APTA Michigan'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, APTA Michigan 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 contact@aptami.org if you have a specific question as it relates to Payment.

Payment News:
 

Institutional Provider's Therapy Claims Suspended by MACs

posted: February 24, 2021

APTA is communicating with CMS about an issue impacting rehab agencies, hospital outpatient departments, and CORFs' therapy claims across the Medicare Administrative Contractors. Therapy codes are receiving Reason Codes 36136 and 36381 in error, resulting in claims being suspended. A fix has been identified and is scheduled to be loaded into the claims processing system in coming weeks. The MACs are working with CMS to see if they can move more quickly, and APTA is pushing for a faster resolution.

APTA also encourages impacted providers to alert their CMS Regional Office with their concerns about the impact of the delay on claims processing, and to contact their members of Congress. Please monitor your MAC's open claims issues webpage for updates. APTA will share more information with providers as it becomes available.

If you are an institutional provider whose therapy claims are being suspended, contact APTA at advocacy@apta.org.

 

Humana updates NCCI Edit Files

posted: February 16, 2021

Humana will adopt the new CMS edit files which have deleted many problematic edits for PTs. Humana will apply the edits retroactive to 1/1/20. They will not automatically reprocess claims but they will reprocess if claims are resubmitted.

Summary of current NCCI Edits status with insurers:

  • CIGNA will not retroactively process claims but will acknowledge the NCCI edits deletions starting 1/1/2021.
  • Aetna will retroactively reprocess claims to 1/1/2020. However, providers DO NOT need to resubmit their claims. Aetna will auto-process the claims. Aetna has indicated this could take several month.
  • Humana will retroactively reprocess claims to 1/1/2020. However, providers DO need to resubmit their claims.

 

Update from Paramount Regarding Treatment of Chronic Vertigo

posted: January 11, 2021

Issued December 2020:

https://www.paramounthealthcare.com/assets/documents/medicalpolicy/PG0193_Treatment_of_Chronic_Vertigo.pdf

 

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.".

 

 


eviCore Clinical Criteria Guidelines Effective 2/14/20
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Michigan Medicaid
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  • APTA MI Letter to BCBSM RE Direct Access
  • APTA MI Letter to BCBSM RE Dry Needling
 

Michigan Medicaid
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  • APTA Michigan Comments on Proposed Home Health Policy Changes - July 10, 2019
 

APTA Michigan Correspondence Re: eviCore
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  • APTA Michigan Letter to BCBSM August 18, 2020
  • APTA Michigan Email to BCBSM Re Direct Access Resources August 24, 2019
  • APTA Michigan Letter to BCBSM July 26, 2019
  • APTA Michigan Letter to BCBSM 3.22.19
  • APTA Michigan Letter to eviCore - October 15, 2018
  • APTA Michigan Email to BCBSM October 15, 2018
  • BCBSM Meeting Minutes - May 11, 2018
  • Summary of Meeting with BCBSM May 11, 2018
  • APTA Michigan Letter to BCBSM April 24, 2018
  • APTA Michigan Meeting with BCBSM and eviCore March 9, 2018
    • Summary - March 9 Meeting
    • Overview of corePath Survey Data
    • APTA Michigan eviCore/corePath Narrative Themes
    • corePath Survey Data Analysis
  • APTA Michigan Letter to BCBSM October 24, 2017
  • APTA Michigan Complaint to Michigan Department of Insurance and Financial Services
  • APTA Michigan Letter to Senator Stabenow
  • eviCore - Update on APTA Michigan Strategies and Related Actions
  • APTA Michigan Letter to BCBSM June 30, 2017
  • APTA Michigan Letter to Priority Health June 6, 2017
  • APTA Michigan Letter to BCBSM May 12, 2017
  • BCBSM Minutes from Meeting March 13, 2017
  • APTA Michigan Letter to BCBSM March 13, 2017
  • APTA Michigan Letter to BCBSM October 17, 2016
  • APTA Michigan 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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