Insurance anti-assignment clauses
By Franklin J. Rooks Jr, PT, MBA, Esq
April 2014
Many physicians have come to the conclusion that some insurance contracts are not worth having. More and more physician specialties have opted out of participating provider contracts or have chosen not to participate in the first place. Reimbursement amount is the primary reason for not participating. The amount allowed for various CPT codes simply is not enough. On top of that, there is Multiple Procedure Payment Reduction (MPPR). This ominous concept was crafted by the Centers for Medicare & Medicaid Services (CMS). The MPPR functions to reduce the allowable amount of multiple medical procedures performed during the same session by the same provider.1 Insurance carriers, such as United Healthcare, have modeled their reimbursement on this CMS policy and implemented their own versions of the MPPR.2 Often, in-network reimbursement is not commensurate with the education, skill, and value that the physician delivers.
April showers bring May flowers and a host of campaigns to help create safer and healthier communities.
By Don Levine, PT, DPT, FAFS
May is not only a time of year for spring blooms, but also a month that highlights several causes. For instance, May is National Bike Safety Month, making May a great time to educate your patients and your community. May is also National Stroke Awareness Month, another area where a physical therapist’s (PT’s) education is vital. And finally, we celebrate Mother’s Day!
How will new laws affect our physical therapy practices?
By Amanda Somers, PT, DPT
It was a cold and wet winter day when I sat down to write this article, and all I could think about was spring. April weather is great in South Carolina, but as much as I wanted warm weather, I was also anxious about the environment for physical therapy by April. Will the sustainable growth rate (SGR) payment methodology be changed? Will it be favorable for our patients and practices? Or will Congress once again kick the can further down the road? Even worse, did the March deadline come and go, leaving us with a 20 percent SGR cut and no cap exceptions process? The battle seems to be the same—in fact there has been little change since 1998. So the questions I ponder are: Does APTA have fighting power left? Did our members rally for the fight or wearily sit on the sidelines, saying “What difference can I make?”
Using EMR and Key Performance Indicators to manage your practice.
By Bridgit Finley, PT, DPT, OCS
Most of us business owners became owners because we were skilled practitioners, not because we knew how to run a business. A business owner requires a skill set different from that of a physical therapist; we must shift roles from hands-on practitioner to manager. Instead of working “in” the business, we now need to work “on” the business and be able to understand financial metrics.
By Angela Wilson Pennisi, PT, MS, OCS
Issues related to electronic medical records (EMR) and practice management systems may occupy more time and energy than most practice owners and managers would like. If you are in the process of selecting an EMR, evaluating the multitude of options can be overwhelming. A lot like dating, a single program will rarely possess all the desired qualities. In addition, your new EMR, like any potential life partner, is also likely to possess some undesirable qualities that you did not anticipate! (Of course, I am not speaking from experience since my husband is perfect, and I am sure he would say the same about me.)
