MPTA's Payment Committee is continually meeting with health care professionals and various insurance companies throughout the state of Michigan to keep our members notified of any changes coming and to advocate for our physical therapy professionals. As a benefit to our membership, MPTA members are notified immediately of any policy changes or deadlines to an insurance plan or group.

Not all Payment questions can be treated the same way. Please email mpta@mpta.com if you have a specific question as it relates to Payment.

Payment News:
 

MPTA COVID-19 Consolidated Resources and Updates

posted: March 26, 2020

In order to consolidate critical information, MPTA will be posting and updating information only in this area.  The information below is provided in topic areas based on inquiries and issues that are most pressing.

 

MPTA sent a letter to the Governor on March 20 requesting relief in many of the areas outlined below.

 

Clinic Operations

APTA has provided broad guidance for members to consider when deciding whether or not to provide in-person/clinic-based care. http://www.apta.org/Coronavirus/Statement/.   APTA President Sharon Dunn also provided further clarification in a letter to members.  

On March 23, Governor Whitmer issued a Stay Home, Stay Safe Executive Order.  In that Executive Order there are exemptions for those who provide essential services. Health care, including physical therapy, is an essential service as noted in this Department of Homeland Security Memo Download file

 

General guidance from various sources suggests that health care providers should defer all in-person, non-essential health care delivery. However, defining when care is non-essential for a given patient is not easy. This decision should be made on a case-by-case basis relative to risk. Some patients will absolutely decline without care and physical therapy interventions can decrease the burden on other health care providers.  In-person care for these patients should only be considered if e-visits and telehealth are not available or appropriate, if you have adequately screened risk of infection/exposure of both staff and patients using a 14 day look-back period, screened for the presence of current symptoms, can ensure adequate distancing from others in the clinic space, and have implemented effective environmental and equipment cleaning practices. Although no Executive Order yet exists regarding limited operations for outpatient clinics that are not state-run, you should ensure that you can safely deliver in-person care for those with essential health care needs.

This is not business as usual and requires ethical evaluation of the risk of exposure to COVID-19 compared to the benefit of therapy treatment requiring in-person care. Providing essential care means:

  • Limiting the volume of in-person visits to patients whose care cannot be postponed or provided via e-visits/telehealth to reflect implementation of the Michigan Executive Order to "stay home, stay safe, save lives"
  • Providing only that in-person care which prevents decline and reduces the burden on other healthcare providers
  • Only providing 1-on-1 care and avoiding the use of group and concurrent therapy
  • Establishing a staff workplace design to adhere to physical distancing guidelines
  • Adopting remote clerical processes to eliminate patient exposure to non-clinical staff during in-person visits
  • Adequately screening for risk of infection/exposure and presence of current symptoms of both staff and patients

MPTA is not a regulatory body and therefore cannot require any specific actions. However, the State of Kentucky did offer regulatory guidance to providers in that state to assist them in the exercise of their judgment. These guidelines may be helpful for physical therapists and physical therapist assistants in Michigan in deciding how their practice should be modified to ensure the safety and well-being of Michigan’s citizens.

Kentucky  Cabinet for Health and Family Services Guidelines Download file

 

E-Visits and Telehealth in Michigan/Payer Updates Related to COVID-19

From a regulatory perspective, physical therapy services via Telehealth are allowed:  For full information download this document:

 

The following payers have approved either e-visits or telehealth:

CMS: http://www.apta.org/PTinMotion/News/2020/03/17/E-VisitsCMSCoronavirus/  and https://www.cms.gov/files/document/se20011.pdf

March 22, the Centers for Medicare & Medicaid Services (CMS) announced unprecedented relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs including the 1.2 million clinicians in the Quality Payment Program and on the front lines of America’s fight against the 2019 Novel Coronavirus (COVID-19).

Specifically, CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19).

Health Alliance Plan of MichiganDownload file

 

BCBSM: BCBSM has informed MPTA that it will cover CPT Codes 97110, 97112, 97116, 97530 and 97535 via telehealth effective for both commercial and MA population until June 30. Unfortunately, this policy decision has not been finalized or implemented and we have not been given any further information. Until official notification is provided, providers should not bill for telehealth services. MPTA continues to advocate for coverage of telehealth services. We will provide additional information as soon as it is received.

 

Priority Health: MPTA has asked for coverage of CPT codes that could feasibly be delivered via telehealth (97110, 97112, 97116, 97530, 97535) using the 02 place of service modifier. A final decision is still pending, though they have indicated that they likely will only cover the G codes consistent with CMS.

