April 2016 Newsletter

PRESIDENTS COLUMN
CONTENT
President Eric Tarrs
Column
Insurance Update
WVPTA 2016 Annual
Conference Update
News from the
Practice Committee

ERIC TARR, PT, DPT, MBA, OCS

PRESIDENT, WVPTA
The faculty at Wheeling Jesuit University invited me to speak to their
physical therapy students who will very soon begin their final
rotations. Dr. Grubler suggested that they needed to hear what it
means to be an advocate and how you fit patient/professional
advocacy into your career. Dr. Grubler, a seasoned physical therapy
professor, could just as easily have given that instruction. She felt,
however, that her students would gain some perspective if a practicing
therapist from outside the instructors they have come to know as
family delivered the message.

The best way I know to teach about advocacy is to tell my story of

professional development. As with development of any kind, my first
Recognition
attempts at advocacy were for the most part egocentric. I was seeking
help for the problems I faced as a young professional. I had no mentor.
HOD Update
My coworkers were as green as I. Although I was a member of the
APTA throughout my time as a PT student, I never really tapped into
the resources provided for us. Once I took those few extra steps
toward the volunteers of the Association, I quickly found I was not
alone in my challenges as a young physical therapist. The path for
which I was searching was well worn by previous therapists eager to show me the way. I began to grow
and found myself helping others grow. That growth could never have taken place had I remained a hermit
of a professional just complaining about my circumstances. Although much condensed for this article,
that was the message.
Membership

We are all in various phases of our professional development. At any given time it can be difficult to see
several steps ahead, so the path forward becomes intimidating. I asked the students to take time to write
a brief description of how they perceived their professional roles outside of the direct hands-on patient
care in the next few years to come. I believe that at the very minimum, we are defined as professionals by
the direct care we provide or letters after our name. What else should be required of us? What should
you be able to expect from other pathfinders of our profession? As an Association, we are a macroscopic
version of the search to these answers. As individuals, we are terribly less effective in finding those
1

answers even for ourselves. So when Dr. Grubler asks you to come speak to her third year students on
advocacy, what is the story you will tell? If its a difficult answer to give, I encourage to you to become
active within the Association. The growth you incur from advocacy can become addictive.

INSURANCE UPDATES
SALLY OXLEY, PT, OCS, CHT, CMDT
WVPTA Payer Relations Committee Chair
PEIA Continue to contact your legislators about the need for more funding for PEIA so beneficiaries will
not be responsible for higher co-pays and deductibles and there will not be a cut in provider payments.
Workers Compensation The Payer Relations Committee has received feedback from the Workers
Compensation Surveys that have been sent out. Participation was not as full as we had hoped, but we did
receive good information. Thanks to all who did participate. We did find there were delays in referring
patients to PT, anywhere from 4 weeks to10 months with an average of 4 months. These delays
contribute to increased time off work and at times failure of the injured worker to return to work. There
seems to be less involvement of case managers, so patients are missing appointments with no incentive
to keep them, if their goal is not prompt return to work.
Highmark As of May 1st there will be a reduction in payments for the Highmark ACA plan. The new
rates are available on Navinet and appear to be 9% less than the commercial plan.
We were able to speak to representatives from Highmark and Healthways about the Performance
Scorecard. On the Practitioner Service Performance Report there are thresholds for all of the metrics
(what they measure). The clinic or practitioner score is listed as well as the Healthways threshold and
the Network score. Where most practitioners are failing to meet the threshold is on the Total
Authorization approval Rate, where the threshold is greater than or equal to 95%. If the practitioner
requests 6 visits and 4 are authorized the authorization is disapproved. In order for it to be approved all
requested visits must be approved, so do not ask for more visits than you may need.
The suggestion was made that when requesting authorization ensure that all documentation is sent to
show progress and establish medical necessity, and include a functional outcome measure. If the number
of visits authorized are not or cannot be used during the period of time allowed you can submit a date
extension form.
Beginning Jan. 1, 2016, you must go to the website to register Highmark patients at their initial visit each
year when providing them with physical therapy, occupational therapy and manipulation services. The
initial eight visits do not require authorization. Physical therapy services, occupational therapy or
manipulation services that extend beyond eight visits will require you to submit clinical information and
a treatment plan to Healthways and, in some cases, the patients pertinent medical records. Healthways
will determine the medical necessity and appropriateness of the authorization request and notify you and
the member of its decision.

