Skip to main content

If you've crossed paths with prior authorization and other utilization management systems, you know that they're practically the definition of "administrative burden" — hours-long telephone waits that lead to dead ends, repeated jumps through hoops for incremental approvals, frustrating delays in authorizations that impede care, and more.

For the sake of the patients we serve, the physical therapy profession needs to push back, both in terms of providing needed care right now and paving the way for systemic change in the future. APTA and the Private Practice Section offer a unique collection of resources to help you do just that.

Now available as an APTA member benefit: a suite of payment advocacy tools to help PTs address the overuse of prior authorization and utilization management. APTA and PPS collaborated to curate the collection, housed on the PPS website, as part of a joint initiative known as the State Payer Advocacy Resource Center, or SPARC.

The extensive list of resources includes both big-picture and nuts-and-bolts offerings, including a history of UM, basic definitions, and an infographic on the need to fix prior authorization, as well as a wide range of template letters to help PTs do everything from fighting a denial to advocating change to lawmakers. The resources even include template letters for patients to use.

In a joint letter announcing the launch of SPARC, APTA President Roger Herr, PT, MPA, and PPS President Mike Horsfield, PT, MBA, assert that  "converging trends" that include an ongoing opioid crisis, the rise of long- COVD, and pandemic-related delays in care for other conditions make it especially important to address systems that hinder care. "Now is not the time for unreasonable administrative burden to limit patient access to high-value physical therapist services," they write.

 


You Might Also Like...

News

APTA-Supported Bill Aims to Eliminate a Medicare Plan of Care Burden

Feb 8, 2024

Bipartisan legislation introduced in the House would relieve PTs from having to pursue signed plans of care from referring physicians.

News

Aetna Update: Telehealth Payment Change Doesn't Apply to Commercial Plans

Jan 23, 2024

The insurer says only employer-sponsored plans are affected by its late 2023 decision to stop payment on telehealth-related codes.

Perspective

Out-of-Network Medicare Advantage Payments: Know What You’re Owed

Jan 17, 2024

Will you be paid less for your services under Medicare Advantage if you're an out-of-network provider?