WELCOME! 2009 KPTA Town Meeting
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Transcript of WELCOME! 2009 KPTA Town Meeting
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WELCOME! 2009 KPTA
Town Meeting
Kansas Physical Therapy AssociationTopeka, Kansas 66603
785-233-5400 Fax: 785-290-0476Email: [email protected]
www.kpta.com
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AGENDA
APTA Branding CampaignPayment/Reimbursement Update:
Local & National Issues APTA Code of Ethics Update2010 KPTA Legislative Plan
UpdateKPTA Website Update
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2009 TOWN 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
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American Physical Therapy Association
The Physical Therapy Brand
Learn It. Live It. Share it. Wear it.
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Brand FundamentalsBrands define expectationBrands live everywhereBrands are hard to createBrands are easy to destroyBrands can be influencedBrands are not fully controlled
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A good brand is relevant.
It stimulates opinions.
It makes a connection.
A good brand is consistent.
A good brand is strategic.
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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?
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APTA conducted primary qualitative and quantitative research to assess the existing strength and potential of the physical therapist. We talked to:
Consumers: Physical therapy Users and Non-Users
MDs and Nurse Practitioners Insurers APTA Leaders and Members Legislators
We evaluated: Macrotrends impacting consumer
behavior
Research Scope
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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
“I’m such a believer…I went for two
months… I’m fixed, I’m cured. Without
any surgery.”
“I usually look forward to physical therapy because it helps, and I don’t
have the will power to do it on my own.”
“There was some genuine caring about how I was doing and
progressing.”
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Esteem: High
“They are highly educated, highly
knowledgeable people. I’m very, very satisfied.”
“Extremely capable. Extremely
knowledgeable. There’s one that’s one of my
favorites as far as someone to direct
patients to.”
Physical Therapist is provider of choice for loss/limitation of movement, injury or experiencing pain – above Orthopedists and Chiropractors.
MDs and Nurse Practitioners express satisfaction with physical therapists
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• 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.
Differentiation: Blurred
“… the physician should be making the diagnosis… It’s expensive treatment. So
there would be a lot of abuse.”
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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
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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
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ProblemPain
Physical Therapist
PILL/RUB PCP/NP Orthopedists
Chiropractor
Physical Therapist
Brand Opportunity: Earlier Mindshare
“What about the physical therapist option?”
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Known as:
Coach/Teacher
Delivers: Knowledge
Offers: Independence
Focus: Understanding
Traits: Experts,
advisors
The SageHelps people act smarter and feel more confident.
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The Hero
Known as:
Rescuer/Warrior
Delivers: Courage
Offers: Mastery
Focus: Proving
Traits: Motivates
Helps people perform at their upper limits.
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Our Brand PromiseWhat we do
Physical therapists help you restore and improve motion to achieve long-term quality of life.
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Our Key Words and PhrasesWhat 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
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Tools You Can Use to Live and Breathe the Brand
• BrandBeat at www.apta.org/brandbeat
• Consumer Web site – www.moveforwardpt.com
• Brand Video on www.youtube.com
• KPTA website www.kpta.com
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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Recovery Audit Contractors (RACs) and Medicare(materials accessed from www. cms.hhs.gov/RAC www. cms.hhs.gov/RAC September 13, 2009) September 13, 2009)
KPTATOWN HALL MEETINGS
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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
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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
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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 protected] )
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)
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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.
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What does a RAC do? RACs review claims on a post-payment basis
RACs use the same Medicare policies as Carriers, FIsand 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
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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
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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
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What are providers’ options?
If you agree with the RAC’s determination:1. Pay by check2. Allow recoupment from future payments3. Request or apply for extended payment plan4. Appeal
Appeal Timeframes: http://www.cms.hhs.gov/OrgMedFFSAppeals/Downloads/Appealsproce ssflowchartAB.pdf
935 MLN Mattershttp://www.cms.hhs.gov/MLNMatterArticles/downloads/MM6183.pdf
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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)
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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
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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
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Maximize Transparency
New issues are posted to the web
Vulnerabilities are posted to the web
RAC claim status website (2010)
Detailed Review Results Letter following all Complex Reviews
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What can providers do to get ready?
Know where previous improper payments have been found
Look to see what improper payments were found by the RACs: Demonstration findings: www.cms.hhs.gov/rac Permanent RAC findings: will be listed on the RACs’
websites
Look to see what improper payments have been found in OIG and CERT reports: OIG reports: www.oig.hhs.gov/reports.html CERT reports: www.cms.hhs.gov/cert
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Know if you are submitting claims with improper payments
Conduct an internal assessment to identify if you are in compliance with Medicare rules
Identify corrective actions to promote compliance
Appeal when necessary
Learn from past experiences
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Prepare to respond to RAC medical record requests
Tell your RAC the precise address and contact person they should use when sending Medical Record Request Letters Call RAC No later 1/1/2010: Use RAC websites
When necessary, check on the status of your medical record (Did the RAC receive it?) Call RAC No later 1/1/2010: use RAC websites
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Appeal when necessary
The appeal process for RAC denials is the same as the appeal process for Carrier/FI/MAC denials
Do not confuse the “RAC Discussion Period” with the Appeals process
If you disagree with the RAC determination… Do not stop with sending a discussion letter
File an appeal before the 120th day after the Demand letter
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Learn from past experiences
Keep track of denied claims
Look for patterns
Determine what corrective actions you need to take to avoid improper payments
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APTA RECOMMENDATIONSAPTA RECOMMENDATIONS
APTA website: www.apta.org
Log in and search for
the RAC link.