THANK YOU TO OUR 2016 SPONSORS

Medicaid We are continuing to pre-authorize all alternative plan Molina Medicaid patients through APS
Healthcare. The initial visit does not need to be pre-authorized. Traditional patients do not need to be
pre-authorized.
Molina upgraded their software system in mid-January which has caused some erroneous denials of
claims. Per James Wallace (field rep), fixes for the two main erroneous denial reasons Benefit requires
UM and Benefit visit limit exceeded are being tested in the production area and once they have
determined that the fixes are working properly there will be a mass reprocessing of all claims that were
denied under these edits. He could not give a definite date, but said that this step is the last step in the
whole process.
In a letter to providers April 25, The Department of Health and Human Resources reported that payments
to Medicaid providers may be delayed amid state budget shortfalls.
Cynthia Beane, Bureau for Medical Services acting commissioner, said the state may be unable to pay
providers within the same timeframe or level due to the 2016 budget deficit.
The deficit began at $354 million for 2016 and $466 million for 2017.
Medicare The Affordable Care Act has provided many mandates such as if you are a MC provider you
must have a compliance plan with regular inservices. You must have them and keep a record of them
with who attended and what was covered.
Medicare will not reimburse for services provided by
individuals who have been excluded from participation in the
program. You must check the LEIE (List of Excluded
Individuals or Entities) for Medicare and Medicaid, on the
OIG website to be sure no providers, other employees, or any
of our referral sources are on the list. From the day a
physician is convicted or excluded you cannot bill for
patients they referred.
Use the GY modifier when you have issued an ABN and do
not think the care is medically necessary, but the patient
wants to continue and pay cash. Once the denial is received
the patient can be billed personally.

Dont forget about the WVPTA

3rd ANNUAL GOLF SCRAMBLE
ON APRIL 29TH, 2016 @
STONEWALL RESORT!
Details below:
Time: 11am (registration
begins @ 10am)

Ensure that Medicare is forwarding the claims to the

secondary payer. If you are finding that you have some
$75/person for teams of 4
patients claims that are not cross walking, encourage the
patient to call Medicare and coordinate their benefits. They
Click Here to sign-up!
can call the # on the front of their cards. Inform the
patient(s) that when they call Medicare that they say "I want
to update my benefits with my secondary insurance
information". Some PTs are finding that the secondary may request a copy of the Medicare EOB after the
claim is submitted by Medicare.

WVPTA 2016 ANNUAL CONFERENCE UPDATE

KRISSY GRUBLER PT, DPT
Education Committee Chair
The WVPTA 2016 Annual Conference will be held on April 29 - May 1, 2016 at Stonewall Resort.
The conference will feature Contemporary Approaches to Foot and Ankle: "Why do you
move this way?" and will be presented by Steve Reischl, PT, DPT, OCS. Dr. Reischl is owner of Reischl
Physical Therapy, Inc., a private practice since 1984 in Long Beach Signal Hill, California. During 1998 to
2015, he held a clinical academic appointment as Adjunct Associate Professor of Clinical Physical Therapy
at the Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry,
University of Southern California. Along with his private practice and teaching, he has been involved in
clinical research of tendon disorders of the lower extremity. Steve is known for his work on Orthopaedic
Physical Therapy for the foot and ankle and has published on topics on foot, ankle and lower extremity
dynamics. Dr. Reischl has lectured through many components of the APTA at the state, national and
international meetings.

