MN APTA COMMITTTEES & WORKGROUPS:
MN APTA COMMITTTEES & WORKGROUPS: |
If you have a question or concern regarding reimbursement, please contact MN APTA Executive Director Judy Hawley, PT. Your issue will be brought to the member(s) who have the expertise to respond to you. MN APTA keeps an ongoing log of questions and responses in the chapter office.
The purpose of the Reimbursement Committee is to be a resource to members regarding Physical Therapy reimbursement issues, and to enhance relationships with third party payers through dialogue and education regarding the practice of Physical Therapy. The Reimbursement Committee includes members from all areas of Physical Therapy practice; each member contributes to issues, concerns or questions relating to their area of expertise.
With the return of the Medicare Therapy Cap in 2006, the need to know the Medicare fee schedule is very important. The APTA website has a Medicare Fee Calculator on its web site for members. They also have a Therapy Cap Resource Center on the web site as well.
To access the APTA Medicare Fee Calculator:
Go to www.apta.org
Click on LOGIN on the top right side of the home page, and log in using your user name and password
Once logged in, return to the home page
On the left column of the APTA home page, click on "Reimbursement"
Click on the Fee Calculator link at the bottom of the Reimbursement Page
The mechanism for reimbursement in the Minnesota Workers Comp system has changed as of October 1, 2005. The system is still based on Medicare’s RVRBS system, which assigns a relative value unit (RVU) to each treatment procedure or modality. Maximum fees are based on the multiplication of the assigned RVU and the conversion factor. Prior to October 1, there was one conversion factor (dollar amount) used for all medical professionals. However, because previous legislation dictated that not all medical professionals should be paid the same, a “scaling” factor was developed to further modify the relative value placed on a service for PM&R and chiropractic. This effectively reduced the overall payment for some individuals even though the same code was being used.
The change that occurred on October 1 was the elimination of the scaling factor and establishment of separate conversion factors for four categories of health care provider. They are:
Medical/Surgical $76.31
Pathology/Laboratory $63.72
PM&R $66.16
Chiropractor $48.08
The statute required that there be no overall change in the maximum fees. The removal of the scaling factors was offset by the establishment of the new conversion factors.
The new law also mandated that the net effect, in cost to the system, be neutral. Because the chiropractic conversion factor increased, as permitted by the new law, there will be no annual adjustments to the other conversion factors. This also means that the conversion factors for the other three categories of medical practitioner cannot be lowered to offset the increase in the chiropractic conversion factor. The chiropractic conversion factor will increase to 72% of the Medical/Surgical rate. The first half of that change is reflected in the current rate and the second adjustment will occur on October 1, 2006.
Reimbursement for Physical Therapy services will now be calculated with the relative value of a modality or service multiplied by $66.16. It should be noted, that although the RVU system is used, the relative values in place are not the current (2006) values. The Department of Labor & Industry (DOLI) is still using the relative values from 1998 (except for 97140, which was added in 1999).
For further information, please consult the DOLI website. PM&R starts on page 245.
Questions? Please feel free to contact Dan Wolfe, PT, at wolfdog@therapypartners.com
Minnesota Chapter American Physical Therapy Association (MN APTA)
970 Raymond Avenue | Suite G-40 | Saint Paul, MN 55114
Phone: 651-635-0902 | Fax: 651-635-0903 | E-mail: info@mnapta.org | Online: www.mnapta.org
All contents © 2008 Minnesota Chapter American Physical Therapy Association. All Rights Reserved.
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