Page 35 - OPTA Access Spring 2021

I am excited to start 2021 with good news.
As most of you are aware, telehealth has made its long-awaited arrival into physical therapy. As I write this, most major payers have agreed to extend telehealth until the Pandemic Health Emergency ends, while a few have agreed to extend telehealth until the end of the calendar year. With APTA, we are excited to continue to advocate to all the payers the value of telehealth. Additionally, APTA will be announcing a virtual telehealth course series overview that will offer both core and electives courses. Continue to watch the OPTA site for updated telehealth end dates.
Payment Policy Report
Berni Willis OPTA Payment Policy Specialist
Insurance authorizations have become a growing administrative nuisance that is severely affecting patient care. Always verify your patient's benefits prior to beginning their care. Most companies will
no longer retro a missed authorization and the visit will remain unpaid. Help us document the struggles your office faces daily trying to get authorizations from AIM (Anthem), Optum (or United Healthcare), Cohere (Humana), ASH (Cigna), and others. The patient’s care is being delayed, or in some cases even denied. Most of these utilization companies or claims administrators use an algorithm to determine how they are authorizing care (or visits), without looking at all of the patient’s diagnosis, comorbidities, and medication records. Please send us case examples of when the patient is discharged (or self discharges) due to authorization constraints. Denied patient care detailed in their insurance policies is of interest to the insurance commissioner.
Third-party payers have made their presence this year as well. When third-party payers first came on the scene, the purpose was to be the "bridge" to give out-of-network patients a small discount to go to providers who were not in-network. At that time, they paid the provider above the rate that they would receive if they were in-network. As third-party payers grew, so did their umbrella span. You find now that
a third-party payer can discount your in-network plans and heavily discount the out-of-network plans. In many cases, the discount can happen without being noticed unless your billing department is on alert to watch the remittance advice closely. When you discover an additional discount (adjustment)
on your claim you should immediately contact the
third-party payer to find out what contract you are in-network with that is enforcing the discount. You will be surprised when you find it was a contract you signed in 1999! In most cases, the contract can be terminated within 60 days after you send a certified letter of termination to the payer.
For more information, contact OPTA at:
opt@ohiopt.org.
OPTA | March 2021 | 35