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WELCOME!2009 KPTA Town Meeting Kansas Physical Therapy Association Topeka, Kansas 66603 785-233-5400 Fax: 785-290-0476 Email: email@example.com www.kpta.com
AGENDA • APTA Branding Campaign • Payment/Reimbursement Update: Local & National Issues • APTA Code of Ethics Update • 2010 KPTA Legislative Plan Update • KPTA Website Update 2
2009 TOWN HALL MEETINGS • Pittsburg at Mt. Carmel Medical Center - Oct. 13 • K.C. at Shawnee Mission Medical Center - Oct. 19 • Manhattan at Mercy Regional Health Center - Oct. 22 • Wichita at Via Christi - St. Francis Campus - Oct. 29 • Topeka at Washburn University - Nov. 2 • K.C. at Olathe Medical Center - Nov. 3 • Great Bend at Advance Therapy & Sports Med. - Nov. 3 • Salina at Comcare - Nov. 5 • Colby at Colby Community College - Nov. 5 • SW Kansas via Webconference - Nov. 5 3
American Physical Therapy Association The Physical Therapy Brand Learn It. Live It. Share it. Wear it.
Brand Fundamentals Brands define expectation Brands live everywhere Brands are hard to create Brands are easy to destroy Brands can be influenced Brands are not fully controlled
A good brand evokes emotion. Good brands connect on a subconscious level.
A good brand is relevant. • It makes a connection. • It stimulates opinions. • A good brand is consistent. • A good brand is strategic.
Evaluation of the Physical Therapist Brand • Existing Strength • Esteem: Is it held in high regard? • Knowledge: What is the level of understanding? • Potential • Differentiation: How distinctive is the brand? • Relevance: Is it meaningful to those who use us?
Esteem: High Nearly 90% of all consumers have a positive impression of physical therapists • 80% of physical therapy users likely to consider using a physical therapist in the future • 68% of non-users likely to consider a physical therapist in the future • 84% of physical therapy users would refer a friend or family member to their physical therapist • 88% of physical therapy users say care was very or somewhat beneficial
Consumers are confused… Who do I go to? And for what condition? Differentiation: Blurred
Differentiation: Blurred • On the whole, physicians did not believe the DPT would improve clinical abilities and were concerned that it would drive the cost of physical therapy even higher • Physicians did not support direct access because they do not trust physical therapists to diagnose possible underlying medical conditions • While consumers do not view physical therapists as doctors, they do see the DPT designation as valuable. In fact, 73% were more likely to consider a physical therapist if they knew that they had completed requirements for a DPT.
94% of consumers have gone to their PCP for pain relief and improvement in movement or performance of daily activities While many consumers still want their PCP to “diagnose”, more than half say they are more likely to use physical therapists if they could “treat” patients without a doctor’s referral Relevance: Growing
Consumers are looking for prevention and wellness options Consumers would be more likely to use a physical therapist if they knew she/he could: Significantly improve mobility to perform daily activities Provide an alternative to surgery, in many cases Manage or eliminate pain without medication, in many cases Relevance: Growing
Physical Therapist Brand Opportunity: Earlier Mindshare “What about the physical therapist option?” Physical Therapist ProblemPain Orthopedists PCP/NP PILL/RUB Chiropractor
Ownership of a Broader Mindshare
Our Brand Promise What we do: Physical therapists help you restore and improve motion to achieve long-term quality of life.
Our Key Words and Phrases • What we say: • Physical therapists can help you improve mobility, in many cases, without surgery or pain medication • Physical therapists have extensive education and expertise • Physical therapists can help you prevent or manage a health condition
It matters because our brand can… Influence Protect Differentiate Command a Premium
We need to act now because… Our future is uncertain.
Our brand needs us… Because we care. Because we have influence. Because we are the brand.
How do I start? Step 1: Learn the brand www.APTA.org Brandbeat Resources www.MoveForwardPT.com Step 2: Live the brand • Be professional. • Be entrepreneurial. • Be knowledgeable. • Be consistent.
