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NCPTA Blue Cross/Blue Shield Quarterly Meeting

Did you know that NCPTA representatives meet with Blue Cross/Blue Shield NC (BC/BS) officials quarterly? Director-at-Large (DAL) for Payer Relations Flo Moses and former DAL of Payer Relations Emma White had been meeting quarterly with BC/BS officials for over 7 years. On February 26, 2018 Flo Moses and Executive Director Nancy Garland met with BC/BS Medical Director Dr. John Campbell and other BC/BS staff.

Co-Pays – For several years NCPTA representatives have discussed the high co-pay required of BC/BSNC patients for PT services which causes some patients not to receive physical therapy and others do not receive the PT needed to reach acceptable outcomes. For the 1st time since the discussion on co-pays started, BCBSNC is talking about how this problem might be addressed. We are encouraged by this discussion and will provide updates if these talks move forward. 

Opioid Crisis – NCPTA reported that NCPTA representatives have been involved in several meeting over the last couple of months with state officials in regard to the opioid crisis. The BC/BSNC officials Encouraged our efforts as they are aware that CDC lists physical therapy as the first alternative to opioids for the management of chronic pain.

Closed Provider Panels – We brought forth the concern of several members regarding closed panels. BCBSNC was receptive to the members’ concerns and provided contact information for the proper channeling of questions regarding this issue.

Disparity in Reimbursement among Physical Therapy Settings – NCPTA brought forth this concern again, as we have in the past, from a member who has requested an explanation for the disparity.  The answer from BCBSNC remained consistent with previous discussions which is that there are many parts of the negotiations with larger entities that are not negotiable for the private practice setting.  

Payer Relations Report
I would like to introduce myself as your new Director-at-Large (DAL) for Payer Relations. I have been an NCPTA member since I moved back to North Carolina in 1992. Since then, I have held several positions within the NCPTA and I am excited to now serve as an NCPTA Board member. The title for my position was DAL for Reimbursement. Payer Relations is much more appropriate as I have learned throughout the years as a private practice owner as we need to approach reimbursement aspect of our profession from a collaborative, relationship oriented perspective.

In the role of Payer Relations DAL, I will continue to represent NCPTA at the quarterly meetings held with Blue Cross Blue Shield (BC/BS) of North Carolina, as I have done for the past 7 years, to discuss issues important to physical therapy with BC/BS policy makers. In these meetings it has been reinforced over and over to me that we must help the insurers understand what we do, how we do it and the value of our services. We will continue these efforts with BCBSNC on your behalf in 2018. 

I would like to share with you the highlights of the APTA State Policy and Payment Forum which I attended as a representative of NCPTA in September, 2017. This is an annual meeting with representatives from each state’s Payer Relations and Legislative committee leaders. 

Define Your Value
Presentation on how important it is for PT’s and PTA’s to define their own value = Cost/Functional Outcomes and Patient Satisfaction. This is derived by the standardized collection of data, data, data!

Federal Regulatory Update

  • We avoided a potential 12% decrease in Medicare fee schedule for PT codes due to APTA comments and work regarding several misvalued codes, which resulted in 2% increase in 2018 for many codes.

  • Discussion of MIPS (Merit Incentive Payment System) – still unsure if/when it will be implemented for physical therapy, APM (Alternate Payment Model) – Value-based – Again – data, data, data – APTA Outcomes Registry, and other outcomes collection software applications are critical.

  • APTA is working to get co-pays for Medicare Advantage plans reduced.
Dry Needling
APTA is working with chiropractors to submit a CPT code for dry needling. This process takes several years, but the process has been initiated. The theme of collaboration with other health care entities is being encouraged and was discussed throughout the meeting.

Quality Update
Physical therapists need to consider themselves as part of the continuum of care, not an isolated Physical Therapy episode of care. Physical therapists should be in the emergency room initiating physical therapy sooner as a first intervention.

Licensing Board Consolidation
Other states are experiencing attempts to consolidate their licensing boards. North Carolina needs to be aware of these efforts and prepared to oppose these efforts as it does not save taxpayers money and will not create efficiencies. Consolidation also leads to decision making by individuals with reduced, or little, expertise in physical therapy.

Pain Prevention and Opioid Policy Initiatives
APTA, and now NCPTA, have been involved with the pain prevention and opioid policy initiatives. NCPTA meeting with state officials. Presentations on these issues were made by health analysts from the National Journal Network Science Initiative, federal legislators, other health care providers, insurers, think tanks, and academics.

Administrative Simplification
Proposals are being made to standardize the rules for submitting claims, i.e. same info in same boxes no matter what the insurance!

The summary take home points from the APTA Policy and Payment Forum coincide with my perspective on how I see my role in this position. It is important that the respective state associations stay informed and on top of developing legislation, regulations, and trends so physical therapists can prepare for these ever-changing policies. It is important for physical therapy to be more open to collaboration with other health care providers in pursuing change in certain areas.

Legislation and reimbursement policy go hand in hand, and it is key for the NCPTA to work harmoniously within the association, as well as, with other associations in our efforts to protect our profession and the public. Finally, all physical therapists and physical therapist assistants benefit from the work of the APTA and NCPTA in the areas of legislation and reimbursement whether or not they are members. However, the benefits of membership are endless.
Utilize the resources available to you through the NCPTA and the APTA. Important information was recently released by APTA on the 2018 Medicare Fee Schedule. Follow the link below to be prepared for the new fee schedule.
Happy Holidays and Happy New Year! Looking forward to working with you all in 2018. 

Flo Moses, PT, MS, AT-Ret