 

Meridian: MPTA has asked for coverage of CPT codes that could feasibly be delivered via telehealth (97110, 97112, 97116, 97530, 97535) using the 02 place of service modifier. A final decision is still pending.

 

Medicaid:  MDHHS has published a Bulletin Download filthat effectively states that telehealth physical therapy is NOT covered.  MPTA immediately responded to this Bulletin.Click here to see the communication:  Download file

 

CIGNA:  APTA can confirm that Cigna has established a telehealth policy for PT, OT, and ST in light of COVID19. Please go the link below.  https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

Click on Virtual Care Guidelines then Click on Virtual Care for Physical, Occupational, and Speech Therapy Services

 

Specifically, as it relates to Physical Therapy the following codes can be billed through May 31, 2020 and will be reimbursed at the standard fee schedule. Providers will need to append the GQ modifier and bill with a standard place of service code.

  Physical therapy

   97161 PT eval low complex 20 min (Telephonic or virtual)

   97162 PT eval mod complex 30 min (Virtual)

   97110 Therapeutic exercises (2 unit limit)

  UnitedHealthcare:   Announcement posted March 26:  

UnitedHealthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio/video technology. State laws and regulations apply. Benefits will be processed in accordance with the member’s plan.

 

This change is effective immediately for dates of service March 18 through June 18, 2020.

Click here to see the specific codes

 

It is important to remind providers that care provided via telehealth must be safe and appropriate to the clinical situation and must continue to meet all associated standards of care. https://www.fsbpt.org/Portals/0/documents/free-resources/TelehealthInPhysicalTherapy2015.pdf

 

Relief for Employers

Relief for small business owners is evolving at a rapid pace at both the federal and state levels.

At the state level, MPTA has been working with the Director of the Department of Labor and Economic Opportunity to share the concerns of owners of PT practices of varying sizes. There is no one-size-fits-all solution, but resources that may be helpful include:

Michigan Small Business Relief Fund:

https://www.michiganbusiness.org/press-releases/2020/03/vital-funding-for-states-small-businesses-gains-michigan-strategic-fund-support/ 

 

Michigan Guidance Regarding Layoffs: 

https://www.michigan.gov/coronavirus/0,9753,7-406-98163-522113--,00.html

 

Contact the Office of Employer Ombudsman on-line through your MiWAM account or at 855-484-2636

APTA is encouraging congress to urgently pass legislation to expand locum tenens and expand financial grant relief beyond Economic Injury Disaster Loans to assist small businesses such as outpatient physical therapy clinics and small home health agencies, so that they can meet short-term obligations, such as payroll and rent, as well as costs associated with ensuring that they are able to comply with Centers for Disease Control and Prevention recommendations. Go to the Legislative Action Center to ask your legislators to pass this legislation now.  https://www.apta.org/TakeAction/

Additional proposed legislation in Congress would provide loans with 100 percent federal guarantees to small employers who keep their workers on payroll during the crisis. If small business owners avoid laying off workers, the loans would be 100 percent forgiven.

The loans would be permitted to cover payroll expenses, sick leave, supply chain disruptions, mortgage payments and other debts. It includes $240 million in grants for small business development centers and women’s business centers for counseling and it would provide loans with 100 percent federal guarantees to small employers who keep their workers on payroll during the crisis. If small business owners avoid laying off workers, the loans would be 100 percent forgiven.

Student Loan Relief:

Effective March 20, all borrowers with federally held student loans will automatically have their interest rates set to 0% for a period of at least 60 days. In addition, each of these borrowers will have the option to suspend their payments for at least two months to allow them greater flexibility during the national emergency. This will allow borrowers to temporarily stop their payments without worrying about accruing interest.

https://www.ed.gov/news/press-releases/delivering-president-trumps-promise-secretary-devos-suspends-federal-student-loan-payments-waives-interest-during-national-emergency

Additional Student Resources are found here: https://studentaid.gov/announcements-events/coronavirus

 

Special COVID-19 Video Message from MPTA President Mile Shoemaker

posted: March 20, 2020

Please click HERE to view this special message from the MPTA President, Mike Shoemaker.

 

 

Tricare Update - PTA Services will be covered as of April 16, 2020

posted: March 16, 2020

APTA announced that  the Department of Defense (DoD) released a final rule to add licensed or certified PTAs as TRICARE-authorized providers operating under the same qualifications established by Medicare. Services must be furnished under the supervision of a TRICARE-authorized licensed physical therapist.

This rule says that direct supervision will be required in a private practice setting. General supervision will be required in all settings other than private practice. These guidelines are in line with the Medicare supervision requirements.

