Page 19 - OPTA Volume 48

Whew! What a Payer Roller Coaster Ride!
I can only hope that when you read this telehealth is closer to being a permanent option for physical therapy that we can offer our patients . I am happy to report that eventually most insurance companies aligned themselves and allowed telehealth during the COVID-19 pandemic, and when we billed the services correctly, the claims were promptly paid . Many payers will continue to allow telehealth beyond the end of the state of emergency date July 24 . 2020, until September 30, 2020 . In the meantime, we need to appreciate the silver lining that telehealth progressed more in three months than in three years! Now, we need to stay the course and provide successful outcomes, in addition to patient satisfaction, reduced cancellations, and no shows .
CMS and other commercial payers have put on hold the 2% sequestration reductions for services beginning May 1 through December 31 . The reduction will resume with January 1, 2021, dates of services .
TriCare has announced a pilot program for patients that present a primary diagnosis of LBP . Ohio is one of the ten selected states to participate . The program is offering to waive cost-sharing for three physical therapy visits to TriCare beneficiaries to encourage physical therapy versus imaging, opioids, and surgery .
• TRICARE beneficiaries must have a primary diagnosis of LBP.
• Beneficiaries must be referred by a TRICARE- authorized provider to receive physical therapy services currently covered by TRICARE.
• Only new therapy episodes of care will be eligible for the waived cost-sharing and provider reimbursements under this demonstration and will follow the current procedures for reimbursement.
• According to the final rule, licensed physical therapists and physical therapist assistants may provide covered physical therapy services to eligible beneficiaries.
You may be receiving a notice from Anthem asking for participation in their Commercial Risk Adjustment (CRA) Reporting . This program has been around for several years; however, Anthem is becoming more aggressive in offering this incentive to Providers to "close the gaps in care ." They are offering to pay the provider $100 per treatment/visit to document in their system or $50 for paper submission . You can read more about the program HERE .
Continue to watch for updates on the OPTA > Resource > Payment Policy tab for updates .
For more information, contact OPTA at:
opt@ohiopt.org.
Payment Policy Report
Berni Willis OPTA Payment Policy Specialist
OPTA | September 2020 | 19