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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.]

    CSM Delivers: Payment

    You can be on the cutting edge when it comes to the latest research in physical therapy, you can have a deep understanding of the technologies available to enhance patient care, and you can be an expert on tests and measures, but at the end of the day, you have to get paid. And to do that, you must stay on top of a payment landscape that's changing rapidly—and dramatically.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, offers multiple sessions all at 1 meeting that help clarify the sometimes-baffling ins and outs of payment, particularly around the Medicare and Medicaid systems. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Emerging Issues in Medicare: Payment Updates and Hot Topics
    Medicare laws, rules, and policies are constantly changing and vary depending on the settings in which physical therapists (PTs) and physical therapist assistants (PTAs) practice. This session will explore the latest developments related to fee schedule payments, prospective payment systems, and payment reform. Find out how you can adapt your practice to keep pace with the changing laws and regulations. Friday, January 25, 8:00 am–10:00 am.

    Emerging Issues in Medicare: Quality Programs and Alternative Payment Models
    PTs and PTAs are facing some of the most comprehensive changes to payment in years, thanks to new quality programs—most prominently the Merit-based Incentive Payment System (MIPS)—and alternative payment models under Medicare. Get up to speed on the shifts that come with implementing comprehensive health care reform legislation; alternative payment models; quality reporting programs, including MIPS; and more. Will there be challenges? Yes. But there are also opportunities worth exploring. Friday, January 25, 11:00 am–1:00 pm.

    The Real World: How Therapists Can Thrive in Value-Based Care
    The transition from fee-for-service to value-based payment is upon us, and this new payment model is here to stay. How do therapists, while still being paid fee-for-service, prepare for a successful shift and show that they are ready for value-based care? Presenters at this session will crack the code to success in value-based care with real-life case studies demonstrating what innovative practices are doing to achieve success in value-based payment arrangements today and capitalize on the opportunities of the future. They'll also review the steps PTs should take now to research, prepare for, and realize the opportunities available to them under value-based care arrangements. Saturday, January 29, 11:00 am–1:00 pm.

    A Little Bit of This and a Little Bit of That: Billing and Payment in 2019
    Multiple billing and payment policies work in combination to affect your bottom line, but do you understand how they all fit together? This session looks at payment's component parts: how the monetary value of a CPT code is determined, the payment rates for the most common CPT codes billed under a physical therapy plan of care, elements of the multiple procedure payment reduction policy, the 2019 therapy dollar threshold and use of the KX modifier, and more. Also on the agenda: a discussion of Medicare's "8 minute rule" and the American Medical Association's definition of "substantial," and how they relate to billing determinations for individual visits. Thursday, January 24, 11:00 am–1:00 pm.

    Register for CSM by midnight ET on Wednesday, December 5 to grab advanced discounts and your chance to win 1 of 2 $500 in VISA gift cards. 

    APTA Members: AMA Seeks Critical Input on New CPT Code Values

    APTA members are being alerted to be on the lookout for 2 important surveys that APTA will disseminate for the American Medical Association (AMA) that will help to shape values for new current procedural terminology (CPT®) codes.

    In the coming days, a random sampling of members will receive 1 of 2 surveys that focus on new CPT codes related to either dry needling or wound care. The surveys are designed to determine the “professional work” value and time involved in the physical therapist’s provision of the services identified by each of these codes.

    "Professional work value" includes the mental effort and judgment, technical skill, and psychological stress involved in providing the service.
    APTA will submit the survey data to AMA’s Relative Value Scale Update Committee (RUC), a multispecialty committee whose purpose is to develop values for CPT codes based in part on survey data such as this. The RUC will make a recommendation to CMS for the professional work value of these newly developed codes.

    If you receive an email requesting your participation in the survey: It is critically important to take the time to complete it. Your responses will be anonymous.

    To learn more about the RUC survey process, check out this AMA video.