APTA has been working for the recognition of PTAs as TRICARE authorized providers for many months and we appreciate the dedication and hard work of the PTAs, PTs, and physical therapy students who submitted comments on the proposed rule.

The rule is effective on April 16, 2020.

For questions regarding the rule, please contact advocacy@apta.org.

 

MPTA Requests Telehealth Coverage for Services

posted: March 15, 2020

MPTA initiated urgent dialogue with Priority Health and BCBSM regarding payment for telehealth-based PT services to facilitate the use of social distancing while continuing to deliver PT care for those who are unable to delay their care and who are among the most vulnerable.

MPTA has also initiated discussions with Meridian Health about coverage for telehealth and direct access. 

Updates will be provided as soon as they are available.  The letters can be viewed here:

             Priority HealthDownload fil

BCBSM  Download file

 

 

Telehealth in Michigan - Information for your practice

posted: March 15, 2020

Can a physical therapist in Michigan provide care via telehealth? 

Starting with professional scope of practice, APTA Policy is clear that telehealth can be an appropriate model of care delivery of physical therapy services (http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/TelehealthHODPolicy.pdf#search=%22telehealth%22).

Further, the FSBPT has a resource paper on important considerations for physical therapists utilizing telehealth (https://www.fsbpt.org/Portals/0/documents/free-resources/TelehealthInPhysicalTherapy2015.pdf).

Regulatory scope of practice is almost always more limiting than professional scope of practice, but there are also many instances of the Physical Therapy Section of the Public Health Code being silent on specific issues. So when you look at the Public Health Code, there is nothing in the Physical Therapy section that specifically permits or prohibits telehealth.  But a quick search of the General Provisions, which apply to all licensed health professionals, reveals that telehealth is permitted to be provided by licensed health professionals in Michigan: (http://www.legislature.mi.gov/(S(0dsbzvzpxu4lawibsw5ym4q2))/mileg.aspx?page=GetMclDocument&objectname=mcl-368-1978-15-161)

From a state regulatory scope of practice perspective, telehealth is permitted by physical therapists:

333.16283 Definitions.

Sec. 16283.

As used in this section and sections 16284 to 16288:

(a) "Health professional" means an individual who is engaging in the practice of a health profession.

(b) "Prescriber" means that term as defined in section 17708.

(c) "Telehealth" means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, "telemedicine" means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

(d) "Telehealth service" means a health care service that is provided through telehealth.

 

Further, the Insurance Code (MCL 500.3476) offers additional guidance:

  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer. Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the health insurance policy agreed upon between the policy holder and the insurer, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

  (2) As used in this section:

  (a) After December 31, 2017, "insurer" includes a nonprofit dental care corporation operating under 1963 PA 125, MCL 550.351 to 550.373.

  (b) "Telemedicine" means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided.

 

Further information regarding "scope of practice."

Expanding your professional boundaries is the epitome of professional practice because a good clinician is always learning. As you consider the directions in which you would like to grow, you also need to understand the legal/regulatory constraints that may impact your decision. 

“Scope of Practice” is a broad term that includes: 1) professional scope of practice as defined by CAPTE entry-level education standards, APTA positions and policies, and FSBPT resource papers, 2) regulatory scope of practice as defined by state law, and 3) personal scope of practice as defined by your individual experiences and professional development.  Other factors that affect your practice include third party payer regulations and facility policies.

All of the resources for determining professional scope of practice can be found at: http://www.apta.org/ScopeOfPractice/. Among the numerous links available is the link to the APTA Policies related to practice (http://www.apta.org/Policies/Practice/).  

Resources related to regulatory scope of practice in MI can be found at: https://www.michigan.gov/lara/0,4601,7-154-72600_72603_27529_27549---,00.html. Especially important are the links to the Physical Therapy section of the Public Health Code, the General Provisions of the Public Health Code, the Administrative Rules, and the FAQs.  Licensing and Regulatory Affairs (LARA), in consultation with the MI Board of Physical Therapy (aka the PT Licensure Board), promulgate the administrative rules and the FAQs which are an interpretation/application/operationalization of the Public Health Code, and have the force of law.  Navigating the legalese of regulatory scope of practice can be challenging, but MPTA is here to help.  One of the many member benefits is the ability to ask MPTA leaders questions about practice.  Although the MPTA cannot offer legal advice, it can provide highly informed opinion to get you going in the right direction. 

