payment reform
The American Physical Therapy Association has been promoting the Alternative Payment System (APS) for some time now. In fact, this was the original effort pushed forth by the association in order to effectively reform the payment system in the physical therapy field.
The APS has been used to include reforms on payments, on the regulatory aspects of the field, as well as the legislative aspects. A large amount of the focus when it came to the Alternative Payment System was to completely change the coding system utilized by those that work in physical therapy.
The goal was to move away from the fee system that works for each service and move towards a coding system that covers each session. It is believed that if a new payment system is in place, rehabilitation for patients will be more successful. The fee-for-services resulted in a massive amount of legislative and regulatory burdens on those that work in the physical therapy field.
As a result, the APTA elected to aggressively push for alternative payment systems and changes in the coding methods of the field. It is believed that the integration of these things could prevent certain policies from occurring and reducing general hardships for physical therapists. In the year of 2011, CMS released a fee schedule that outlined 3 different approached for therapy caps.
The most popular of these was the coding system that session-based treatments. Just two years later, the Medicare Commission referred to as “MedPAC” included the recommendations for those needing physical therapy under Medicare services. Additionally, it included reductions in payments, controls on utilization, and limitations on access.
The Payment Reform Stemming from the Alternative Health Payment System
The new coding method will aid in eliminating the current coding system, with places a strong emphasis on procedures and modality. When transitioning to the coding system that is based on per-session, it will allow physical therapists to bill patients and insurance companies using just 1 code for each session. Naturally, there will be many exceptions that may come into play. As a result of these exceptions, some of the current codes of the old system will still be available so that PTs may report certain services separately.
The new codes that will come into place with this payment reform will describe the work of the clinical-based practices in higher detail. Additionally, these codes will be better able to describe the severity of the patient and their condition, the intensity of the services, and several other important details. Examples include edits to the codes, and payment reductions for multiple services.
This payment reform system will offer the best level of care for patients. It will look at them – as individuals – and ensure that they are receiving the care that they need. There will be no need for patients to receive unnecessary services and treatments. As a result, insurance companies and patients will pay less and will have a better chance of overcoming the unique challenges that they face.
