Details from the PTA Caucus at APTA House of Delegates

The 47 PTA Caucus representatives and five PTA Caucus delegates attending the meetings divided into small groups to discuss issues and opportunities in communication, education, practice, advocacy and strategy, areas identified by the 2010 PTA Caucus as requiring further discussion and planning.

The delegate summary of 2010-2011 activities included use of the data collected from the Representatives Survey at the 2010 House of Delegates to update and prioritize PTA Caucus goals and objectives; and to facilitate the development of two new task forces within the PTA Caucus – Communication and Education. The Delegates also reviewed the Federation of State Boards of PT’s revised model practice act and monitored payment concerns, especially the situation with Kansas BC/BS; and developed RC 13-11 as a result of this activity.

Motions to the 2011 House were also discussed, including motion content and possible ramifications of passing/failing each motion of concern, especially in regards to those motions of greatest importance to the work and career of the PTA – RC 3-11, RCs 4-11 through 12-11, RC 13-11, and RC 14-11. Additionally, potential actions that could be taken on the floor of the House were described.

During the HOD, extensive discussion was heard relative to RC 3-11 that proposed expanding the current model of service delivery (ie, PT, PTA, PT aide/tech) to include other support personnel with the requisite training to provide physical therapy interventions under the direction and supervision of the physical therapist. This motion passed with a proviso delaying the effective date of the position to July 1, 2012. Prior to discussion of RC 4-11 the house adopted a motion referring RC 4-11 through 12-11 to the APTA Board of Directors with instruction to conduct a thorough investigation into possible service delivery models and their impact on the profession and patient/client care and called for the review of PTA education with any models of service delivery and the necessary changes in position(s) associated with them to be presented to the 2012 House. RC 13-11 that addressed payment was withdrawn by the PTA Caucus. RC 14-11 that addressed PTA student supervision was passed allowing PTAs to provide clinical supervision to PTA students with general supervision by the physical therapist. A summary of House actions written by APTA’s Secretary may be found on the House Community.

The following individuals were elected to leadership positions in the PTA Caucus and installed to begin their terms at the close of the 2011 House of Delegates: Carrie Perkins (AZ), delegate; Paul Purdue (WA), delegate; Niki Wallen (MO), alternate delegate; and Christina Wilson (AL), Nominating Committee.

The following individuals were acknowledged for completion of their terms: Carrie Perkins (AZ), delegate; Deb Bornmann (TX), delegate; Luis Williams (CA), alternate delegate; and Brenda Norton (SD), Chair, Nominating Committee.

PPSIG Provides Help With Complex and Evolving Billing Practices

If you are a PT in private practice, you are probably following what is happening with our profession on the national level. But are you up-to-speed – do you have the latest scoop – on the changes and happenings in Washington that affect your clinic?  For instance, do you know…

  • Which third party payers will now pay for physical therapy services provided under locum tenens arrangements (locum tenens are therapists who cover for PTs who are away from the clinic for vacations, medical leaves, CE, etc.)?  Do you know how to bill for these services?  Do you use a modifier? Are there limits on the amount of time you can use a locum tenens provider?   Does L&I or Medicare allow PTs to bill for locum tenens services?
  • About the recent change in Washington law to require health insurers that provide coverage for prescribed DME and mobility enhancing equipment to include the sales tax or calculated use tax in their payment to providers?  Do you know how to calculate and bill the health plan for the tax? Do you invoice with a separate line item and what HCPCS code do you use? Who is responsible for remitting the tax to the state?
  • That some MedAdvantage plans require specific documentation if you bill for services above the $1,870 cap on outpatient physical therapy? Do you know which plans require what documentation?
  • That class action litigation has been filed in Washington on behalf of medical providers, including private practice PTs, against specific MVA carriers for automatically applying “UCR/geographic reductions” to providers’ billings in PIP claims using Ingenix as the basis for the reductions? Do you know how to keep current on the progress of this class action litigation?
  • How to fight back when third party payers, such as MVA carriers and workers’ compensation third party administrators, apply a discount to your billings based on a PPO contract that you previously terminated or never even had?

