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:
 

eviCore corePath Program WILL be effective July 1, 2018 for BCBSM commercial products - Training Dates scheduled

posted: November 20, 2017

Important Update:  BCBSM has issued a correction to MPTA that the eviCore corePath Program WILL be effective July 1, 2018 for its commercial products.  Additional information and training dates for the corePath program that will become effective January 1, 2018 for the Medicare Plus Blue product is now available on the webDENIS website and HERE

 

BCBSM - eviCore Update 11/7/2017

posted: November 06, 2017

The MPTA Payment Committee met this morning with BCBSM, who provided an overview of the changes to the eviCore program.  Although many more details will be forthcoming, there are several important changes:

1) The new corePath program will replace the existing eviCore program starting January 1, 2018 for the Medicare Plus Blue product and July 1, 2018 for the BCN products.

2) implementation of the eviCore program to BCBSM commercial products will start July 1, 2018.

3) Training for the new corePath program will be made available by BCBSM very soon.  The MPTA believes the corePath program appears to be an improvement on the current program.

 

Final Analysis of Member Survey Regarding eviCore Experience in 2017

posted: August 03, 2017

CLICK HERE to view the final analysis.  Thank you to all who participated in the survey.

 

New APTA Toolkit re: Utilization Management

posted: May 10, 2017

Go to the APTA website for this new resource:

  • Utilization Management Toolkit New

    This toolkit offers an overview of challenges and opportunities for PTs in the commercial sector, strategies to mitigate the current and future impacts of UM use, and ways to foster cooperation between providers and UM vendors so that both parties benefit. 

 

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.".

 

 


MPTA Correspondence Re: eviCore
[Click to Login and View]

  • BCBSM Minutes from Meeting November 6, 2017
  • 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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