Apple and Apta's Physical Therapy Appeal letter

Apple and Apta's Physical Therapy Appeal letter mynextmove.org

Apple and Apta's Physical Therapy Appeal letter

The American Physical Therapy Association (APTA) is an individual membership organization based in the US that represents approximately 100,000 physical therapist members, physical therapist assistants, and physical therapy students. The nonprofit association, based in Alexandria, Virginia, seeks to improve the health and quality of life of individuals in society by advancing the practice of physical therapy, education, and research, and by increasing awareness and understanding of the role of physical therapy in the nation's health care system.

APTA annually holds two major conferences & publishes the Physical Therapy Journal, a leading international journal for research in physical therapy and related fields and also PT in Motion, a professional problem magazine that provides legislative, health care, human interest, and association news.

APTA also advocates on behalf of the profession & for issues that have an impact on public health and welfare such as funding for health research and for adequate health care workers. It lobbied health care reform to improve access to health care.

APTA was originally formed in 1921 as the Association of American Women's Physical Therapy. The association was first headed by President Mary McMillan, and the executive committee of elected officials arranged for the Association, which included 274 charter members. In 1922, the association changed its name to the American Physiotherapy Association, and also men treated. Membership grew to just under 1,000 in the late 1930s.

With the advent of World War II & the national polio epidemic during the 1940s until the 1950s, physical therapists were more in demand. Association membership swelled to 8,000, and the number of physical therapy education programs across the US increased from 16 to 39.

During the mid 1940s, the association adopted its current name, employed several full-time staff, and opened its first national office in New York City. The House of Delegates representing members of the chapter was established to establish policies. The House elects the board of directors, formerly the Executive Committee, to manage the association. In addition, sections are created to promote and develop the specific objectives of the profession. Among the initial sections are the School (now the Education Section) and Entrepreneurs (now the Private Practice Section).

In the 1960s, the APTA membership reached approximately 15,000, and the number of national education programs increased to 52. At present, 242 institutions offer physical therapy education programs and 364 institutions offer physical therapist assistant education programs in the United States. These numbers will change significantly in the coming years to cover 17 PT development programs and 18 PTA development programs.

Apple and Apta's Physical Therapy Appeal letter therapynewsletter.com

About Us

Apple Physical Therapy is one of the providers of physical rehabilitation, massage, work, and massage therapy in Washington State. Operating locally since 1984, the Apple Physical Therapy clinic is located throughout Puget Sound, which is dedicated to providing superior patient care, and is committed to serving the local community where patients live and work.

In October 2014, Apple Physical Therapy joined the ATI Physical Therapy family, partnering with the largest physical therapy company in the country with one brand. All clinics, therapists, and clinic directors will remain in place, with the same dedication to excellent patient care and local communities that have been typical of Apple for 30 years.

Don't Slip on Appeals: Tips & Resources to Help You Navigate Payers and Members of the Board of Commissioners

Everyone knows the old saying about death & tax is the only certainty in life. Physical therapists (PTs) and physical therapist assistants (PTA) may be able to add 1 more to the list: withdraw payment decisions from insurance companies.

Here are some tips and resources from APTA, to help you do it right.

Tips

Appeal is important ...

Yes, the appeal process adds another administrative burden to your costs, but do not forget the process when you feel that the required medical services have been rejected or partially approved. You have the responsibility to protect the patient if the payment for the appropriate treatment is rejected. And, remember, you will not be able to pursue appeals at a higher level - the insurance commission office - unless you have carried out due diligence and spent all other review methods.

but must be smart.

The appeal takes time for you, but they are also time-consuming & expensive for the payer. Payers track the number of appeals submitted by service providers, and they see a high level of unprofitable utilization of vendor statistics.

The patient's voice carries a lot of weight

Patient experience is important, and mass protests from consumers will get the payer's ear, the employer (especially the insured himself), and the insurance commissioner. Delays in approval of authorization, visits approved little by little by waiting in between, or rejection of medically necessary services are all examples of access problems. The job of the insurance commissioner is to protect consumers, and the office is very interested in hearing about access problems.

Apple and Apta's Physical Therapy Appeal letter healhy.unl.com

So make sure the patient has the necessary resources.

Yes, patients should be encouraged to report problems with access to payers, employers, benefit managers, human resources, as well as the office of the insurance commissioner, or whatever appropriate body may be in the state, in writing or by telephone. But they need to know who to contact. Give consumers the contact information they need to facilitate timely reporting.

Know what insurance commissioners are and aren't interested in

You may experience an increase in expenses as well as a reduction in payments as a result of using users from third-party vendors or vendor management (UM) vendors, but the problem is not in the insurance commissioner's domain. Instead, it is ready to show measurably through collecting data on how UM vendor policies adversely affect patient access to medically needed services.

And work, sometimes collectively, to supply important data.

Work with your country chapter to collect data that will show the problems you and your patients experience - or at the very least, get your clinic to collect clinical data.

Resource

Documentation

Accurate and complete documentation is the main tool in any appeal. Start with the "Key to Effective Documentation," a large picture review published in the August 2016 issue of the magazine PT in Motion. From there, switch to APTA resources on the association documentation web page.

Appeal

Get the basics through the FAQ offered on the APTA claim rejection web page; then, when you are ready, use this appeal letter outline (.pdf) as a template for your own challenge.

Insurance commission

The April 2016 edition of PT in Motion magazine includes a big picture of filing complaints with insurance commissions (and if you attend the APTA State Policy and Payment Forum, be sure to check out the escape session titled "Working with the State Commissioner Insurance Office: Case Study"). Contact and other information for each state insurance commission is available on the National Insurance Association Association website. If the complaint is about quick payments, you can access the state-by-state overview of fast payment laws.