APTA Releases Webinar on Repeal of Medicare Cap

APTA Government Affairs released a webinar with details on the Medicare Cap and other items included in the budget bill repealing the cap.

The link can be found on the APTA website at www.apta.org/insiderintel. Click on the February 15 recording posted under the "Archives" section.

The budget bill contained the following provisions:

  • Permanently extend the current exceptions process.
  • Claims that go above $2,010 (adjusted annually) still will require the use of the KX modifier for attestation that services are medically necessary.
  • The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027; however, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
  • Claims that go above $3,000 will not automatically be subject to targeted medical review. Instead, only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.
Medicaid Managed Care Concept Paper - Therapists Not Included

DHHS Medicaid issued a managed care concept paper, Prepaid Health Plan Network Adequacy and Accessibility Standardsrecently to consider standards for perspectives of beneficiaries, plans and providers on what each defines as an “adequate and accessible” network. The proposed network does not include physical therapists, occupational therapists, respiratory therapists or speech/language pathologists.

NCPTA will be advocating for the inclusion of therapists in the Appendix B: Providers Subject to Specialty Care Access Standards. We are encouraging members to also comment on these standards. Comments can be emailed to Medicaid, through March 29, 2018, at transformation@dhhs.nc.gov.

NCPTA Officials Attend Medicaid Opioid Stakeholders Meeting
The Medicaid Outpatient Specialized Therapies Stakeholder Committee held a committee meeting on February 1 to discuss adult therapy services. Flo Moses, Director for Payor Relations and Liz Reeser, Payor Relations Committee member attended the meeting on behalf of NCPTA. Medicaid’s Outpatient Specialized Therapies staff have been charged with developing policy recommendations to address the opioid crisis. Due to the complicated clinical coverage policy for therapy services for adults the group was asked to make new recommendations for therapy services for adults. Read More
  North Carolina Student Conclave
Hosted by the North Carolina Student Special Interest Group

All North Carolina DPT & PTA students are encouraged to attend!

March 24, 2018
Breakfast & Lunch Provided

Mary Duke Biddle Trent Semans Center
   for Health Education

Duke University Medical Center
Durham, NC 27710
$20 NCPTA Members
$30 Non-Members

Register Here

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PT Pub Night (following Conclave)

Ponysaurus Brewing

5:30 PM

219 Hood Street, Durham,NC 27701

Jimmy McKay will be in attendance!


Advocacy Day 
Thursday, May 31, 2018
Registration and Presentations
North Carolina Museum of History
Schedule Visits
After 10:00am
NCPTA's legislative agenda cannot succeed without your involvement!
NCPTA Updates
Extended to July 8, 2017

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PT Pub Night (after NCPTA Student Conclave)

North Carolina Student Conclave