APTA NH Payment/Reimbursement Update

• IRF/SNF Fed Reg Rules- IRF appears will get 2% increase in payment and SNF pay cut of 4.6% but market basket update will offset most so will be more of a .7% cut total

• IP/OP/HC Fed Reg Rule changes coming soon. Scheduled in July, stay tuned

• CMS Telehealth has extended per the PHE with 5-month extension beyond the end of PHE. PHE renewed until 7/15/22 and with extension will bring it until 12/15/22.  Congress must act at that time and APTA hopes to get permanent extension for PT’s.  This does not include PTA sequestration.  Sequestration will stop once the $ is met but no known date.

  • LBP NCD references dry needling as acupuncture and now commercial payers putting in policies. APTA wants dry needling in PT guidelines not as acupuncture
• APTA At Work for Profession with AMA survey shows that many are still experiencing delays in payment; AMA is considering a  lawsuit to target abuses.
• Cohere roll out has been quiet.
• NIA/Magellan-Aetna-Centene Ambetter plans from 3/16/22 working well. Roll outs will be sent in advance and will work together to set up education.
• UHC/UHC CCP moving away from paper to electronic claims submission by June 1
  • OPTUM LBP and PT first program to decrease opioid use has moved from the pilot phase to general implementation.  However, uptake on the part of employers to participate in the program has been minimal.  As UHC promoted the program in 2020 during the height of the pandemic,  APTA asked to revisit.
  • 97140/97530 pairing edit and time in/time out for each CPT code.  APTA says unreasonable and is addressing.
  • Habilitation  needs to be prescribed by physician but those states with Direct Access are fighting this. NH does not appear to be impacted.
• Aetna looking at the 180-day evaluation policy. APTA working to change policy as may have 2^nd diagnosis unrelated.  Aetna says in that case they will allow if medically necessary but is not written.
  • • • 97530 and 97535 same date code pair will be overturning if denied.  No denials should be seen after April.
• Anthem dry needling no longer covered as of June 12,2022. APTA sent a  letter to challenge the decision  and awaits a response from AIM. Providers can send comments/ references supporting dry needling to the AIM Providers may send comments to aim.guidelines@aimspecialtyhealth.com.  Please be aware that AIM will not reflect your comments or input in this version of the guidelines.
• Noting payers are trying to become providers to control expenses and to advance value-based efforts.  This needs to be monitored. Integrated Health Systems and Virtual Programs. Some are calling it Virtual PT Programs which APTA and the chapters will address.

Please visit www.apta.org then click on the “Your Practice” tab at the top, then click on the “Payment” tab for more information on these and other payment areas of interest.