Tools You Can Use to Live • and Breathe the Brand • BrandBeat at www.apta.org/brandbeat • Consumer Web site – www.moveforwardpt.com • Brand Video onwww.youtube.com
KPTA Plans for the Brand • Links on KPTA website • Promote at KPTA and community events • Informational handouts, media advertising • Encouraging you to use APTA resources to promote and “live the brand” in your region
THANK YOU Questions?Christina Wisdom, PT, DPT, OCS firstname.lastname@example.org
Payment/ Reimbursement Update: Local & National Issues Maximizing and Protecting It
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Documentation • Computerized documentation appears “canned” with little to no originality from provider • Abbreviations are not standard – should avoid • No documented time frames • What was provided for codes billed is not clearly documented
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Documentation • Skill (why service of PT / PTA needed) • BCBSKS released a letter to all Kansas PT providers contracted with BCBSKS on September 21, 2009 that outlines what medical necessity is and standards for documentation
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Modalities (lack of documented rationale or rationale “canned”) • No tapering • Ultrasound and HP to the same body part same day repeatedly • Massage and Man Therapy for the same body part same day repeatedly • Ultrasound and E-stim to the same body part same day repeatedly
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Length of episode of care • Medically necessary versus maintenance • Co-morbidities and confounding factors not clearly documented • Referral source sends patient back despite PT recommendation to D/C
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • “Decompression Therapy” versus “Decompression Traction” • Length of episode of care • Multiple modalities included as well as braces and foot orthotics • All patients get the same type of treatment (package deal)
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • PT signs note however handwriting in body of note is different • Qualified provider of services • Utilization of available documentation resources
CONCERNS SHARED BY BLUE CROSS BLUE SHIELD KANSAS • Patient signing a waiver for non-covered services • This excludes modalities considered “content of service” • When is good enough – “good enough” • Trying to achieve function higher than pre morbid function
Educate yourself on all codes and proper utilization • Educate yourself on all available resources for documentation • “Say what you see” and “what your skill is” • Documentation “Quality” versus “Quantity” • Ask yourself “if I had to pay for this would I pay based on what is in my documentation?” • READ and become familiar with BCBSKS – Business Procedure Manual ( Appendix F: Occupational and Physical Therapy Guidelines ( pages F 1 – F 33) http://www.bcbsks.com/CustomerService/Providers/Publications/professional/manuals/pdf/BPMappF_OccPT.pdf
Recovery Audit Contractors (RACs) and Medicare(materials accessed from www. cms.hhs.gov/RAC September 13, 2009) KPTA TOWN HALL MEETINGS
What is a RAC? The RACs detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments Providers can avoid submitting claims that do not comply with Medicare rules CMS can lower its error rate Taxpayers and future Medicare beneficiaries are protected
Will the RACs affect me? • Yes, if you bill fee-for-service programs • Claims will be subject to review by the RACs • If so, when? • The expansion schedule can be viewed at www.cms.hhs.gov/rac
CMS RAC Review Phase-in Strategies as of 06/24/09 Earliest possible dates for reviews in yellow/green states KANSAS (Region D: HealthDataInsights, Inc.-Part A: 866-590- 5598, Part B: 866-376-2319, e-mail: email@example.com ) • Automated Review-Black & White Issues (June 2009) • DRG Validation-complex review (Aug/Sept 2009) • Complex Review for coding errors (Aug/Sept 2009) • DME Medical Necessity Reviews-complex review (Fiscal year 2010) • Medical Necessity Reviews-complex review (calendar year 2010)
RAC Legislation • Medicare Modernization Act, Section 306 Required the three year RAC demonstration • Tax Relief and Healthcare Act of 2006, Section 302 Requires a permanent and nationwide RAC program by no later than 2010 • Both Statutes gave CMS the authority to pay the RACs on a contingency fee basis.
What does a RAC do? • RACs review claims on a post-payment basis • RACs use the same Medicare policies as Carriers, FIs and MACs: NCDs, LCDs and CMS Manuals • Two types of review: • Automated (no medical record needed) • Complex (medical record required) • RACs will not be able to review claims paid prior to October 1, 2007 • RACs will be able to look back three years from the date the claim was paid • RACs are required to employ a staff consisting of nurses, therapists, certified coders, and a physician
The Collection Process • Same as for Carrier, FI and MAC identified overpayments (except the demand letter comes from the RAC) • Carriers, FIs and MACs issue Remittance Advice • Remark Code N432: Adjustment Based on Recovery Audit • Carrier/FI/MAC recoups by offset unless provider has submitted a check or a valid appeal
What is different? • Demand letter is issued by the RAC: • RAC will offer an opportunity for the provider to discuss the improper payment determination with the RAC (this is outside the normal appeal process) • Issues reviewed by the RAC will be approved by CMS prior to widespread review • Approved issues will be posted to a RAC website before widespread review
What are providers’ options? • If you agree with the RAC’s determination: • Pay by check • Allow recoupment from future payments • Request or apply for extended payment plan • Appeal • Appeal Timeframes: http://www.cms.hhs.gov/OrgMedFFSAppeals/Downloads/Appealsproce ssflowchartAB.pdf • 935 MLN Matters http://www.cms.hhs.gov/MLNMatterArticles/downloads/MM6183.pdf
Three Keys to Success Minimize Provider Burden Ensure Accuracy Maximize Transparency
Minimize Provider Burden • Limit the RAC “look back period” to three years • Limit the number of medical record requests • Maximum look back date is October 1, 2007 • RACs will accept imaged medical records on CD/DVD (CMS requirements coming soon)
Summary of Medical Record Limits (FY 2009) • Inpatient Hospital, IRF, SNF, Hospice • 10% of the average monthly Medicare claims (max 200) per 45 days per NPI • Other Part A Billers (HH) • 1% of the average monthly Medicare episodes of care (max 200) per 45 days per NPI • Physicians (including podiatrists, chiropractors) • Sole Practitioner: 10 medical records per 45 days per NPI • Partnership (2-5 individuals): 20 medical records per 45 days per NPI • Group (6-15 individuals): 30 medical records per 45 days per NPI • Large Group (16+ individuals): 50 medical records per 45 days per NPI • Other Part B Billers (DME, Lab, Outpatient Hospital) • 1% of the average monthly Medicare claim lines (max 200) per NPI per 45 days
Ensure Accuracy • Each RAC employs: • Certified coders • Nurses • Therapists • A physician CMD • CMS’ New Issue Review Board provides greater oversight • RAC Validation Contractor provides annual accuracy scores for each RAC • If a RAC loses at any level of appeal, the RAC must return its contingency fee