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Adopted by the 2009 House of Delegates
Disseminated to all members Shared with the state licensing boards Shared with all Education Program Directors Available on the APTA website which will also
include a Frequently Asked Questions about the Code/Standards
Ethics and Judicial Committee will develop online courses
PT in Motion …”Ethics in Action”
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Encompasses the five roles we play in contemporary medicine
Clinical Management of the patient/client
ConsultantEducatorResearcherAdministrator
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Now 8 vs 11 principles Ex. Principle # 7 in the Code of Ethics: Physical therapists shall promote
organizational behaviors and business practices that benefit patients/clients and society.
7A. PTs shall promote practice environments that support autonomous and accountable professional judgments.
7B. PTs shall seek remuneration as is deserved and reasonable for PT services.
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Principle 7 Continued…7C. PTs shall not accept gifts or other considerations that
influence or give an appearance of influencing their professional judgment.
7D. PTs shall disclose any financial interest they have in products or services that they recommend to patients/clients.
7E. PTs shall be aware of charges and shall ensure documentation and coding for PT services accurately reflect the nature and extent of services provided.
7F. PTs shall refrain from employment arrangements, or other arrangements, that prevent PTs from fulfilling professional obligations to patients/clients.
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Standard #7 in Ethical Conduct for the PTA
PTAs shall support organizational behaviors and business practices that benefit patients/clients and society.
7A. PTAs shall promote work environments that support ethical and accountable decision-making.
7B. PTAs shall not accept gifts or other considerations that influence or give an appearance of influencing their decisions.
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Standard #7 continued…7C. PTAs shall fully disclose any financial interest
they have in products or services they recommend to patients/clients.
7D. PTAs shall ensure that documentation for their interventions accurately reflects the nature and extent of the services provided.
7E. PTAs shall refrain from employment arrangements, or other arrangements, that prevent PTAs from fulfilling ethical obligations to patients/clients.
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2010 LEGISLATIVE PLAN Propose legislation to remove the direct
access provisions:
Remove the previous referral to a PT provision Remove the referral within one year provision Remove the provision for same diagnosis
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2010 LEGISLATIVE PLAN Keep:
Treatment for thirty (30) days before referring to a M.D., D.O., etc.
Transmit evaluation report to one of the above practitioners of patient’s choice within five days
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QUESTIONS / CONCERNS? Does everyone support this legislative plan?
Concerns about it or about expanding direct access in Kansas?
Questions?
Interest in getting involved in making this happen? Key contact, etc.
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WEBSITE UPDATE KPTA’s Updated Website – Featuring:
News Updates on HealthCare Reform and the N1H1 Virus
Pre-approved CE Class List Research Articles Calendar of Upcoming Events Features are updated daily And much more….
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KPTA AWARDSSusan Tork Distinguished Service Award: to honor a member who has
given honorable, dedicated, and meritorious service to the chapter and community at large.
Distinguished Clinical Service Award: to honor a peer who has given long, loyal, and professional clinical service to the profession through serving the needs of their patients, coworkers, and community at large.
Carolyn Bloom Lifetime Achievement Award: to honor long-standing members of the KPTA.
Outstanding Physical Therapist Student Award and the Candy Bahner Outstanding Physical Therapist Assistant Student Award: to honor outstanding students
Award for Academic Excellence: to recognize a faculty member within Kansas who has made significant contributions to physical therapy education.
Friend of Physical Therapy: to honor those who have contributed to the profession of physical therapy and the chapter as a whole.
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Contact Information
Please contact the members of the nominating committee if you have any questions:
Julie Newman, PTA
Candy Bahner, PT, DPT
KPTA Office: Phone: (785) 233-5400 Fax: (785) 290-0476
KPTA website: www.kpta.com82
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KPTA PAC FundraiserBeautiful San Diego for APTA CSM in February!
3 nights in hotel, dinner for 2 at hotel and CSM registration = $1200 value!!!
Tickets: 1 for $20 or 3 for $50
Contact KPTA PAC for tickets.
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Thank you
for attending the KPTA Town Meeting.
If you have any questions regarding membership or any of the issues discussed
tonight please contact the KPTA office at 785.233.5400 or [email protected].