In a letter urging Aetna to withdraw its multiple procedure payment reduction (MPPR) payment policy, APTA calls the policy "unfair" and "arbitrary" and illustrates how it would result in underpayments for therapy services and ultimately jeopardize access to care for Aetna members. The association calls on Aetna to give more thorough consideration to the fact that the practice expense relative value units have already been reduced to avoid duplication when multiple services are provided in a single session. APTA suggests Aetna should take the time to ensure that individual services are based on the resources needed to deliver them.

UnitedHealthcare® Announces Multiple Therapy Reduction Policy

The October 2011 OptumHealthSM Physical Health Provider Newsletter provides details on the new multiple therapy reduction payment policy for claims paid by UnitedHealthcare (UHC). Modeled after the multiple procedure payment reduction (MPPR) policy implemented by the Centers for Medicare and Medicaid Services (CMS) in January 2011, UHC's policy will take effect for claims reported with a date of service on or after March 1, 2012. The policy will apply to United HealthCare paid claims. OptumHealth is evaluating the policy and will notify OptumHealth providers in a future Newsletter if it will be implemented on OptumHealth systems.

It is important to note that the UHC policy differs from CMS' MPPR policy in that the procedure that has the highest percentage of the total relative value in the practice expense is the procedure that will be paid at 100%. Subsequent units paid on the same date of service are paid at 80% of the practice expense. Work expense and malpractice expense RVU's will not be affected. The article also notes that the policy does not apply to providers contracted at a flat rate per diem payment methodology.

Modifier 76 description revised in 2011

Modifier 76 is used to report procedures performed more than once on a date of service. Therefore, the phrase "or other qualified health care professional" was added to the code descriptor. The August 2011 issue of CPT® Assistant provides a clinical example for use of this modifier in a physical therapy setting. In the example, a 67-year-old woman with a severe ankle sprain requires treatment to reduce swelling. A therapist performed electrical stimulation in the morning and in the late afternoon. The morning procedure should be reported using CPT code 97014 and the afternoon procedure should be reported using CPT code 97014 with modifier 76.

The article also provides the following guidance for use of modifier 76:

"Modifier 76 should be used for all procedures when the physician or other qualified health care professional repeats the procedure or services the same day or during the postoperative period. Modifier 76 indicates that the claim is not a duplicate bill, but is for a second incidence of the same procedure or service. The repeated procedure reported with modifier 76 must be the same procedure or service (ie, same procedure or service code) by the same qualified health care professional. An explanation of medical necessity for the repeated procedure or service reported with modifier 76 is required by many insurance carriers."

Federal Payment

Revised SNF student supervision requirement under Medicare: New resources now available from APTA

On October 1, 2011, the new Medicare student supervision requirement created by the Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule for Fiscal Year (FY) 2012, will take effect. Within this rule, the Centers for Medicare and Medicaid Services (CMS) discontinued the policy announced in the FY 2000 final rule's preamble requiring line-of-sight supervision of therapy students in a SNF.

The supervising therapist within a SNF will now determine the appropriate level of supervision of each therapy student, consistent with state and local laws and practice standards, starting October 1. However, CMS stated that the student is still viewed as an extension of the therapist, which means the policies regarding individual, concurrent, and group therapy as articulated in the RAI (Resident Assessment Instrument) manual are still applicable.

To help you with the transition to this new policy, the APTA has updated its student supervision resources on the APTA website as well as provided a full summary (login before linking) of the rule on the website. In addition, APTA, AOTA, and ASHA submitted student supervision guidelines to CMS, which can be found on the CMS website.

Outpatient Physical Therapy Comparative Billing Report for KX Modifier Released

In early August, CMS released a Comparative Billing Report for Independent Physical Therapists in outpatient settings. CMS released a similar report in 2009. This year's reports focus on 2010 billing data and are being sent to 5000 providers.

These reports are sent only to the provider of service, and are one of the tools that CMS uses to help providers comply with Medicare billing rules and improve patient care. For more information and to review a sample of the Outpatient Physical Therapy Services CBR, please visit the CBR Services Website.

