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Commercial Insurance

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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
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