National Telehealth:  It would appear that despite the remarks from the President on expanding the use of telehealth, the declaration will not provide for a waiver to expand authorized health care professionals to deliver services via telehealth under Medicare. APTA will continue to press Congress to include legislative language that waives the current restrictions on PTs and other health care providers from delivering services via telehealth under Medicare to assist with the current COVID 19 situation.

 

SB 612 MPTA Testimony at Senate Health Policy and Human Services Committee Meeting January 30

posted: January 30, 2020

Visit our legislative resources page to view the testimony provided by MPTA President Michael Shoemaker at the January 30 Senate Health Policy and Human Services Committee meeting.  

 

 

CMS Reverses Most of Its Damaging Coding Edits

posted: January 25, 2020

Details remain to be worked out, but the bottom line is that CMS is reversing its decision to prohibit payment for evaluation and certain interventions delivered on the same day — a big win driven by the combined advocacy efforts of APTA, its members, and other stakeholders.

Click here to read the full article on the APTA website. 

 

Notice from BCBSM about Provider Authorization Form

posted: January 02, 2020

Updating changes to your Provider Authorization form

Blue Cross Blue Shield of Michigan is dedicated to safeguarding the protected health information of our members. These safeguards include completion of a Trading Partner Agreement and Provider Authorization form as part of the electronic data interchange setup process. All EDI trading partners must complete a TPA and Provider Authorization form before they can exchange PHI with Blue Cross.

Terms of the TPA require you to notify Blue Cross of any changes in your trading partner information. If you switch service bureaus (clearinghouses), software vendors, billing services or the recipient for your 835 files, you must update your Provider Authorization form. Updating the form ensures information is routed to the appropriate destination. You don’t need to update the Provider Authorization form if your submitter and Trading Partner IDs don’t change. 

You should review your provider authorization information if you’ve:

  • Joined a new group practice
  • Left a group practice and now bill using your own NPI
  • Hired a new billing service
  • Started submitting claims through a clearinghouse or you’ve changed clearinghouses
  • Decided you no longer want to receive 835 remittance files
  • Selected a new destination for your 835s

You must update your Provider Authorization form if you’ll be sending claims using a different submitter ID or routing your 835s to a different unique receiver or Trading Partner ID. To make changes to your EDI setup, visit bcbsm.com/providers and follow these steps:

  • Click on Quick Links.
  • Click on Electronic Connectivity (EDI).
  • Click on How to use EDI to exchange information with us electronically.
  • Click on Update your Provider Authorization Form under EDI Agreements.

If you have any questions about EDI enrollment, contact the EDI Help Desk at 1-800-542-0945. For assistance with the TPA and Provider Authorization form, select the TPA option.

 

Senate Bill 612 Introduced - Prior Authorization Reform

posted: November 13, 2019

We are very excited to announce the introduction of Senate Bill (SB) 612 which seeks to reform prior authorization practices in Michigan.  This bill is the result of our collaboration with a large provider and consumer advocacy group coalition called Health Can’t Wait.  The legislation is but 1 component of the this campaign that also includes consumer education and collection of patient stories.

The bill is sponsored by Senator Curt Vanderwall (Benzie, Crawford, Kalkaska, Lake, Leelanau, Manistee, Mason, Missaukee, Ogemaw, Osceola, Roscommon and Wexford).  The most important parts of the bill that impact physical therapy include:

  • Requiring payers to post prior authorization requirements on their public website and be readily available to providers at the point of care
  • Criteria that are based on peer-reviewed clinical review criteria which:
    • Must be based on national association guidelines
    • Account for atypical patient populations/diagnoses
    • Ensure quality of care
    • Be flexible for case-by-case deviation
    • Evaluated and updated annually
    • Be developed with input from health professionals licensed in the same profession
  • Requiring payers to “conspicuously” post statistics about denials and appeals, including the top 10 reasons for denial, on their public website

Please contact your State Senator and State Representative NOW and tell them about the adverse impact that prior authorization is having on our ability to deliver medically, necessary care to our patients.  For more information on the Health Can’t Wait coalition and to submit your patients’ stories, visit https://www.healthcantwait.org/

 

 

Guide to Access BCBSM Provider Manuals

posted: August 22, 2018

Following our meeting with BCBSM on May 11, 2018, the MPTA reported that BCBSM was moving to a vendor-based auditing program for its PPO, similar to what is currently being used for its Plus Blue product, starting this summer 2018. BCBSM stressed that this program is not being used as a utilization

management tool. Rather, it is a tool for fiduciary responsibility to ensure that policies and procedures are being followed and will be equally implemented across all health care providers and settings. Providers will be selected for audit based on computerized algorithms. Thus, it is difficult to predict for a given practice whether audit risk will increase or decrease under this new system.

