intended to prevent payment of services that should not be reported together. Each edit has a Column One and Column Two Health Care Common Procedure/Current Procedural Terminology (HCPCS/CPT) code, called a “pair.” If a provider reports the two codes of a pair for the same beneficiary on the same date of service, only the Column One code is eligible for payment; the Column Two code is denied unless a clinically appropriate NCCI-associated modifier is also reported.

    As for modifiers, each PTP edit has a modifier indicator, represented by (0), (1), and (9), that appears after the code number. Here's what those numbers mean:

    • 0 - There are no circumstances in which a modifier would be appropriate. The services represented by the code combination will not be paid separately.
    • 1 - A modifier is allowed in order to differentiate between the services provided. Assuming the modifier is used correctly and appropriately, this distinction provides the basis upon which separate payment for the services billed may be considered justifiable.
    • 9 – The deletion date of the code pair is the same as the effective date. In other words, these edits are no longer active, so the code combinations are billable, and no other modifier is needed.

    2. What happens if I bill 97530 (therapeutic activities) and 97161, 97162, or 97163 (physical therapy evaluations) together on same day for same patient?
    This is at the heart of the recent edit. Under the new rules, the use of both codes is prohibited, and there's no modifier that you can use to bypass the denial. That includes the 59 modifier/X modifier: You can't use the 59 modifier/X modifier when billing 97530 with 97161, 97162, or 97163 to bypass the edit.

    Bottom line: when 97530 and one of the physical therapy evaluation codes are billed together on the same day for the same patient, the evaluation code will be denied. This is because in the PTP edits list, 97530 is the Column One code and 97161, 97162, and 97163 are Column Two codes (see the answer to question 1 for more background on Column One and Column Two codes).

    3. Why is 97530 (therapeutic activities) in Column One and 97161-97163 (physical therapy evaluations) in Column 2?
    Good question. We believe this PTP edit is inconsistent with the general guidelines for PTP edits, and it's one of the reasons APTA and other stakeholders are working with CMS to have this edit removed as soon as possible.

    4. What happens if I bill 97150 (group therapy) and 97161, 97162, or 97163 (physical therapy evaluations) together on the same day for same patient?
    As with the therapeutic activities code covered in question 2, the answer is, you won't get reimbursed for the evaluation — and there is no modifier you can use to bypass the edit, including the 59 modifier/X modifier. This is because in the PTP edits list, 97150 is the Column One code and 97161, 97162, and 97163 are Column Two codes. Under the policy, when Column One and Column Two codes are billed, the Column One code is eligible for payment and the Column Two code is denied.

    5. Can I use the 59 modifier/X modifier to bypass the PTP edit for 97140 (manual therapy) and 97161-97163 (physical therapy evaluation codes)?
    Yes. It's possible to bypass the edit by using the 59 modifier/X modifier when billing 97140 with the physical therapy evaluation codes (97161, 97162, or 97163). If you don't use the modifier for this combination of codes, CMS will deny the manual therapy code. This is because in the PTP edits list, 97161-97163 is the Column One code and 97140 is the Column Two code. Under the policy, when Column One and Column Two codes are billed, the Column One code is eligible for payment and the Column Two code is denied — unless an appropriate modifier is used.

    6. Can I use the 59 modifier/X modifier to bypass the PTP edit for 97530 (therapeutic activities) and 97164 (physical therapy re-evaluation)?
    Yes, you are permitted to bill 97530 with 97164 if you use the 59 modifier/X modifier. If you do not bill with the appropriate modifier, then 97164 (Column Two code) will be denied. (See question 5).

    7. Can I use the 59 modifier/X modifier to bypass the PTP edit for 97150 (group therapy) and 97164 (physical therapy re-evaluation)?
    Yes, for the same reason explained in questions 5 and 6.

    8. Do PTP edits apply across disciplines?
    Unfortunately yes, when services are billed under the same provider number. For example, if the occupational therapist performs 97530 on the same day as the PT who bills an evaluation code, the evaluation code will be denied if the services of both providers are billed under the same provider number (as in institutional billing).

    9. What settings do PTP code pair edits apply to?
    The NCCI edits consist of two provider-type choices of PTP code pair edits: practitioners and hospitals.

    By "practitioners," CMS means that the NCCI edits apply to claims submitted by physicians, nonphysician practitioners, and ambulatory surgical centers. This includes PT private practitioners.

    The definition of "hospital," for purposes of this edit, extends to outpatient hospital services and other facility services including, but not limited to, therapy providers in Part B skilled nursing facilities, comprehensive outpatient rehabilitation facilities, outpatient physical therapy and speech-language pathology providers, and home health agencies for certain claims billed under Type of Bill (TOB) 22X, 23X, 75X, 74X, 34X.

    10. Do NCCI edits apply to all third-party payers?
    Yes and no. Technically, the NCCI edits only apply to Medicare fee-for-service, but the majority of commercial payers do use the NCCI edits in their systems, so there's a good chance you'll need to comply with the edits even if you aren't working with Medicare. Some workers compensation programs and self-insured plans may create their own edits.

    11. Are there other edits I should be aware of?
    Yes, there are many PTP edits for hospital and practitioner settings. The PTP edits are updated on a quarterly basis. To stay up to date, visit the CMS PTP Coding Edits page, scroll down to related links, and click on the appropriate setting link (Hospital PTP edit or Practitioner PTP edit) for the relevant time period.

