2014 fall kpta newsletter

Fall 2014

The Donald H. Lange Lifetime Achievement Award was presented to Stuart Lowenthal, PT. For those of us interested in this year’s second annual Fall FUNction “Celebration of the history of physical You” reception, our members took center stage. In addition to abundant food, networking and exhibits, the annual therapy, we would do well to look at the caevent featured recognition of anniversary members and the presentation of KPTA service awards. Highlights of the reer of Stuart Lowenthal. Stuart has not evening included a roast of outgoing President, Michael Muscarella, PT, DPT, LDE and a thought-provoking, tender only watched our prospeech by KPTA’s 2014 Donald H. Lange Lifetime Achieve- fession evolve, but has been at the epicenter of ment Award recipient, Stuart Lowenthal, PT. many of the changes If you missed the event, or just want to relive the good within our profession. memories, you can watch a fun recap by clicking the picStuart Lowenthal, PT (left) with In 1963, spurred on by a ture below.

KPTA President, Michael Muscafederal grant to pay for rella, PT, DPT, LDE. Click HERE to his studies, Stuart enwatch Stuart’s acceptance speech. tered Duke University’s post-graduate physical therapy program. His graduate thesis focused on a little know niche within physical therapy: self-employment. The thesis was picked up by the American Physical Therapy Association and published 6 Meet KPTA’s Core Ambassador in their “Physical Therapy 8 CMS Attempts to Reduce BackJournal.” log of Appeals of Medicare

Members Shine At Fall FUNction “Celebration of You” Reception At

Inside…

Honoring Our Own: KPTA Awards a Highlight of Kentucky Student Conclave & Fall FUNction

Stuart worked at Mercy Hospital in Gary, Indiana and from there he went on KPTA’s annual awards are designed to recognize those to become chief physical members whose dedication has had a profound effect not therapist at Good Samarionly on the association, but on the profession as well. Con- tan Hospital, where he was gratulations to this year’s winners! the only physical therapist on staff. (Continued pg. 2)

Claims Denials 14 Conquering the Kentucky Student Conclave 18 Kentucky Health Cooperative Troubleshooting 19 Payment Policy/Advocacy News AND MUCH MORE!

The Donald H. Lange Lifetime Achievement Award (continued from cover) In the 70’s, with the aerobic exercise phenomenon sweeping the country, Stuart created the first, full cardiac rehabilitation physical therapy program in the state, bringing lifestyle changes to heart patients. Good Samaritan’s cardiac rehab program received national attention and Stuart was asked to speak at conferences throughout the United States. His published research included the article “Establishing a Graded Exercise Testing Program in a Community Hospital” in APTA’s Physical Therapy Journal; as well as research published in the KY Journal of Medicine. Physicians began to take notice. Stuart convinced an array of physicians about the benefits of physical therapy and cardiac rehabilitation. The perception of physical therapy, and its potential for helping a variety of patients regain their health and function, was changing.

er, Tony returned to school and received his Master’s Degree in Orthopedic Physical Therapy from UK and his Doctor of Health Science from the University of Indianapolis.

With a keen interest in musculoskeletal and sports physical therapy, Tony is also a Sport Certified Specialist.

Stuart did not achieve success alone. He is quick to credit his lovely wife, Donna, and the many colleagues who accompanied him on this journey, including Jack Gamet, Joe Drake, Franklin Moosnick and many others.

(Awards continued on page 4)

In addition to being an excellent clinician, Tony is a highly regarded academician. He currently holds the rank of Professor with tenure in the DPT Program at Bellarmine University and serves as Assistant Dean of the Lansing School of Nursing and Health Sciences.

Tony is a tireless servant to our profession. He has served as a Delegate to the APTA House of Delegates since 2008 and helped develop the state Professional Continued Competency Guidelines, where he continues to serve as a member of the Professional Continued Competency Committee. He has served as KPTA’s liaison to the Kentucky Stuart left Good Samaritan Hospital in 1981, where it had Board of Physical Therapy. Tony attends KPTA’s Advocacy grown from one therapist to 5 full-time physical theraDay in Frankfort each year and ensures his students attend pists, 8 supporting staff and 5,000 square feet occupying as well. He received the Louisville Convention and Visitors the entire fourth-floor wing of the hospital.

Bureau Ambassador Award in 2010 for his efforts in bringing APTA’s 2013 National Student Conclave to Louisville.

