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 Campaign

Payment/Reimbursement Update: Local & National Issues

APTA Code of Ethics Update 2010 KPTA Legislative Plan Update

KPTA Website Update

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

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American Physical Therapy Association

The Physical Therapy Brand

Learn It. Live It. Share it. Wear it.

Brand FundamentalsBrands define expectation

Brands live everywhere

Brands are hard tocreate

Brands are easy to destroy

Brands can be influenced

Brands are not fully controlled

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A good brandevokes 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.7

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So, how are we doing?

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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?

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 10

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Consumers are confused…

Who do I go to? And for what condition?

Differentiation: Blurred

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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

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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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Expand Mindshare of Physical Therapy

Rehabilitation

MOTION

The Physical Therapist = MOTION

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Ownership of aBroader Mindshare

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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 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

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Our Tag Line

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It matters because our brand can…

Influence

Protect

Differentiate

Command a Premium

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We need to act now because…

Our future is uncertain.

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Because we care.

Because we have influence.

Because we are the brand.

Our brand needs us…

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.24

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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

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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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THANK YOU Questions?

Christina Wisdom, PT, DPT, [email protected]

Payment/ Reimbursement Update: Local & National Issues

Maximizing and Protecting It

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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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SEE HANDOUTS

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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Three Keys to Success

Minimize Provider Burden

Ensure Accuracy

Maximize Transparency

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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: apta.org.

Log in and search for

the RAC link.

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Contacts / References

RAC Website: www.cms.hhs.gov/RAC

RAC Email: [email protected]

NEW Code of Ethics and Standards of Conduct

Effective July 1, 2010

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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 Magazine …”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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Code/Standards is built upon the seven core values of the profession

Accountability Altruism Compassion/caring Excellence Integrity Professional Duty Social Responsibility

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PurposeDefines the ethical principles that form the foundation of physical therapy practice.

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PurposeProvides standards of

behavior and performance that form the basis of professional accountability to the public.

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PurposeProvides guidance for

facing ethical challenges, regardless of their professional roles and responsibilities.

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PurposeEducate physical therapists,

physical therapist assistants, students, other health care professionals, regulators and the public regarding the core values, ethical principles and standards that guide our professional conduct.

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PurposeEstablishes the standards by

which the APTA can determine if a physical therapist/physical therapist assistant has engaged in unethical conduct.

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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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Fundamental to Code/Standard…A special obligation to empower, educate

and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life.

2010 KPTA LEGISLATIVE PLAN

MOVE FORWARD!

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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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KPTA Website UPDATE

www.kpta.com

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WEBSITE UPDATE

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SPRING, 2010CALL FOR AWARDS

Please submit nominations

by January 4, 2010.

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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

[email protected]

Candy Bahner, PT, DPT

[email protected]

KPTA Office: Phone: (785) 233-5400 Fax: (785) 290-0476

KPTA website: www.kpta.com81

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KPTA PAC FundraiserBeautiful San Diego for APTA’S 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].