Members of the PTWA Private Practice Special Interest Group (PPSIG) know the answers because PPSIG has the resources to keep its members informed. PPSIG takes the lead to solve problems and make changes to benefit our private practice members. We successfully took on the locum tenens issue and we’re now fighting on behalf of our members to stop unauthorized and improper PPO discounting. Our executive director, Diana Godwin, is an attorney who has spent the last 25 years representing private practice physical therapy clinics and she is available to help individual PPSIG members.

You can share in these benefits by becoming a member of PPSIG. Just go to our website,, and click on the “Renew Your Membership” tab in the left hand column. That will take you the application to join. Since we are half way through our membership year, we are offering new membership at just $150 for the principal member of the practice and $75 for associate members. Join today!

Shannon O’Kelley, PT
PTWA Private Practice Special Interest Group Chair

Consider Cultural Competency In Your Practice Setting

PTWA’s Cultural Competency Task Force invites you to consider how you might apply cultural competency to your practice. The task force’s mission is to heighten practitioners’ awareness of what cultural competency means in the workplace and community, and to facilitate and promote cultural diversity within the physical therapy profession.

What does cultural competence mean to you?

As you think about this, I thought it might be helpful for you to know the ethnic makeup of our state. According to the 2010 Census, there are more than 6.7 million residents in Washington, up 14 percent since 2000. King County is the largest county with a population of almost 2 million and Mason County the smallest with a population of about 61,000. According to the census, Washington is predominantly white with about 11 percent Hispanic or Latino, 7 percent Asian or Pacific Islander, 4 percent black, 2 percent American or Alaskan Indian Native and 3 percent mixed. While 69 percent white, 15 percent of King County’s population is Asian. Mason County is 86 percent white with an 8 percent Hispanic/Latino population.

Given this demographic information, can you think of ways to promote the cultural competency of the physical therapy profession in your community? And have you considered how gay, lesbian, bisexuals and transgender people fit into the concept of cultural competence? Think about how you can improve your awareness of cultural competency both in the workplace and in the community.  We would love to hear any suggestions or ideas on the above facts.

Robert Cheng, PT, DPT, OCS, COMT
Chair, PTWA Cultural Competence Task Force

To share your thoughts and ideas with the task force contact Robert Cheng.

Adjustment of Therapy Claims Subject to 2010 Medicare Physician Fee Schedule Changes

This update is from the Centers for Medicare & Medicaid Services’ June 28 CMS Medicare FFS Provider e-News:

On Tuesday, March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law became effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to Friday, January 1, 2010.

Because of the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare Fee-For-Service claims are being reprocessed. We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume and each individual Medicare claims administration contractor.

We have previously advised providers that, in the majority of cases, they will not have to request adjustments because Medicare claims administration contractors will automatically reprocess claims, and that remains the case. However, there have been situations where the original claim for a service subject to the therapy cap as per Internet Only Manual 100-04, Chapter 5, Section 10.2 was processed without a KX modifier, presumably because the beneficiary had not yet reached the therapy cap and, therefore, no KX modifier was necessary. When processing adjustments for such claims, Medicare contractors have found that the therapy cap was often subsequently reached, causing the adjustment claim to reject, and in some cases for the original claim to be subject to over-payment recovery.

To prevent this, contractors will not be automatically processing Affordable Care Act adjustments on claims for services subject to the therapy cap. If you performed services subject to the therapy cap between Friday, January 1 and Monday, May 31, 2010, and if you believe you are entitled to an additional payment as a result of the change to the fee schedule in that year, then you will need to request that your Medicare contractor reopen those claims to receive the adjustment. When doing so, you should also indicate which of those services would have been subject to the KX modifier if the therapy cap had been reached when the original claim was processed. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, CMS believes that these circumstances  fall under the “good cause” criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11. CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.

In some cases the Medicare contractor may generate an adjustment claim without the provider requesting it and either return it to the provider (RTP) or deny it. If you receive such a notice, believe you are entitled to an adjustment, and want to pursue the matter, you should contact the Medicare contractor and request it be reopened. You should also indicate whether the service would have qualified for the KX modifier.

The Centers for Medicare and Medicaid Services wants to remind physicians, practitioners and other providers impacted by the retroactive increases in payment rates by the Affordable Care Act and the 2010 MPFS changes of the Office of Inspector General policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations. The policy may be found here.

Please contact your Medicare claims administration contractor with any questions about this information.