Join/Renew
Find a PT
APTA Communities
Related Organizations
Store
Login
|
Profile

Prospective Students
Current Students
New Professionals
PTAs
Educators

About Us
- Membership & Benefits
  Vision, Mission, Strategic Plan
  Policies & Bylaws
  Leadership & Governance
  Chapters & Sections
  Councils
  Honors & Awards Program
  APTA Staff
  Jobs at APTA
  Partnerships
  Who We Are & What We Do
  APTA represents more than 100,000 members: physical therapists, physical therapist assistants, and students of physical therapy.
  Other Popular Resources:
  - Contact Us
  - Member Directory
  - Annual Reports
Careers & Education
- Find Jobs
  Courses & Conferences
  About PT/PTA Careers
  Career Management
  Career Development
  For Educators
  The APTA Learning Center is your starting point for personalized learning.
  Other Popular Resources:
  - Search for Courses
  - Events Calendar
Practice & Patient Care
- Patient Care
  Practice Administration
  Evidence & Research
  Licensure
  Scope of Practice
  Ethics & Professionalism
  Legal Matters
  PR & Marketing
  PTNow helps you put evidence into patient care.
  Other Popular Resources:
  - ArticleSearch at PTNow
  - Rehab Reference Center at PTNow
  - Patient Handouts
Payment
- Coding & Billing
  Value-Based Care
  Private Insurance
  Medicare
  Medicaid
  Workers' Compensation
  VA & TRICARE
  Info for Payers
  Prepare for MIPS in 2019
  Other Popular Resources:
  - Medicare Changes
  - New Evaluation Codes
  - MPPR/fee calculator - calculate payment for each CPT code based on geographic location
Advocacy
- Federal Advocacy
  State Advocacy
  Take Action
  Involvement Opportunities
  PT-PAC
  For Legislators
  Take action in seconds with the APTA Action app!
  Other Popular Resources:
  - Federal Advocacy Forum
  - State Forum
News & Publications
- Latest News
  PTJ
  PT in Motion
  Guide to PT Practice
  Blogs
  Podcasts
  Social Media
  Other Publications
  For Media
  Subscribe to Friday Focus.
  Other Popular Resources:
  - PT in Motion News
  - Go Green
  - Subscriptions
For the Public
Prospective Students
Current Students
New Professionals
PTAs
Educators
Join/Renew
Find a PT
APTA Communities
Related Organizations
Store
Login
Profile

Bg Carusel

Bg Carusel

Payment
Coding & Billing
Value-Based Care
Private Insurance
- Utilization Management and Utlization Review
Medicare
Medicaid
Workers' Compensation
VA & TRICARE
Info for Payers

Home
Payment
Commercial Insurance

Commercial Insurance

Coding & Billing
Value-Based Care
Private Insurance
- Utilization Management and Utlization Review
Medicare
Medicaid
Workers' Compensation
VA & TRICARE
Info for Payers

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

Compliance Matters: Creating a Written Portrait
"Documenting value-based care" simply means painting a clear picture of the good things you're doing as a PT. (PT in Motion, October 2018)
Compliance Matters: The Keys to Effective Documentation
"Be thorough and try to think like a payer." PT in Motion Magazine (PT in Motion, August 2016)
Third-party Payers: Strategies for Private Practice PTs
Private practices have a variety of choices when it comes to contracting with third party payers. What do private practice physical therapists need to know? (PT Magazine - April 2009)

Payment

Adoption of Multiple Procedure Payment Reduction (MPPR) by Nonfederal Payers
Health Care Reform: Expansion of Coverage
Rehabilitation Versus Habilitation: Modifiers 96 and 97 Replace Modifier SZ
Payment by Treatment Setting
Payment Methodologies: Advantages vs. Disadvantages for Practice
Prompt-Payment Laws Are Being Undermined
Retroactive Claim Denials and Adjustments
Third-Party Administrators (TPA): Utilization Management & Utilization Review
Working With Employers Toward Population Health

Articles

Compliance Matters: The Keys to Effective Documentation
PT in Motion Magazine (August 2016)
Third-Party Payers: Strategies for Private Practice PTs
PT Magazine (April 2009)
Responding to Cost Shifts
PT Magazine - May 2009

Podcasts

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

Related Resources

Cash Practice: Considerations for Physical Therapists
FAQ: Medicare Payment

Insurance Plan Design

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

FAQ: Audits
FAQ: Claim Denials

APTA Template Letters: Appeals

Appeal for 59 Modifier (.doc)
Appeal for Medical Necessity (.doc)
APTA Member Appeal Template Letter (.doc)
Denial of PTA Services Template Letter (.doc)
Request for Insurance Policy to Cover PTA Services Template Letter (.doc)

Last Updated: 11/20/2018
Contact: advocacy@apta.org
= Members Only

print
Email
Facebook
Twitter
LinkedIn
More OptionsShare

ADVERTISEMENT

ADVERTISEMENT

About Us

Membership & Benefits
Vision & Strategic Plan
Policies & Bylaws
Leadership & Governance
Chapters & Sections
Honors & Awards Program
APTA Staff
Jobs at APTA
Strategic Business Partners

Careers & Education

Find Jobs
Courses & Conferences
About PT/PTA Careers
Career Management
Career Development
For Educators

Practice & Patient Care

Patient Care
Practice Administration
Evidence & Research
Licensure
Scope of Practice
Ethics & Professionalism
Legal Matters
PR & Marketing

Payment

Coding & Billing
Private Insurance
Medicare
Medicaid
Workers' Compensation
Tricare & VA
Payment Reform
Info for Payers

Advocacy

Federal Advocacy
State Advocacy
Take Action
Involvement Opportunities
PT-PAC
For Legislators

News & Publications

Latest News
PTJ (Journal)
PT in Motion
Guide to PT Practice
Blogs
Podcasts
Social Media
Other Publications
For Media

American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782)
800/999-2782
703/684-7343 (fax)

Contact Us
For Advertisers & Exhibitors
For Media
Follow APTA

All contents © 2019 American Physical Therapy Association. All Rights Reserved.

Use of this and other APTA websites constitutes acceptance of our Terms & Conditions | Privacy Policy | Disclaimer