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  • APTA Opposes UnitedHealthcare's Plan to Use Functional Reporting Requirements

    APTA is urging that UnitedHealthcare (UHC) stop its plan to implement Medicare outpatient therapy functional reporting code requirements in its Medicare Advantage plans.

    UHC announced its decision to implement functional limitation reporting in their May bulletin (.pdf, p.46). The company plans to require G-codes and severity/complexity modifiers on contracted physical therapist (PT) claims with dates of service on or after August 1, 2014. Claims that do not include the appropriate G-code and modifiers will be rejected.

    In its letter to UHC, APTA argues that the difficulties experienced by PTs during Medicare's changeover to the requirements, as well as limitations in data, make UHC's planned August 1 move ill-advised.

    APTA has its own functional limitation reporting webpage that provides resources to help members meet this reporting requirement.


    • Now this is what APTA should be doing. We should resist these ridiculous codes at all times. We are being set up. If a patient comes to PT with a 19% impairment (what the hell is that? They complete PT with a 1% impairment (seriously?) so they start and end with a CI modifier. That means they did not improve. So, by extension, PT was not necessary. BTW is anyone ever 0% impaired? These codes are a farce and we should resist ALL efforts to implement them.

      Posted by Rob Jordan on 7/22/2014 9:50 PM

    • Yes, I agree. The G codes do not provide accurate nor enough choices to describe many of my patients. We frequently treat two or three issues at a time thereby meeting the needs of the "whole patient". The codes do not allow for relapses (as with MS) or additional injuries without looking like PT has failed. I agree with Rob that this reporting system feels like a "set up".

      Posted by Linda A. on 7/25/2014 4:20 PM

    • I could not agree more Rob. What is happening across the broad is a farce. So when UHC says screw the APTA, what is the APTA going to do to push up against it? Is the APTA going to let them steamroll right over us or are they going to push back like IPT CA has done who are doing a great job at pushing back at insurance companies. The CPTA does nothing for us in California. The APTA could learn a ton from those Men and Women at IPT CA, and how to bring things back to fairness.

      Posted by Fred on 7/25/2014 5:36 PM

    • These are terrible times for therapists! G code requirements are almost as absurd as requiring MDs,APRN's, and PA's to sign off on a Physical Therapy plan of care!! These regs are designed to undermine our profession and keep us subserviant to medical doctors!

      Posted by lisa dransfield on 7/25/2014 6:08 PM

    • Yes the 20% increments are not good. Yes the measures are complicated to implement (I still have claims that nerd payment fro early on as FLR codes ended on page 2 of claim) and Yes the standards for making determinations of impairment level is arbitrary and ripe for abuse, but this is clearly the future and we need to be ahead of it. I have bashed and criticized the APTA for many things over the years; I know applaud their effort to get Medicare to see some sense and make a useful, practical and meaningful Functional Reporting Measure process in anticipation for the Pay for Performance programs that are around the corner.

      Posted by Jonathan Holtz on 7/25/2014 7:05 PM

    • I really hope that APTA will do everything to get this to stop. Even though direct access is effective the insurance companies have total control . FLR for Medicare has already taken away significant treatment time from the beneficiaries. There is no set of standard tests so the FLR is not consistent with the real outcomes. We find so many times that the patients don't understand these questions and why they have to fill out these forms . Instead of making it convenient for them FLR has added more papers to fill and strain their eyes!!!!

      Posted by Dimple on 7/25/2014 7:19 PM

    • All of this is a set-up for the government to continue the push for socialized medicine.....they don't want independent thinkers....they only want compliant workers who do as they are told so they are more able to easily control the healthcare environment.

      Posted by Jason on 7/25/2014 7:23 PM

    • I could not disagree with you more Jonathan. If this is the future you desire Jonathan, more power to you. However, there are some of us professionals that don't want our futures dedicated by the APTA, the CPTA, Insurance Carriers and the occasional foolish State or Federal Regulation. Before you know it, you'll be working for personal trainers and massage therapists because there will be nothing left of any value to the national population to want anything a PT has to offer. Thank goodness we got out of all the networks, are cash based and all I have to do is get rid of Medicare when the APTA gets off their butts and gets the OPT OUT provision in place to legally do so. To our Clinic it is not worth the trauma, hassle etc. to play ball with any insurance company because they are ripping us off of our own profession.

      Posted by Fred on 7/25/2014 8:09 PM

    • Now I know how teachers feel when they say they are reduced to training kids to take a test vs actually teaching their students. Here is a thought- why shouldn't we be able to charge separately to administer these tests/compile the data? It costs us our time, takes actual treatment time away from our patients, and in my opinion is detrimental to the long term PT outcome as we start to worry more on getting a CK to a CI vs getting our patient's functionality improved. If the insurance companies actually incurred an expense for adding to our workload and taking us from actually treating patients they would think long and hard before dumping a boatload of extra work on us. It is kind of like a patient who exhausts their insurance and has to go self-pay. Incurring an expense makes you really think if you need something or not

      Posted by Charlie on 7/26/2014 8:59 AM

    • I have to go with Fred here. The point he hit on is one the main reasons I closed my 33 year old practice. If Medicare and insurance companies think I am not worth more than 13 cents on the dollar then it is time to move on. It is bad when you were glad to see an attorney acct over a w/c or private insurance acct.. and you really didn't mind being interrupted to go out and see a home health patient. In 30 years I asked the APTA for assistance 4 or 5 times and I am still waiting for some help. So after 30 years of being a member I pass! And I do not expect this issue to be any different.

      Posted by Jerry W on 7/26/2014 1:09 PM

    • I'm sorry to hear Jerry that you closed your practice and hope that it closed where you were in a financially favorable position after all your years of hard work. Honestly, I don't have much faith in the APTA or our California CPTA. They have proven time and time again how lame their decisions are. In California, we have a terrible Direct Access Deal that went into effect this year, all because of the CPTA, APTA, and the CPTA's lobbyist. It opened the flood gates to 15 other professionals also owning physical therapy clinics. They all placed us under the bus in private practice and we have the tire tracks to prove it. The only good group was IPT who fought hard for private practice folks and continues to do so on payment issues and the additional burden of paperwork etc. I would agree Jerry that it will not change in these Associations.

      Posted by Fred on 7/29/2014 3:32 PM

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