Page 9 - OPTA Access March 2018

assessment and intervention (HBAI) services offered to injured workers OPTA and OOTA requested that PTs and OTs be permitted to initiate this service OPTA/OOTA requested that a healthcare practitioner should be able to initiate a referral for this service when health and behavior barriers are suspected to delay recovery Currently a HBAI has to be requested by the physician of record The OPTA/OOTA also commented on section (C)(3) which references a list of provider types who can provide assessment and intervention It was suggested that this be modi ed to state the health and behavioral assessment may be performed by any practitioner that is quali ed based on their education, training, and scope of practice to provide this service
Feedback from Ohio Bureau of Workers’ Compensation came on January 11th BWC completed their review and revisions and made updates OPTA comments were accepted in part and the rule draft was modi ed to allow any provider acting within their scope to perform health and behavioral assessment
Payment Policy Report
Berni Willis – Payment Policy Specialist
The past few months several payers have provided many issues to comment on, and one of the most important is CMS announced that they would begin a new audit process Targeted Probe and Education (TPE) The audit performed by the CGS,
the Ohio Medicare Administrative Contractor (MAC) in three tiers allowing the provider training and an opportunity to correct documentation and billing errors before submitting
any recommendations to CMS More information about this process is accessible on the CGS website The audit is performed by individual provider, not by Practice, Facility, etc
Medicare 2018 Fee Schedule was released and noted that both there were increases and decreases in commonly
used CPT codes Also, the orthotic and prosthetic codes
and de nition were revised noting that 97762 is deleted and CPT 97763 added Learn more on the Centers for Medicare
& Medicaid Services website You can review all the CPT reimbursement amounts on the CMS website Toggle to Ohio MAC to get the correct schedule If you are a member of APTA you can access their calculator, which also includes MPPR calculation at apta org
Additionally, Medicare will begin mailing the new Medicare
ID cards in April 2018 Due to security, there is no publication in what order the cards will be mailed The new id number
will be 11 characters in length made up only of numbers and uppercase letters, no special characters The cards will appear the same and the effective date will remain the same, the date
Exemption from First Aid Training
It was brought to the attention of OPTA that PTs who are Board Certi ed in Sports Physical Therapy are also required to take
a rst aid training course and ful ll the requirements of the Pupil Activity Permit if they want to pursue a coaching position within certain school districts There is an exemption to this requirement for many other licensed healthcare professionals Upon reviewing the board certi cation requirements for
sports physical therapy, we saw that many requirements are redundant. OPTA has submitted a request to the Of ce of Educator Licensure within the Department of Education to ask that Physical Therapists who are Board Certi ed in Sports Physical Therapy also be exempt from these additional training requirements
For more information, contact Amanda or Mikayla at: amanda@gov-advantage com and mikayla@gov-advantage com
each bene ciary was or is eligible for Medicare. It is important to note that ALL bene ciaries will receive a new card, even if they have enrolled with an Advantage plan You can print a free New Medicare Card Poster to place in your location, for more information for the patient, through the CMS website
Tricare - President Trump has signed the National Defense Authorization Act into law allowing PTAs to be eligible to treat patients with Tricare, however until the Department of Defense updates their policy, PTAs cannot treat the patient A huge stride has been made as we near crossing over the nish line.
Humana terminated the authorization requirement with Orthonet It is important however to note that you must carefully follow the patient’s policy requirements and documentation must meet CMS Medical Necessity Guidelines
The Ohio Bureau of Workers’ Compensation announced that lower back injuries would rst undergo at least 60 days of conservative care that includes physical therapy
Theramatrix effective on January 1, 2018 will only be authorizing care for Ford UAW Employees Ford UAW retiree claims are now being processed via Aetna Call Aetna to learn the required authorization process
New modi ers have been introduced to distinguish between Habilitative Therapy (96) and Rehabilitative (97) Payers have not yet identi ed themselves that will be using these new modi ers. Be sure to look closely at any denied Explanation of Bene ts commenting on missing modi ers.
Note: Hotlinks are available on the online version of ACCESS For more information, contact the OPTA of ce at: opt@ohiopt org
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Legislative & Payment Policy Report