Private Insurance

For additional assistance with payment and reimbursement issues, contact APTA's Payment Policy & Advocacy department at 800/999-2782, ext. 8511 or advocacy@apta.org.

• Major Insurers
• ERISA Claims Procedures
• Silent Preferred Provider Organizations (PPO)
• Video: Managed Care Contracting Toolkit
• Managed Care Contracting Toolkit (.pdf)

Articles

• Third-party Payers: Strategies for Private Practice PTs

  PT Magazine - April 2009

Payment

• Adoption of Multiple Procedure Payment Reduction (MPPR) by Nonfederal Payers
• Health Care Reform: Expansion of Coverage
• Payment by Treatment Setting
• Payment Methodologies: Advantages vs. Disadvantages for Practice
• Prompt-Payment Laws Are Being Undermined
• Retroactive Claim Denials and Adjustments
• FAQ: First-party Payment/Cash-based Business
• FAQ: Medicare Payment

Articles

• Responding to Cost Shifts

  PT Magazine - May 2009

Podcasts

• Effective Patient Advocacy – Reducing Copayments in New Jersey - 9/21/11

Insurance Plan Design

• Defining Medically Necessary Physical Therapy Services
• Insurance Plan Design Model

Articles

• A Model Plan

  Perspectives Magazine - September 2012

Podcasts

• Physical Therapy Model Benefit Plan Design: From Position to Practice, Part 2 - 6/1/12
• Physical Therapy Model Benefit Plan Design: From Position to Practice, Part 1 - 5/31/12
• Physical Therapy Model Benefit Plan Design - 1/9/12
• Defining Medically Necessary Physical Therapy Services - 11/18/11

Audits, Denials & Appeals

• Appeal Letter Outline (.pdf)
• FAQ: Audits
• FAQ: Claim Denials

• Last Updated: 1/16/2014
• Contact: advocacy@apta.org
• = Members Only