If your office is contracted with Aetna’s Medicare network, they should have received the following memo.
Aetna will begin to offer individual Medicare HMO plans in King, Pierce, and Snohomish counties.
See attached memo:
Aetna Memo August 2017
If your office houses LMPs/LMTs, please review the attached notice from Cigna.
Previously, Massage Therapists contracted with Healthways to become participating in Cigna.
Effective 1/1/2018, Massage Therapists must contract with American Specialty Health Group to become contracted providers with Cigna.
Claims after 1/1/2018 must be submitted to American Specialty Health to be eligible to be processed.
The attached memo was issued by Cigna on August 16th, 2017.
At the August 2017 Round Table conference we spoke about the delays in receiving TriWest authorizations, which delays the care of Veterans. Please see the attached email Alecia received from Kyle Levin at APTA.
“Dear Mrs. Johnson,
My name is Kyle Levin and I am a regulatory specialist here at the APTA. The reason that I am writing is that your information was forwarded to me by Kara Gainer, the Director of Regulatory Affairs here. I understand that you were having some issues with Triwest regarding long reauthorization times. I have been in contact with Triwest, and I wanted to give you an update on our efforts. Once Triwest receives the request for reauthorization, they submit the request to the appropriate VA Medical center. Once the VA has the request, they have 14 business days to approve or reject the request, and send it back to VV.
So even if Triwest submits the paperwork in a timely fashion, you are still looking at around a three week turnaround before reauthorization is granted in the best case scenario. However, the problem is further compounded due to the sheer volume of authorizations being submitted to TriWest. The VA OIG recently completed a review of the VA Choice Program at the request of Senator Isakson (see https://www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf). The OIG flagged authorization and scheduling procedures as potential barriers to veterans receiving care, and in TriWest’s response to the VA OIG Report, they discussed the number of care requests it receives on a monthly basis, noting that since August 2015, the number of requests submitted to TriWest has increased by 120%.
Within the report, the VA OIG made the following recommendations:
1. We recommended the Under Secretary for Health streamline processes and procedures for accessing care under the Veterans Choice Program.
2. We recommended the Under Secretary for Health develop accurate forecasts of demand for care purchased in the community.
3. We recommended the Under Secretary for Health simplify requirements for network providers to bill for services under the Veterans Choice Program.
4. We recommended the Under Secretary for Health ensure eligible veterans are not financially liable for the full cost of treatment authorized under the Veterans Choice Program.
5. We recommended the Under Secretary of Health ensure community providers are paid in a timely manner under the Veterans Choice Program.
6. We recommended the Under Secretary for Health review the Veterans Choice Program to determine if growth of provider networks is being limited by allowing reimbursement below Medicare rates.
The Under Secretary for Health concurred with the OIG’s findings and stated it would implement the recommendations, which the OIG is closely monitoring.
At this point I know that there is a plan to follow up with Senator Isakson’s office to see if there has been any further legislative pushes to help ease some of the burden on Triwest.
Please let me know if you have any further questions or concerns.
American Physical Therapy Association
Membership Guidelines and Fees
Article III: Membership
Section 1. Any individual in a solely administrative role, working for a licensed physical or occupational therapist, in a clinic which practices outpatient physical/occupational therapy is eligible for membership. In addition, any PT/OT who, as an owner, operates in the role of an administrator of a private practice clinic shall be eligible for membership.
Section 3: Membership Fees – Dues are assessed by the Board of Directors. Membership dues will be paid at the time of each quarterly conference in the amount of $10 and will, in essence, create a rolling membership throughout each year. Anyone eligible for membership as stated in Article 3; Section 1, will be assessed to $10 membership fee at the time of each quarterly meeting (in addition to the cost of the conference) and will have full voting rights during those meetings.
PLEASE NOTE: Once you’ve registered, you will have the opportunity to pay your registration fees online for the pre-registration amount! Please scroll down below the registration form to find the link to our secure Paypal portal.
About Our Meetings
WSPTMA hosts 4 quarterly conferences each year. The conferences generally last a half-day and include a buffet luncheon. Conference costs are $55 and includes the $10 rolling membership fee as well as the cost of lunch and facilities. There is a $5 discount for those who register and pay no later than one week in advance. Registration fees are non-refundable as we are required to pay our vendor for all who register even when we have no shows.
March 24-25, 2017
WSPTMA is proud to be joining this years PPSIG Spring Conference in Chelan, Washington.
May 11, 2017
Guest speakers from OneHealthPort, Premera Bluecross, Medversant, and eviCore.
August 10, 2017
Annual Round Table Conference.
November 9, 2017
Guest Speaker Dwight Johnson, FHFMA – Coopersmith Law’s Executive Director of Provider Contracting, as well as a speaker from Clinicient – a PT & OT EMR and Billing Software.
Meeting Time – 11am-3pm * Meeting Location – Foster Golf Links 13500 Interurban Ave S in Tukwila
Morris Award for Administrative Excellence
Nominations for the 2016 Recipient are now being accepted through October 31, 2017.
• A positive attitude toward work responsibilities, co-workers and patients. Serves as a role model to others
• A willingness to exercise leadership, take initiative and accept and carry out responsibilities beyond regular job assignments
• A passion and commitment to the role in the PT industry
PDF Nomination Form
Online Nomination Form:
2016 – Monica Olivares, Oasis Physical Therapy
2015 – Kathy Harada, Harada Physical Therapy
2014 – Tonia Morris, Apple Physical Therapy
Premera Blue Cross of Washington (and Alaska) have announced that starting July 1st 2016, they will be using EviCore for outpatient rehabilitation utilization management. I am including the notice that was sent out as well as the link to their website.
Tuesday, February 16, 2016
CMS Announces New Approach to Manual Medical Reviews
To the surprise of APTA and other organizations that were expecting to get more information and provide input on the plan, the US Centers for Medicare and Medicaid Services (CMS) has moved ahead with a system for manual medical reviews for physical therapy and other services that exceed the therapy cap.
Last week, CMS announced that it has contracted with Strategic Health Solutions to serve as a supplemental medical review contractor (SMRC) to conduct a “targeted review process” for claims that exceed the $3,700 cap for physical therapy and speech-language pathology combined, and $3,700 for occupational therapy services. Unlike previous years, in which reviews were conducted for all claims exceeding the thresholds, the new approach allows Strategic Health to select only certain claims for review.
According to CMS, Strategic Health will pay particular attention to 2 main areas: providers with “a high percentage” of patients receiving therapy beyond the thresholds compared with peers; and “therapy provided in skilled nursing facilities, therapists in private practice, and outpatient physical therapy or speech-language pathology providers … or other rehabilitation providers.” CMS writes that an evaluation of the number of units or hours of therapy provided in a day will be “of particular interest.”
The new approach is required as part of changes adopted in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The announcement was made with little warning from CMS, and was apparently developed without input of any stakeholders, including APTA, which made numerous requests to meet with CMS on the subject. The association has requested more information on the new process, and will provide members with details as they become available.
Posted by News Now Staff at 2:04 PM