Spring 2017 Conference
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Alaska Chapter of the APTA, Spring 2017 Conference
Title: Physical Therapy Payment and Compliance 2017 Update
May 6, 2017
8:00 am – 5:00 pm
Providence Alaska Medical Center
East and West Auditorium (Basement Level, Near the Cafeteria)
3200 Providence Drive
Anchorage, AK 99508
Registration – 7:30 am
Session – 8:00 am–12:00 pm
Lunch – 12:00 pm–1:00 pm
Session – 1:00 pm–5:00 pm
“The more things change the more they stay the same”, this phrase very well describes the environment that administrators and clinicians find themselves in when considering payment policy, regulation and compliance pertaining to the delivery of physical therapy services in all OP setting’s. The important elements involved in current policy and regulations, that all OP practice environments need to understand and implement appropriately, changes constantly, yet the underlying definitions and requirements of the benefit under the Medicare program basically remain the same. In light of all the payment reform efforts and changing service delivery models, it is always good to assure that compliance with these policies and regulations is up to date and a reflection of the most current interpretation and implementation. This presentation is made up of lecture/ practice management scenarios, audience participation for discussion and Q/A, on topics to include payment policy, regulation and compliance issues related to the current billing and payment environment. Clinical scenarios are used often in the context for how to best report the clinical service to a third party to support medical necessity, as well as best reflect the clinician’s clinical decision making.
Who Should Attend
Physical Therapists, Physical Therapist Assistants, Occupational Therapists, Certified Occupational Therapy Assistants, Speech-Language Pathologists, Front Office Administrators, Practice Managers, and Billers
.8 CEU’s Offered
Course: Learner Objectives/References
This session will present information on the various payment policies, reporting requirements and administrative processes necessary for the OP Therapy practice to understand and implement in order to be an efficient, effective and compliant Medicare Part B provider.
The content will be provided in an organized manner to facilitate practice and payment in a sometimes challenging environment. The course content begins with an overview of the environment in terms of the what, where and how of therapy utilization, review and policy. The course also includes specific information regarding Medicare requirements related to documentation, coding and billing in the OP setting, discussion of various tools to facilitate better collections of cash from certain patient populations, and updates on the audit environment. There will be ample time for interaction with the speaker and others in attendance, with several Q&A sessions throughout the one-day presentation. The afternoon will close with a moderated panel of chapter representatives familiar with state payment and policy issues.
- Payment Policy: Medicare Fee Schedule Update (Therapy Cap, Manual Medical review, CPT/ICD-10/FLR review and updates) and any impacts on Commercial or other payers
- Coding: ICD-10 lessons learned, CPT Coding including new evaluation codes and review/updates on other coding issues (interventions, Functional Limitation reporting, Quality Reporting)
- Medicare and the Cash-pay patient: Use of Advanced Beneficiary Notice (ABN), Decisions related to Medicare enrollment
Provider audits and assuring effective response
- Be able to describe current issues in the Federal legislative and regulatory arena and their impact on delivery, documentation, and payment for rehabilitation in 2017 and beyond
- Learn and be able to apply the most updated Medicare documentation requirements as well as other Medicare compliance issues and any implications to other commercial third party policy
- Learn and be able to properly report the new PT eval and re-eval CPT codes and identify other challenging areas in coding of clinical services (documentation of time, medical necessity)
- Be able to describe the basic construct of and resources for effective reporting of ICD-10 codes for OP rehabilitation services
- Understand the opportunity for cash based programs involving your Medicare population
- Understand the most significant risk areas for audits, specific to private practice and OP rehabilitation and how to best address through documentation both clinically and administratively
Program Content References
- AMA CPT 2017
- Coding and Payment Guide for the Physical Therapist, OptumHealth/APTA , 2017
- Functional Outcomes, Documentation for Rehabilitation, Quinn/Gordon, Saunders 2003-third edition, 2016
- ICD-10-CM, 2017
- International Classification of Functioning, Disability and Health, WHO, Geneva, 2001:
- Rehab related CMS transmittals and Policy Manuals: http://www.CMS.hhs.gov/therapyservices/
- APTA Practice Guidelines and Payment Policy and Advocacy resources: www.APTA.org
Helene Fearon has over 24 years of experience consulting in the area of physical therapy coding, billing, documentation and compliance. Her experience includes 12 years as a partner in Fearon & Levine, a national consulting firm focusing on practice management and payment policy in the outpatient rehabilitation setting. She is co-owner of Fearon Physical Therapy and President of Physical Therapy Provider Network (PTPN) of Arizona. Helene shares her expertise through consulting in the areas of reporting of clinical services through the lens of the diagnosis, evaluations and interventions as well as fiscal management and health policy development as it relates to rehabilitation services. Since 1993, she has been intimately involved in the process of developing, and revising CPT code nomenclature primarily used in the description of services provided by healthcare professionals in the area of physical medicine and rehabilitation. In this role she frequently is called upon for her expertise in development of payment policy and training materials utilizing these CPT codes.
Helene served 8 years on the AMA’s CPT editorial panel and continues to be the APTA appointee to the CPT process and represents physical therapists in those AMA CPT discussions. She also served as a governor appointee to the State of Arizona’s Board of Physical Therapy Licensure for 8 years, and served as president of this regulatory board from 2003 – 2007. The APTA named Ms. Fearon a Fellow of the APTA in June 2012.