PTs enrolled in Medicare prior to March 25, 2011 must revalidate enrollment. New screening criteria implemented under the Affordable Care Act (ACA) place newly enrolled and revalidating providers in 1 of 3 screening categories. PTs enrolled as individuals or as group practices are in the "moderate" risk category and will be subject to onsite visits by MACs.

CMS recommends providers and suppliers begin the revalidation process as soon as they hear from their MAC, but not before. Providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. During that time your payment status will be uninterrupted. However, if you fail to respond in a timely manner your payment status could be halted until Medicare has a "clean" application. More information about provider revalidation is available in the Medicare Learning Network article titled "Further Details on the Revalidation of Provider Enrollment Information".

A detailed APTA summary of the final enrollment requirements for physical therapists and other Medicare enrollment information is available on the APTA Medicare Enrollment website.

CMS also notes that providers should continue to submit routine changes - address updates, reassignments, additions to practices, changes in authorized officials, information updates, etc. as they always have.

CY2009 Physician Quality Reporting System (PQRS) Participation Data Released

CMS released data on participation in the PQRS program during CY2009 in August 2011. A total of 5,414 physical and occupational therapists in private practice submitted data during the CY2009 reporting period. For more information about the report, see the November 7, 2011 PT in Motion: News Now article.

PQRS is currently a voluntary program to incentivize practitioners' participation in quality reporting. However, beginning in 2015, providers who do not successfully participate will be subject to a financial penalty. The proposed CY2012 Physician Fee Schedule Rule outlines CMS' intent to use CY 2013 data to inform penalties in 2015. If this is adopted in the final CY2012 rule, providers must begin to participate in 2013 to avoid financial penalties beginning in 2015.

CMS to Conduct National Coverage Analysis on TENS

The Centers for Medicare and Medicaid (CMS) will conduct a national coverage analysis on evidence for the use of transcutaneous electrical nerve stimulation (TENS) for treatment of chronic low back pain. The agency is particularly interested in receiving evidence on health outcomes attributable to the use of TENS in home settings. CMS also encourages the submission of comments that pertain to clinical studies falling under the Coverage with Evidence Development paradigm, as it is considering coverage under Section 1862(a)(1)(A) and Section 1862(a)(1)(E) of the Social Security Act.

CMS' analysis follows a 2010 report by the Therapeutic and Technology Assessment Subcommittee of the American Academy of Neurology that found TENS ineffective for chronic low back pain. APTA will submit comments by the October 13 deadline.

CMS Resources

"The Medicare Overpayment Collection Process" fact sheet, which includes the definition of a physician or supplier overpayment and information about the overpayment collection process, has been revised and is now available in a downloadable format.

Preparing for Version 5010 and ICD-10: New Resources From CMS

On October 1, 2013, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by January 1, 2012. To help providers prepare for these changes, the Centers for Medicare and Medicaid Services (CMS) has released several new resources, including Version 5010 and ICD-10 transition basics fact sheets, a Version 5010 readiness fact sheet and a timeline widget. Sign up for industry e-mail updates and receive news and information about new resources to help ensure smooth transitions to Version 5010 and ICD-10.

HELPFUL LINKS

TrailBlazer Manual - Therapy Services

TrailBlazer LCDs (Local Coverage Determination) 

NEWS FROM CARRINGTON COLLEGE

NEWS FROM PIMA MEDICAL INSTITUTE

Submitted by Marnie Doctor, PTA, BUS

We are excited to announce that our second cohort has graduated, as of November 3rd, from the PTA program at Pima Medical Institute. They are now in the process of applying for licensure and studying for the board exam.

Cohort 3 finished their first clinical rotation this past week and are set to return to class on November 14th for their fourth semester. Cohort 4 is our new class, also starting on November 14th.

Many of the students in our cohort 3 class are active within the community; volunteering at local events, such as the State Fair and Special Olympics, and at different hospitals and facilities within the Albuquerque metro area. Several of the students also attended the 2-day Fall Conference hosted by the New Mexico chapter of the American Physical Therapy (NMAPTA). Each student who participated expressed their excitement to be a part of this professional organization and their appreciation for including students in these events.