In response to MPTA’s concern about transparency of auditing criteria, BCBSM stated that the criteria are the policies and procedures in the applicable Provider Manuals.  However, actually finding and accessing the Provider Manuals can be a substantial challenge.  Therefore, MPTA has outlined the requisite steps below:

Log onto the BCBSM website “Provider Secured Services”

Click “webDENIS” (must have webDENIS access)

Choose “Provider Manual”

     You will have a choice of 5 different Provider Manuals: 

      1) BlueCross PPO Provider Manual     click to choose

          click provider type  Independent Therapist or Freestanding Out Patient PT

          Search and you will get categories / chapters to choose from.  This particular manual is

          for therapies.

      2) BCN Provider Manual  

           When you make this choice, you must go through the manual to find the chapters    

           that refer to therapy.

     3) Blue Cross Medicare Plus Blue PPO Provider Manual 

     4) Blue Cross Medicare Private Fee for Service Provider Manual

     5)  Blue Cross Complete Provider Manual (for managed Medicaid)

           When you choose manuals 3,4 or 5 you must scroll through the index to find the

           chapters and pages that refer to therapy.  Unfortunately, there is no short cut to specific sections

           in these three manuals.

 

 

 

Public Health Code Amended to Allow Nurse Practitioners to Prescribe Physical Therapy - Effective April 9, 2017

posted: April 24, 2017

The Physical Therapy Section of the Public Health Code has been amended to allow Advanced Practice Registered Nurses to prescribe physical therapy:

 

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****



333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

 

 

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

Section 17201:

Sec. 17201. (1) As used in this part:

(a) “Advanced practice registered nurse” or “a.p.r.n.” means a registered professional nurse who has been granted

a specialty certification under section 17210 in 1 of the following health profession specialty fields:

(i) Nurse midwifery.

(ii) Nurse practitioner.

(iii) Clinical nurse specialist.

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****

 


333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

 

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

 

 


eviCore Clinical Criteria Guidelines Effective 2/14/20
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Michigan Medicaid
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  • MPTA Comments on Proposed Home Health Policy Changes - July 10, 2019

MPTA Correspondence Re: eviCore
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  • MPTA Email to BCBSM Re Direct Access Resources August 24, 2019
  • MPTA Letter to BCBSM July 26, 2019
  • MPTA Letter to BCBSM 3.22.19
  • MPTA Letter to eviCore - October 15, 2018
  • MPTA Email to BCBSM October 15, 2018
  • BCBSM Meeting Minutes - May 11, 2018
  • Summary of Meeting with BCBSM May 11, 2018
  • MPTA Letter to BCBSM April 24, 2018
  • MPTA Meeting with BCBSM and eviCore March 9, 2018
    • Summary - March 9 Meeting
    • Overview of corePath Survey Data
    • MPTA eviCore/corePath Narrative Themes
    • corePath Survey Data Analysis
  • MPTA Letter to BCBSM October 24, 2017
  • MPTA Complaint to Michigan Department of Insurance and Financial Services
  • MPTA Letter to Senator Stabenow
  • eviCore - Update on MPTA Strategies and Related Actions
  • MPTA Letter to BCBSM June 30, 2017
  • MPTA Letter to Priority Health June 6, 2017
  • MPTA Letter to BCBSM May 12, 2017
  • BCBSM Minutes from Meeting March 13, 2017
  • MPTA Letter to BCBSM March 13, 2017
  • MPTA Letter to BCBSM October 17, 2016
  • MPTA Letter to BCBSM June 23, 2016

Important Payment Resources

Medicare Resources

Medicare Claims Update

Fiscal Intermediaries (FI's) process Medicare claims for services provided in facilities such as Hospitals, Skilled Nursing Facilities (SNF's), Outpatient Rehabilitation Facilities (ORF's), and Comprehensive Outpatient Rehabilitation Facilities (CORF's). These FI's have web sites that provide a vast amount of information regarding Medicare coverage and billing. Your billing office will know the identity of the FI that processes your claims.

United Government Services (UGS) is the largest Medicare Part A Intermediary processing over 30 million claims nationwide each year. UGS serves customers in (insert association's state MI or WI) as well as many other states. The following UGS website contains valuable information that includes: the publication "Physical Therapy, Occupational Therapy and Speech-Language Pathology Outpatient Services Educational Update", Frequently Asked Questions (FAQs), Local Medical Review Policies, Medicare Memos (the monthly newsletter from UGS), links to Centers for Medicare and Medicaid (CMS) websites and more.

Medicare Links

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