Stuart then partnered with Joe Drake in private practice, Tony is an Item Writer for the National PT Exam, serves on forming Physical Therapy Associates, which eventually be- professional committees at the national level, and has viscame American Rehabilitation Group with contracts span- ited Capitol Hill to lobby in support of issues facing the ning the state. profession.

Seeing a need to help patients develop a home exercise regimen, Stuart began selling ergonomic exercise bicycles Tony is a trusted, and treadmills out of his garage. Within a few years the proven leader and business moved to a retail location called Fitness Pro. an advocate for patients and our proIn 2003, Stuart turned his attention to yet another patient fession. His colneed: quick care for simple medical problems at convenleagues refer to him ient hours. Stuart and his co-investors started an in-store as “a humble servmini-clinic called Fast Care, which was eventually renamed ant who puts aside The Little Clinic. The Little Clinic was purchased by Kroger, his ego and stands and can be found in select stores throughout the United up for what he beStates. lieves in.”

Today, Stuart remains an advocate for our profession and its evolution.

The Outstanding Physical Therapist Service Award was presented to Tony Brosky, PT, DHS, SCS. Tony has been an active member of the KPTA/APTA since 1987 when he graduated with his Bachelor of Health Science in physical therapy from the University of Kentucky. A life-long learn-

Tony Brosky, PT, DHS, SCS (left) accepts the Outstanding Physical Therapist Service Award from KPTA President, Michael Muscarella, PT, DPT, LDE.

The Outstanding Physical Therapist Assistant Service Award was presented to Chris Garland, PTA. Chris proved her leadership skills while still a student at Somerset Community College. As a student, Chris Garland was selected to receive the Orthopaedic Section’s Outstanding Student Physical Therapist Assistant Award, the James H. Anderson Award and served on the APTA Student Assembly Board of Directors as the Student PTA Delegate to the House of Delegates.

Passionate about legislative affairs, she participates in KPTA’s Advocacy Day and has also attended APTA’s Federal Advocacy Forum in Washington, D.C. Chris currently serves as PTA Caucus Representative, where she is a respected member of the KPTA Board of Directors. Chris is passionate about the PTA profession, having presented on the PT/PTA team dynamic at APTA's National Student Conclave as well as the Kentucky Student Conclave.

received APTA national and section scholarships and many named “PTA student of the year” by APTA’s orthopaedic, geriatric and other sections.

Dr. Hammons serves on APTA’s NEXT Conference Planning Committee, on KPTA’s Professional Continued Competency Committee and Nominating Committee and participates in KPTA’s FunFitness Screenings for Special Olympics athletes.

One student said about him: “Dr. Hammons exceeds the qualifications of a professor. He is kind, passionate, flexible, respectful, personable and charitable. He makes learning fun, yet challenging.” And a colleague of Dr. Hammons says: “He is among the most hard-working, conscientious and dependable individuals I have been blessed to know.

His commitment to excellence, service to community and his profession, outcomes related to his efforts and, yes, even his quick wit and sense of humor merit consideration of this award.”

It is a great privilege to bestow upon John Stephen Hammons, the 2014 David A. Pariser Exceptional Educator Award.

The Richard V. McDougall Fledling Award was presented to Matt Scott, PT, DPT, OCS. Matt is a 2011 graduate of The David A. Pariser Exceptional Educator Award was pre- Washington Universented to John “Steve” Hammons. Steve is the Academic sity. As an employCoordinator of Clinical Education at Somerset Community ee for Baptist College’s PTA Program where his accomplishments have Health Paducah, his earned him accolades, including a Teacher of the Year colleagues refer to Award. He has also him as a “walking received the New Ho- anatomy book.” He rizons Award for Fac- strives to continualulty Excellence, the ly learn having reNational Institute of cently achieved cerStaff and Organizatification as an Ortional Development thopedic Clinical Award and the Somer- Specialist. Matt set-Pulaski County shares his Educator of the Year knowledge by Award. providing in-services at KPTA district meetings and also serving as a clinical instructor. Matt recently was appointHis innate ability to ed to serve as KPTA Purchase District Chair. develop his students into leaders has brought national attention to the Somerset Community College PTA Program. Dr. Hammons’s students have been elected to positions within the APTA National Student Assembly, have

Kentucky Core Ambassador to the APTA Student Assembly for the 2014-2015 Academic Year Greetings, and I hope this finds you well. I’d like to take this time to introduce myself, my name is Chrissy Watson and I am your APTA Student Assembly Core Ambassador to Kentucky for the 2014-2015 academic year. Currently I am a second year DPT student at the University of Kentucky and I also serve as the Alumni and Web Chair for my class, connecting us with Alumni and establishing and maintaining a strong online presence for our class. Along with these roles I’ve been fortunate to have the opportunity to work in the community with Habitat for Humanity, the Down Syndrome Association of Central Kentucky and the National Wheelchair Basketball Association.