The entire weekend will offer 12.5 CEUs with Dr. Reischl providing 11 of those hours.
On Friday, April 29th, we will host the 3rd Annual Golf Scramble as well as host a Wine Tasting event by
Lambert's Vintage Wines Friday evening from 8:00-10:00 PM. Please join students and fellow clinicians
for an evening of networking, fun and prizes!

The WVPTA will hold its Annual Meeting during the luncheon Saturday where you will hear the State of
the Association Address by Eric Tarr, PT, DPT, MBA, OCS, WVPTA President; receive current APTA
updates from Sheila Nicholson, Esquire, DPT, MBA, MA, PT, the APTA Board of Directors State Liaison; be
provided with an update from the West Virginia Legislature by Senate Health Committee Chairman Ryan
Ferns, PT, DPT; enjoy WVPTA Awards and Recognitions; reveal WVPTA 2016 Election results; and hear
platform presentations by students Sara Giebell of West Virginia University and Gabriel Blanca of
Marshall University.
On Saturday evening, we will host the 1st Annual Research Mix and Mingle where clinicians, students and
faculty can network and discuss/collaborate on research ideas. On Saturday evening, we will also host a
WVPTA members-only reception open to all current WVPTA members.
On Sunday, there will be Poster Presentations where you can review and discuss current research with
each of the presenters.
To register, visit the following link: http://www.wvpta.org/events/#online-registration
To learn more, visit the following link: http://www.wvpta.org/events/#about-the-conference

THANK YOU TO OUR SPRING

CONFERENCE 2016 SPONSORS

NEWS FROM THE PRACTICE COMMITTEE

RHONDA HALEY PT, DPT
Practice Committee Chair
EMILY VOGEL SPT
New to the APTA website are the Innovation 2.0 Learning Labs. These start this month with the first topic Payfor-Quality Program to Improve Value-Based Care for Patients With Low Back Pain Learning Lab on April 21,
2016. The Learning Labs are a series of interactive educational experiences with currently 4 different topics that
give users the insight on how to develop or initiate an innovative payment/practice model. The APTA will also
provide templates for members to use as resources to replicate the work once the labs have been conducted.
Registration is limited for the Learning Labs, so please sign up early. To find out more information, please visit the
APTA website at www.apta.org/Innovation2.0/ or from the APTA home page this can be found under the Practice &
Patient Care - Practice Administration - Innovations in Practice tabs.
Updates continue to be made to PTNow. One searching tip that may be helpful is the general search bar that can be
found near the top right corner. This search box allows you to search across the website for a particular topic;
however, it does not search across the ArticleSearch or Rehabilitation Reference Center sections. This step will
need to be completed in each of those tabs separately.
An interesting update to PTNow is the Rehabilitation Reference Center tab. You have the option to ask a librarian
at the APTA library to assist with topic searches and clinically-related questions. There is also a tutorial to help
navigate this new addition to PTNow which includes information on diseases and conditions, drug information,
patient educations, exercise images, and practice resources.
A snapshot of various topics is also available under the Clinical Summaries tab. Members can access portable
summaries of different diagnoses and add it to their personal clinical collections or download the portable
summary for quick viewing. These summaries include classification, screening, examination, diagnosis, prognosis,
intervention, and medical management tools right at your fingertips.

