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Outpatient OTAs and PTAs in Kansas are facing a 50-percent pay cut from Blue Cross Blue Shield which began on Jan. 1, 2011.
(This post is from An article by E.J Brown News Watch on: Advance for Occupational Therapy Practitioners website)
...Blue Cross issued a statement rescinding part of the policy.
"After speaking with industry experts across the country and receiving input from our physical medicine partners in Kansas during the past several weeks, we observed that we were interpreting AMA/CPT codes as they relate to services provided by certified physical therapist assistants (CPTA) and certified occupational therapy assistants (COTA) more narrowly than others in our industry," the statement read. "We recognize that there are a range of therapeutic services that CPTAs/COTAs can perform under the direction of a therapist and will align our policy to complement industry standards."
Nevertheless, the insurer's rate cut will go into effect as scheduled.
"We are, however, not changing our plans to recognize CPTAs/COTAs as a class of providers that can bill separately under their own National Provider Identification (NPI) number," the statement said. "Likewise, we will hold the line on health care costs by reimbursing these providers at 50 percent of our maximum allowable payment established for each covered service they provide our members beginning Jan. 1, 2011."
The company gave two reasons for doing this. First, it is noting the difference in education and certification between assistants and their professional colleagues. Right now, assistants from both professions still enter practice at an associate-degree level, whereas OTs and PTs enter at masters' and doctoral levels. However, both levels of each profession are regulated in Kansas. Occupational therapy assistants have been fully licensed there for more than 10 years. Physical therapist assistants are certified.
The other reason for the cuts are telling. They had to do with some recent incidents in the Sunflower State.
"Audits indicated some physical medicine providers weren't adhering to Blue Cross guidelines and improperly billing the insurance company for services provided," the Journal reported, attributing the information to Blue Cross spokesperson Mary Beth Chambers. She added, "It was not widespread, but it was enough to get our attention."
The Journal also reported that "In 2009, Chambers said, physical medicine had the highest reimbursement total of all of its health care providers. She said she didn't know how much money would be saved by the new provider classifications."
The average annual salary for each profession in Kansas is about $50,000.
Chambers told the Journal that Blue Cross sees the difference in reimbursement rates as simply a "write-off for the medical practice."
The new classifications won't apply to therapy provided in hospital settings. Still at issue, however, is the insurer's bid to require that both PTAs and OTAs receive on-site supervision. Occupational therapy assistants have never been required to do that. In Kansas, even PTAs may be supervised by phone, according to Lori Khan, program director of the physical therapy assistant program at Washburn University.
Kahn also told the Journal that "Blue Cross' action will 'trickle down' and cause the university to see a drop in the number of students applying to the physical therapy assistant program."
Janice Bacon, program director of the occupational therapy assistant program at Washburn, "said she didn't expect the new provider classifications to deflate enrollment in the occupational therapy assistant program because the need for occupational therapists and occupational therapist assistants throughout the state is so great."
E.J. Brown is editor of ADVANCE.
[/i]
I would Like to know how all you PT's/PTA's and OT's/OTA's feel about this, It's interesting that these changes of reimbursement won't apply to assistants who work in hospitals. If an occupational/physical therapist assistant leaves his/her hospital practice and works in outpatient, is his/her work then worth 50% less? Are his skills suddenly reduced by 50%. Is that assistant 50% less qualified to care for patients? I encourage everyone who cares about the future access to therapy in the US to write a letter explaining the value of assistants to BCBS of Kansas and please forward a copy to your representatives, senators, your state insurance commisioner and to Secretary of Health Kathleen Sebelius.
- or just post your opinion-
Honestly to put this into perspective-this trend of 50% cuts in reimbursement will more than likely spread to other states which will continue into a cascading effect to even more states, unless we voice a strong disagreement- As a taxpayer, and working professional especially if you work in Outpatient Physical Therapy- ask yourself: Can you afford not to say anything-if nothing is done about this what do you think will happen to outpatient physical therapy? What are your thoughts about this outrageous cut in reimbursement?