Therese Tomkie, Director of the PTA program, was elected President of NMAPTA in October. Marnie Doctor, an instructor for the program, was elected PTA Caucus Representative for the state of New Mexico.

Thank you to the community for continuing to support our students and offering your knowledge and expertise to shape the minds of our future PTAs.

NEWS FROM SAN JUAN COLLEGE

NEWS FROM UNM PHYSICAL THERAPY PROGRAM

Submitted by Ross Arena, PT, PhD, FAHA

The Physical Therapy Program at the University of New Mexico graduated the last Master of Physical Therapy class on May 20, 2011. We have now successfully transitioned to the DPT with the addition of the third year of the new curriculum this fall semester. Third year students spent 8 weeks in classes before they embarked on 28 weeks of clinical internships. They will return in early June to complete the curriculum before they graduate on June 27, 2012.

The Program completed an evaluation of the feasibility to continue offering the specifically tailored Completion Track in a quality manner to our earlier MPT graduates. Unfortunately, data from our survey indicates the level of interest is not high enough to do so. We have been directing individuals who wish to enroll in a tDPT program to other options.

I joined the UNM Physical Therapy Program in June 2011 and have enjoyed my time here immensely. We have initiated several new and exciting projects that should come to fruition in the near future. These include: 1) Development of a faculty practice, 2) Development of a CEU center for Physical Therapists; our first CEU course is scheduled for November 2011, and 3) We are in the process of formalizing relationships with several physical therapy programs in Brazil. This will allow us to create many new and exciting research and potentially clinical opportunities for our faculty and students.

Faculty Updates

Ross Arena has been invited to speak at conferences in India and Brazil in 2012. He is also an invited speaker at the 2012 Scientific Sessions American of Cardiology Conference. Ross recently received a joint appointment in the Department of Internal Medicine - Division of Cardiology. From a research perspective, 2011 has been a productive year with more than 20 peer-reviewed publications. Ross is currently chairing 2 writing groups for American Heart Association scientific statements and is serving on 2 additional writing groups. These scientific statements will be published in 2012 in Circulation.

Ross is teaching the 2 Administration and Supervision courses in the Physical Therapy Program. He just completed the first course in October 2011.

Beth Jones recently completed another successful anatomy teaching block with the medical school and is currently "grossly" involved with the class of 2014 PT students. She is pleased to report that we are offering our first anatomy/kinesiology continuing education course November 19. Please contact UNM by November 15 if you are interested in returning to the class and lab for a lower extremity review. We hope to offer the upper extremity the beginning of March. Beth continues to be involved with the Orthopedic Section of APTA planning programming for CSM 2012 in Chicago. 

Burke Gurney continues to teach, work in the clinic, and do research. He recently returned from Rio de Janeiro where he presented some of his research on absorption of cortisone using phonophoresis. He was also recently in Guatemala, where he took 4 students on the inaugural UNM PT Program Study Abroad Program. The experience included intensive Spanish study for the students as well as volunteer work at a local hospital/orphanage in Antigua. He is planning on bringing students with him every year.

Beth Provost was honored in May to receive a UNM School of Medicine "Apple for the Teacher" Award for Excellence in Teaching during academic year 2010-2011. She is enjoying teaching the newly revised and concentrated pediatric PT course this semester, and she also participates periodically in assessments of young children at the Early Childhood Evaluation Program. Beth continues to love helping individuals explore various aspects of hypnotherapy, and she is also developing a continuing education course in this area to increase awareness of mind-body interactions that affect health care practitioners as well as patients.

Bone Dexter continues to divide his time between teaching, admissions, working with Lobo athletes and operating the program's new motion analysis lab. Currently, the lab is being utilized to investigate changes in gait patterns with various shoe types and with biomechanical foot orthoses. The lab is currently located in a small room which limits its functionality, but we hope to find a more suitable and permanent location in the near future so that we can provide comprehensive gait and motion studies for the academic and clinical community in New Mexico.