MEMBERSHIP RECOGNITION
SCOTT DAVIS PT, MS, EdD, OCS
Vice President, WVPTA
One of the duties bestowed on the Vice President according to Chapter Bylaws is to oversee Chapter awards and
recognitions. Recognizing members and those who serve the Chapter is more of an honor than a duty. At the
upcoming General Membership meeting on Saturday, April 30, during the 2016 Annual Conference, I will have the
privilege of recognizing members who have reached various membership milestones. Those individuals who have
been a member for 5, 10, 15, 20, etc. years will receive a special recognition pin. As I prepare for the meeting and
peruse the list of names and years of membership, I am amazed by the impressive longevity of many of our Chapter
members, but I am also impressed that some of these members have also consistently contributed their time and
talents over many years to promote Physical Therapy here in West Virginia. While I won't give away the names of
all those who will be recognized at the meeting, I do want to give special attention to a few individuals who have
been members for 40 or more years. While 40 years is impressive, we have a few individuals who far surpassed the
quadrennial mark. Two individuals (MaryBeth Mandich and Sally Oxley) who have contributed much to the
physical therapy profession will be recognized for 40 years of membership. Edward Lampton and Irene Tsapis will
be recognized for 45 years of APTA membership. Robert Jones will receive a very impressive 55-year recognition
pin. Last, but certainly not least, are two individuals who have reached the sexagenary mark. James Demus and
Jane Downey will receive recognition for 60 years of membership. That is a tremendous accomplishment, and all of
these individuals serve as an inspiration for the rest of us.

While our Chapter and parent Association (APTA) rely on membership, those who volunteer their time are the
heart of the association. It has been my experience that many members want to serve but sometimes they dont
know where to start or need to be asked. Therefore, as one of your elected Board members, I would like to take this
opportunity to invite you to consider serving the WVPTA in some capacity. We have a need for committee
members and elected officers, and we would love to have you join us and share your knowledge, experience, and
enthusiasm. Please contact a nominating committee member or a Board member and let us know how and where
you would like to get involved. I look forward to seeing you at the Membership meeting.

THE HOUSE OF DELEGATES UPDATE

KELLY TERRY, DPT, ATC
Chief Delegate, WVPTA
The 2016 House of Delegates (HOD) is scheduled to be held June 6-8 in Nashville, TN. The House session will
precede the NEXT Annual Conference which will be held June 8-11. The APTA HOD is the policy-making body
comprised of delegates from 51 Chapters, non-voting delegates (Board of Directors, Sections, Student Assembly,
PTA Caucus delegates), and consultants. West Virginia is considered a small state delegation carrying two votes.
This year as a delegation, we have tried to become more involved in the motion making process by co-sponsoring
motions that we feel strongly will help guide our profession into the future. One motion we are co-sponsoring is
RC 3-16 which is being sponsored by the Michigan Delegation. The motion is related to the Physical Therapists
Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability. This
amendment better defines how Physical Therapists can serve as a link between the clinic and community and play
a valuable role in promotion of a healthy lifestyle in order to better manage or even prevent the development of
chronic disease.
A second motion the WV Delegation is co-sponsoring is RC-11-16 Charge: Investigation and Plan to Address
Student Debt in Physical Therapy. This motion has been proposed by the Oregon Chapter and the goal of the
motion is to better understand the effect that student debt has on the profession, the association, and society. The
following are some questions that hopefully will be answered if the motion passes. What is the impact on the size
and characteristics of the applicant pools in education programs? How might this effect our ability to serve diverse
populations? Are new graduates seeking initial employment based upon financial considerations rather than
career enhancement and skills development? As a delegation, we have discussed the need for involvement of
ASHA and the AOTA in order to have more of an impact on the current state of student debt. It is unfortunate that
the profession may be losing future clinicians when they analyze the amount of debt they will accrue verses the
compensation received upon graduation.
The third motion the WV Delegation is co-sponsoring is RC 16-16 Amend: Bylaws of the American Physical
Therapy Association to Change the Definition of a Post Professional Student proposed by the Florida Delegation.
The new definition would identify an individual completing post-doctoral research fellowship as a Post
Professional Student. Because these individuals are earning a considerably lower salary compared to other
working clinicians, this would allow them to the opportunity for reduced membership fees. It is felt that this will
assist in encouraging individuals to seek post-doctoral fellowships which would enhance qualifications of faculty in
Physical Therapist Programs as well as therapists working in the clinical community.
As always, the House of Delegates (HOD) this year looks to be a very busy and productive session. This body plays
a valuable role in making sure Physical Therapy continues to be a primary component in the healthcare
environment of today as well as in the future. I am looking forward to seeing what is accomplished when the
session comes to a close.