(This post is from An article by E.J Brown News Watch on: Advance for Occupational Therapy Practitioners website)
...Blue Cross issued a statement rescinding part of the policy.
"After speaking with industry experts across the country and receiving input from our physical medicine partners in Kansas during the past several weeks, we observed that we were interpreting AMA/CPT codes as they relate to services provided by certified physical therapist assistants (CPTA) and certified occupational therapy assistants (COTA) more narrowly than others in our industry," the statement read. "We recognize that there are a range of therapeutic services that CPTAs/COTAs can perform under the direction of a therapist and will align our policy to complement industry standards."
Nevertheless, the insurer's rate cut will go into effect as scheduled.
"We are, however, not changing our plans to recognize CPTAs/COTAs as a class of providers that can bill separately under their own National Provider Identification (NPI) number," the statement said. "Likewise, we will hold the line on health care costs by reimbursing these providers at 50 percent of our maximum allowable payment established for each covered service they provide our members beginning Jan. 1, 2011."
The company gave two reasons for doing this. First, it is noting the difference in education and certification between assistants and their professional colleagues. Right now, assistants from both professions still enter practice at an associate-degree level, whereas OTs and PTs enter at masters' and doctoral levels. However, both levels of each profession are regulated in Kansas. Occupational therapy assistants have been fully licensed there for more than 10 years. Physical therapist assistants are certified.
The other reason for the cuts are telling. They had to do with some recent incidents in the Sunflower State.
"Audits indicated some physical medicine providers weren't adhering to Blue Cross guidelines and improperly billing the insurance company for services provided," the Journal reported, attributing the information to Blue Cross spokesperson Mary Beth Chambers. She added, "It was not widespread, but it was enough to get our attention."
The Journal also reported that "In 2009, Chambers said, physical medicine had the highest reimbursement total of all of its health care providers. She said she didn't know how much money would be saved by the new provider classifications."
The average annual salary for each profession in Kansas is about $50,000.
Chambers told the Journal that Blue Cross sees the difference in reimbursement rates as simply a "write-off for the medical practice."
The new classifications won't apply to therapy provided in hospital settings. Still at issue, however, is the insurer's bid to require that both PTAs and OTAs receive on-site supervision. Occupational therapy assistants have never been required to do that. In Kansas, even PTAs may be supervised by phone, according to Lori Khan, program director of the physical therapy assistant program at Washburn University.
Kahn also told the Journal that "Blue Cross' action will 'trickle down' and cause the university to see a drop in the number of students applying to the physical therapy assistant program."
Janice Bacon, program director of the occupational therapy assistant program at Washburn, "said she didn't expect the new provider classifications to deflate enrollment in the occupational therapy assistant program because the need for occupational therapists and occupational therapist assistants throughout the state is so great."
E.J. Brown is editor of ADVANCE.
[/i]
I would Like to know how all you PT's/PTA's and OT's/OTA's feel about this, It's interesting that these changes of reimbursement won't apply to assistants who work in hospitals. If an occupational/physical therapist assistant leaves his/her hospital practice and works in outpatient, is his/her work then worth 50% less? Are his skills suddenly reduced by 50%. Is that assistant 50% less qualified to care for patients? I encourage everyone who cares about the future access to therapy in the US to write a letter explaining the value of assistants to BCBS of Kansas and please forward a copy to your representatives, senators, your state insurance commisioner and to Secretary of Health Kathleen Sebelius.
- or just post your opinion-
Honestly to put this into perspective-this trend of 50% cuts in reimbursement will more than likely spread to other states which will continue into a cascading effect to even more states, unless we voice a strong disagreement- As a taxpayer, and working professional especially if you work in Outpatient Physical Therapy- ask yourself: Can you afford not to say anything-if nothing is done about this what do you think will happen to outpatient physical therapy? What are your thoughts about this outrageous cut in reimbursement?