To give you a short background, I am somewhat of a non-traditional student. I graduated from the University of Louisville in December of 2009 and wasn’t accepted to the DPT program at UK until spring of 2013.

That year was my second time applying, so I am also a successful re-applicant. Within the physical therapy spectrum my interests are outpatient orthopedics, upper extremity pathology, private practice and health policy. Outside of physical therapy I am a voracious reader and enjoy classical theatre. Being physically active is a priority of mine, and I am an avid outdoorswoman. I also enjoy watching sports, specifically college and professional football and baseball. As you can tell, my interests are quite varied.

Chrissy Watson from the University of Kentucky’s DPT Program will serve as Kentucky’s Core Ambassador to the American Physical Therapy Association for the 2014-2105 academic year.

It is my pleasure to provide students in Kentucky PTA/DPT programs with all the updates from the APTA Student Assembly with the hope that it will enrich your educational and professional experience. I think it’s important to stay abreast of current topics and news in our field so that your transition from student to practitioner can be as seamless as possible. Please contact me with any questions or concerns. I look forward to serving all of you, and to developing the student physical therapy community in Kentucky.

Sincerely, Chrissy Watson APTA Student Assembly Kentucky Core Ambassador Crwa229@uky.edu

CMS Attempts to Reduce Backlog of Appeals of Medicare Claims Denials The Centers for Medicare and Medicaid Services (CMS) has decided to use two mechanisms to attempt to reduce pending appeals of denied Medicare claims. There are cuurently approximately 1 million pending claims. The mechanisms CMS will use include:  

Settlement Conference Facilitation Pilot Statistical Sampling Initiative

The goal of these initiatives is to help reduce the backlog of claims by allowing adjudication of a large number of appeals with similar issues filed by one provider at the same time.

In the Settlement Conference Facilitation Pilot (SCFP), CMS will use mediators who are employees of the Office of Medicare Hearings and Appeals (OMHA) to attempt to reach mutually agreeable resolutions that include dismissal of requests for hearings before administrative law judges (ALJs). If CMS and providers cannot agree, claims will be returned to ALJs for hearings.

Medicare Parts A, C, D, appeals of Social Security Administration decisions regarding entitlements, Part B late enrollment penalties and Part B and Part D income-related monthly adjustment amounts are not currently eligible for SCFP. The criteria that must be met in order to qualify for the Settlement Conference Facilitation Pilot include:         

Requests for hearings must appeal Qualified Independent Contractor (QIC) reconsiderations of claims for Medicare Part B items or services.

Appellants must be Medicare providers or suppliers.

Beneficiaries must not be found liable after initial determinations or participation in QIC reconsiderations.

Jurisdictional requirements must be met for requests for hearings and appealed claims.

Requests for hearings must have been filed in 2013 and are not currently assigned to ALJs. Amounts of each claim must be less than $100,000 or extrapolated amounts for purposes of extrapolated statistical samples must be less than $100,000.

There must be at least 20 claims at issue or at least $10,000 at issue, if the number of claims is less than 20.

No requests for statistical sampling for the same claims can be outstanding.

Requests must include all of providers' pending appeals for the same items or services that meet SCFP criteria.

The Statistical Sampling Initiative (SSI) is intended to speed adjudication of pending denials for providers that have a large volume of claims pending before the ALJ. The process begins with selection of a random sample of providers' pending claims consistent with Medicare guidelines by a statistician at OMHA. Then an ALJ will review the sample and make a decision based on the sample. CMS contractors will then extrapolate ALJs decisions to all of providers' denied claims.

The following criteria must be met to participate in SSI:    

Requests for hearings must appeal Medicare QIC reconsideration decisions.

Requests must come from a single Medicare Provider or supplier, or providers or suppliers owned by a single entity.

Jurisdictional requirements for all requests for hearings and appealed claims must be met.