Kathy Dieruf continues to coordinate and teach the adult neurology content in the curriculum, as well as the ethics/legal content, the psychology and cultural content and co-taught the Gender Health content with Peg Wanta. All the classes are in transition due to the new DPT curriculum. Kathy is also the co-chair of the Admissions Committee with Bone Dexter and the two of them are using a nationwide on line application called PTCAS. There is a related computer program called PTADMIT that calculates scores and keeps tract of communication with applicants. Kathy attended a training conference in North Carolina this summer to learn more about maximizing our use of these computer programs. She is primarily in charge of the PTADMIT program. Kathy will be presenting a poster on the GivMohr sling and the GaitRite at the APTA CSM conference in Chicago in February.

Fred Carey is co-author of a poster that will be presented at CSM in February. Fred has a diverse teaching load, encompassing Gross Anatomy, Neuroanatomy, Cardio-Pulmonary and Acute Care. He continues to have a clinical appointment at UNM Hospital in acute care.

Ron Andrews is the primary faculty for the first year orthopaedic blocks. These blocks encompass principles and methods of orthopaedic evaluation and treatment, as well as, kinesiology and functional anatomy, coordinating with the gross anatomy course work. Bone Dexter, Peg Wanta and Burke Gurney are all involved in these blocks. The gross anatomy course, taught by Beth Jones and assisted by Fred Carey, now coincides and integrates directly with the first year orthopaedic blocks. Ron has also been involved with teaching in the first year Foundations block and the Advanced Differential Diagnosis course offered in the third year.

Ron is back seeing patients after his brief hiatus from his clinical duties in order to commit time to the Interim Director duties. Ron has been working with Sunita Rajput, MD, Fred Harrington, MD and Lesley Toser MPT to provide physical therapy services in house for the newly developed Spine Center at UNMH. The Spine Center will facilitate multidisciplinary team based and focused management of patients with spinal pain.  

Peg Wanta and Jackie Vigeon

UNM DPT final clinical experiences are in full swing for the class of 2012. They will be in clinic from October 2011 - May 2012 at various settings and facilities, and then on to graduation in the summer of 2012!  We greatly appreciate all of the outstanding clinical experiences our community provides as well as the leadership and mentoring the clinical instructors provide for our students. The class of 2013 will return to the clinic in the fall of 2012, while our first year students will get their first clinical experiences in the Summer of 2012 in orthopedics.

We have added many mini clinics to our curriculum to supplement class content and create "real life" application of concepts the students are learning in class. Currently, the students are involved in mini clinic experiences in the following settings: orthopedics, pediatrics, geriatric, inpatient rehabilitation, acute care and home health. The mini clinics are half day experiences built into the semester during which the students are learning specific content. For example, the students visit pediatric mini clinics during their peds courses, etc. We are always looking to expand our facilities offering mini clinical experiences. It is a great way to meet UNM students and get them out to your clinic. The mini clinics provide a brief clinical experience (half day) in which the students get to see you and your facility in action. This is an excellent opportunity for new clinical instructors to get their feet wet or for facilities that are unable to support full time experiences to still be involved with clinical education and PT students. Please contact myself or Jackie Vigeon if you would like any additional information or would like to host a mini clinic experience.

As always, Jackie and I sincerely thank all of you and appreciate all you do for our UNM PT students in clinical education.

Peg Wanta, PT, DPT, ACCE

pwanta@salud.unm.edu 

505/272-6836

Sue Queen completed the expansion of the pharmacology content in the DPT curriculum. The specific pharmacology topics are now presented with their corresponding course content. For example, drugs used to treat neurological conditions were covered in the Neurology I and Neurology II courses in the 2nd year, and cardiac and pulmonary disorders were covered in the Acute Care/Cardiopulmonary course this past summer. The students have responded favorably to this approach. Sue also coordinated the advanced differential diagnosis course this fall semester for third year students. The course is designed to progress each student's ability to make appropriate treatment versus referral decisions with each patient evaluation through cases studies. The other major aspect of Sue's work has been her research.