    12. What happens next?
    APTA continues to pressure CMS to remove these edits. CMS has met with the NCCI contractor to discuss the edits and is working on a resolution. We hope to have additional information to share in the near future.

    Looking for additional information about NCCI edits? Visit the National Correct Coding Initiative Edits webpage or contact APTA at advocacy@apta.org.

    The Good Stuff: Members and the Profession in the Media, January 2020

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs, PTAs, and students are transforming health care and society every day. Enjoy!

    PT leadership for USA Gymnastics: Kim Kranz, PT, DscPT, has been named USA Gymnastics' first vice president of Athlete Health and Wellness. (Around the Rings)

    When resolutions become a pain: Ryan Balmes, PT, DPT, and Jessica Douglas, PT, MSPT, offer advice on how to take on that New Year's fitness resolution without getting hurt. (Boston Globe)

    Redskins score a key PT: Kevin Wilk, PT, DPT, FAPTA, is now the Washington Redskins' medical trainer. (Redskins Wire)

    The importance of the pelvic floor: Riana Taktikos, PT, DPT, explains the ways pelvic floor physical therapy can help conditions that many people think they just have to live with. (Warren, Ohio, Tribune-Chronicle)

    Home is where the gym is: David Reavy, PT, MBA, shares his favorite piece of home gym equipment. (Gear Patrol)

    Solving middle back pain: Tony D'Angelo, PT, outlines what's different about middle back pain, and provides tips on addressing it. (Shape)

    Balance in all things: Ben Fung, PT, DPT, MBA; and Kathleen Walworth, PT, DPT, stress the importance of good balance, and suggest ways to improve. (Vitacost.com)

    Flying with the Eagles: St. Francis University (Pennsylvania) physical therapy students helped members of the Philadelphia Eagles create adaptive ride-ons for kids with disabilities at a recent GoBabyGo event. (Altoona, Pennsylvania Mirror)

    The power of neurologic physical therapy: Ian Lonich, PT, DPT, is making a difference for patients in southwest Pennsylvania. (Uniontown, Pennsylvania Herald-Standard)

    Pillow talk: Karena Wu, PT, DPT, MS, discusses the advantages of body pillows. (Bustle)

    Goodbye, crunches: Bethanie Bayha, PT, DPT, provides insight on better core-strengthening exercises. (Self)

    Go ask pectoralis: Danielle Weis, PT, DPT, discusses ways to counter pectoralis muscle imbalances that cause neck pain. (Well and Good)

    The PT's role in responding to autism spectrum disorder: Anjana Bhat, PT, is leading the way helping children with ASD improve social skills and communication through physical therapy. (University of Delaware News)

    Speedbumps on the road to fitness: Todd Kruse, PT, MPT, shares insights on preventing injury while pursuing fitness resolutions. (KEYC12 News, Mankato, Minnesota)

    I'll be sore for Christmas: Anna Friedman, PT, says yes, Virginia, there is a "Santa strain." (KOMO News, Seattle)

    Delivering postpartum fitness: Carrie Pagliano, PT, DPT, unpacks the trend toward exercise programs for new mothers. (Wall Street Journal)

    GoBabyGo, Colorado style: Jessica Albers, PT; and Kristen Holman, PT, DPT, spearheaded a recent effort to retrofit children's vehicles to provide independence — and a lot of fun — for children with disabilities. (Coloradoan)

    There's no place like foam: Theresa Marko, PT, DPT, MS, discusses the advantages and uses of foam rollers. (Insider)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    We Have a Winner: ONE by ONE Member Recruitment Effort's Prizewinner List Continues to Grow

    Heather Prather, PT, DPT, says APTA membership gives her the information and peer connections she needs to thrive in her profession. And she must make a pretty compelling case, at least as far as new APTA member Erin Brannan, PTA, is concerned.

    Prather is the latest prize-drawing winner in APTA's ONE by ONE membership campaign, a project that encourages members to recruit their fellow PTs, PTAs, and physical therapy students — in Prather's case, it was Erin Bannan — to join APTA. Every member who refers a new or returning member is entered into a monthly drawing for a free year of APTA membership. In December, Prather's name was drawn. Both Prather and Brannon are from New Mexico.

    "I renewed my APTA membership, as I enjoy having access to the clinical tool box for quick access to different outcome measures and appropriate exercises and protocols to utilize based on diagnosis," Prather said. “I enjoy receiving the PT in Motion magazine and reading about up-to-date topics and what’s happening in the physical therapy world. The community boards are helpful to see what is being discussed, or as a lifeline to ask fellow members their advice or suggestions from their experiences on certain topics. It is great to be a member of APTA, to show support and that we are proud of our profession."

    The ONE by ONE campaign also holds a monthly prize drawing for new or renewing members referred through the campaign, awarding winners a subscription to APTA's Passport to Learning continuing education access system. The most recent winner was Steve Baron, PT, DPT, a new member from Pennsylvania. Baron was recruited by Matthew Will, PT, DPT, also from Pennsylvania.

    ONE by ONE offers additional opportunities to win, including a prize for the participating section that experiences the largest year-over-year growth rate during the campaign, and the chance to win one of five iPads that will be given away in a drawing of members who recruit five or more new members by the end of the campaign.

    Details on the recruitment effort — and a list of past prize winners — can be found on the ONE by ONE webpage, including a toolkit that gives you everything you need to join the campaign. ONE by ONE runs through September 30, 2020.