UPTA Reimbursement News

February 2011

Fellow PTs,

I recently had the opportunity to meet with Workers Compensation Fund of Utah. It was a very good meeting. I was surprised by how much respect the representative had for physical therapy and their willingness to discuss important and sensitive information. My main purpose in meeting was to continue to build on the relationship that former UPTA Reimbursement Chair, Lance Dougher, PT had established. I also wanted to learn more about the issue many of you are facing with Universal Smart-Comp. This is my understanding of the situation:

Smart-Comp came to WCF of Utah and offered to process their claims to ultimately help lower costs for WCF. WCF administration liked the idea of lowering overall cost, so they agreed to the partnership. Smart-Comp sent out letters to all providers of WCF that stated the partnership. The letter also stated that every provider would then also automatically become a member of Smart-Comp UNLESS they opted out. Now, many therapists are automatically members of Smart-Comp because; either they were ok with it, or they did not read the contract fully that was sent to them and did not opt-out.

When you send a claim to WCF it is never even opened by WCF. Their processing department is basically set up, currently, to automatically send claims to Smart-Comp. Smart-Comp then processes any claims for their members, or will send those that are not part of Smart-Comp back. WCF will then process those claims. So far this has been saving WCF money due to the partnership.

Smart-Comp is a national company. They have contracts with many states. They partner with WCF firms to decrease their paper work and they fund this by taking a portion of the therapist/provider’s payment. So the therapist/provider gets paid less for the service they provide when they have a contract with Smart-Comp. The therapist/provider will get their full payment if they deal directly with WCF and eliminate going through Smart-Comp.

If you are currently having concerns about Smart-Comp here are a few ways to address them:

1. Let WCF know when Smart-Comp is not adhering to the Utah Fee Schedule.

2. If you never opted out of anything, you are likely a member of Smart-Comp.

3. Go to http://www.universalsmartcomp.com to learn more about them and to find information on how to contact them to find out if you are a provider.

4. If you are unsatisfied with how they pay claims or their service you can opt-out just by calling them.

5. If you have opted-out you can label your claims as needing to be processed by WCF. Do this directly on the envelope you mail out, in BOLD, etc. It will not guarantee those claims will be stopped from going to Smart-Comp first, but it can help WCF in noticing that it should not be sent. Also, if you have opted out, the claims should be sent back to WCF unprocessed anyway, there just may be a small lag time.

6. If you have further questions let me know and I will try to find out as much as I can. I have already sent emails to Smart-Comp and hope for responses soon.

Sincerely,
Aaron Hackett, DPT
Reimbursement Chairperson

January 2011

Dear Physical Therapist Friends and Colleagues,

I am excited to be part of the UPTA Board and want to be part of such a great profession.

In early December, I had the chance to take part of the APTA Reimbursement Chair Meeting. This was a meeting with reimbursement chairs of all the states and APTA staff the works on payment issues. This was a great meeting and really helped me see just how much work APTA does for the profession. I learned that they are at our disposal and really want to hear from all of us on what the issues are we face. They want to reach out to all of us. The attached file is a summary of all the notes we went over. Please look over it, and if there are questions on a certain topic please let me know. We went over many topics including medicare, workers comp, health reform, current issues, CPT updates, and more. There is important information for each area of physical therapy as well as many tips that are working in other states to improve business; so I really urge you to go over the information!

Below, I also have a list of some information I've received as I've contacted each company.

Thank you for your support, and please do not hesitate to contact me:

Aaron Hackett, DPT
UPTA Reimbursement Chair
amhackdpt@hotmail.com
801 699-7106

2010 Reimbursement Chair Meeting Summary »

Altius – No longer need to authorize the first 6 visits, will need auth for the 7th, etc. They will still be requiring a physician referral for PT. They will not discuss their fee schedule with me as it is “proprietary. Any contracting PT can call a provider service rep to discuss it. Remember that for plans with a yearly limit – those are for PT/OT/Speech combined.

Aetna – State they don’t require a referral any longer (however I have been notified of a few issues clinics are having please let me know if you are seeing issues with this). Spoke with on phone, has yet to respond to my email.

BCBS – There are some member benefit contracts that do limit the $ amount on PT. They have a “what’s new” section of their website that usually updates on all changes. Fees are updated in July. All panels are still open and the process is done all online now. PT as a whole is doing very well with BCBS!

Educators (EMI) – Best bet is to bill electronically on HCFA form. Make sure to include the provider NPI #. Fee schedule is negotiated through BeechStreet. No issues

Medicare – through Noridian, please read medicare information on attached file

PEHP – no new changes as of now that they made me aware of. They are not credentialing new individuals at this time. If they higher on with a group that is already on the panel then they can participate. Can be looked at on an individual basis.

Western – WISE should show an increase in reimbursement for 2011! They are still seeing many coding errors and misuse of KX modifiers. Recommend getting your coders certified if possible. Getting info back from payers that there are concerns about duplicate claims and a general lack of documentation to support claims and necessity of PT. Also recommend investing in software that tracks your denials or pendings so that you can more easily fix the issue instead of just “resubmitting” the claim. The current cost of processing duplicate claims is HUGE

WCF – will likely be meeting with them introductorily January 7th. Will no longer be paying for electrodes for iontophoresis. Take home supplies such as Thera-putty and bands are covered. State there is a problem with providers billing the same date of service on separate HCFA forms, “There are 6 lines on a HCFA. Providers may bill 3 modalities/procedures per date of service so 2 dates or service may be billed per HCFA. However if there are more than 3 modalities performed per DOS a new HCFA should be used.” Please make sure your claim numbers, CPTs, and provider payment address are correct. Fee schedule is updated on 12-1 of each year. Providers can always contact the Labor Commission with changes or issues they have. The Medical Fee Advisory Committee meets in Spring, so best to get recommendations in before March. Issues related to payment should be directed to PRG at 385-351-8300. There is a WCF conference Friday Jan 28th in St. George at Dixie State College in the Gardner Center from 7:30 to 12:30. Registration forms are available on the Utah Labor Commission website (http://www.laborcommission.utah.gov/) right on the home page (on the right hand side). It is only $40.

In the process of contacting Cigna, DMBA, UHC, and Utah Labor Commission

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