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 [email protected] if you have a specific question as it relates to Payment.

Payment News:
 

Seeking Candidates for Payment Specialist

posted: February 04, 2019

MPTA is seeking candidates to become our Payment Specialist

The MPTA Board of Directors has approved and funded a paid position for this important role. 

Quick overview:

  • Part-time paid position, 10-hours/week.
  • Designed to assist MPTA members with their questions about payment for physical therapy services.
  • Expertise needed on physical therapy payment issues in the State of Michigan involving Michigan commercial insurers, Michigan Medicaid, Michigan Workers’ Compensation.
    • MPTA will continue to refer members with questions about federal payment issues e.g. Medicare, TRICARE, VA, etc. to APTA Payment Staff.
  • This position works with the MPTA Payment Director and Committee to educate MPTA members about payment issues in various formats such as direct phone calls, emails, conferences, newsletters, MPTA website postings, etc.
    • The Payment Specialist will have the full support of the MPTA Payment Team. 

This is a chance for you to engage directly with your MPTA colleagues, truly assisting them in their daily practice. 

Click here to download the full position description.  Email [email protected] with a letter of interest and a resume if you would like to apply.  

 

 

 

MDHHS Policy Updates - Final Bulletin Released - Effective August 31, 2018

posted: November 19, 2018

MDHHS recently published the final bulletin regarding the proposed policy changes on which MPTA had commented this summer.  The final bulletin, MSA 18-29 was effective August 31, 2018.  It should be noted that these policy changes were not reflected in the October 1, 2018 version of the Medicaid Provider Manual. Of note, one change is that independent (private practice) therapists are eligible to enroll retroactively (if needed for reimbursement purposes) back to January 1, 2018 and bill for all Medicaid covered therapy for dates of service on and after 1/1/2018.    Reimbursement is no longer restricted to Medicare coinsurance amounts for these dates of service.

Click HERE to dowonload the bulletin. 

 

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.".

 

 


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

  • 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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