Beneficiaries cannot have been found liable after initial determinations or participation in QIC reconsiderations. (continued page 10)

CMS Attempts to Reduce Backlog of Appeals of Medicare Claims Denials (continued from page 5)  Claims must be currently assigned to ALJs or have been filed during the time period currently being assigned by OMHA Central Operations for hearings, which currently includes appeals filed between April 1, 2013, and June 30, 2013.  Hearings on the claims have not been scheduled or conducted.  There can be no outstanding requests for SCFP for the same claims.  There is a minimum of 250 claims in the following categories:  Pre-payment claims denials  Post-payment [i.e., overpayments non-Recovery Audit Contractor (RAC) claims denials]  Post-payment (i.e., overpayments RAC claims denials from one RAC) While it is clear that the backlog of appeals must be reduced, it remains to be seen whether either of these mechanisms will provide any relief. Initially, it appears that the limitations their use may be so restricted that they will be useful to few providers and suppliers. Neither mechanism will result in the immediate relief that providers and suppliers need and to which they certainly seem entitled. ©2014 Elizabeth E. Hogue, Esq. All rights reserved.

Why PT Pub Night? By Avery Schroyer, PT, DPT I met with Derek Fenwick, PT, MBA, GCS, at CSM Las Vegas, who came up with the award winning idea of PT Pub Night. After speaking with him I brought PT Pub Night to the Lexington area in April of 2014. The goal is to gather physical therapy colleagues on a regular schedule. By bringing together physical therapy colleagues for face-to-face conversations, to share perspectives and form relationships we will enhance the professional life of each person who attends. APTA/KPTA members and nonmembers are welcome to discuss topics and share stories about what they see in clinical settings. Some of the past topics have included dry-needling, changes in education, and UK honoring their clinical instructors and guest faculty who help with the Samaritan's Touch Free Clinic. PT Pub Night takes place every 3rd Thursday of the month in the Lexington area. The next PT Pub Night will be November 20th at 7:00p.m. at Marikka’s, 711 Southland Drive in Lexington.

Want Notifications on Upcoming KPTA PT Pub Nights? Like Us On Facebook or Follow Us On Twitter @KyPTPubNight

Students: Take Advantage of Career Starter Dues APTA launched its Career Starter Dues Pilot in 2013, of which KPTA opted to be a test chapter. Career Starter Dues is the automatic way for you to save 50% (up to $270) off your dues in your first year post-graduation. For a limited-time, members 2-4 years post-graduation save 40%, 30%, or 20% on national dues and participating chapter dues.

What you get: First year post-graduation  50% off national & chapter dues  FREE registration to APTA's NEXT Conference & Exposition Second year post-graduation  40% off national & participating chapter dues Third year post-graduation  30% off national & participating chapter dues Fourth year post-graduation  20% off national & participating chapter dues

If my membership expires, am I still eligible for Career Starter Dues savings? No, continuous membership is required to qualify for subsequent phase(s) of Career Starter Dues savings. Note: Student members at graduation have up to 6 months from their student expiration date to renew and still maintain eligibility for Career Starter Dues savings.

Other Questions About Your APTA Membership or Career Starter Dues? Chat live now with a member services representative or contact APTA at: memberservices@apta.org Phone: 800/999-APTA (2782) 1111 North Fairfax Street Alexandria, VA 22314-1488

Discount on Career Center Postings for KPTA Members

What do I need to do to receive Career Starter Dues savings at my next renewal? Nothing! Your hard copy and KPTA’s Career Center is your destination for exciting Physionline membership renewal form will automatically recal Therapy job opportunities and the best resource for flect the appropriate Career Starter Dues savings, if you're qualified candidates within the Physical Therapy Industry. eligible. Refunds for prior renewals will not be provided.

KPTA members looking to fill a position can now use disHow do I know if I'm eligible for Career Starter Dues sav- count code KYPTAMEM20 to receive 20% off postings. ings? Make sure that your APTA student membership is active at graduation. Maintain continuous APTA member- Searching for a job within your industry? ship post-graduation.

We feature various Physical Therapy jobs. Ready to start your job search? Click here to find your next Physical TherWhat's the cost to renew my APTA membership? apy job! Resume postings are FREE! Use the APTA Dues Calculator to estimate your national, chapter, and optional section dues before Career Starter Dues savings are applied. Your renewal notice will indicate Looking to fill a position? career starter dues savings, if you're eligible. Note: Career This job board is custom tailored for the Physical Therapy Starter Dues savings do not apply to section dues. industry, which means we attract the most qualified proI graduated from PT/PTA school in 2012; will I qualify for fessionals in Kentucky. Create an Employer Account and Career Starter Dues savings at my next renewal in 2014? post your Physical Therapy jobs today!

Yes, as long as you've been an APTA member continuously since your last year as a student PT or PTA through now.

For questions and concerns, call us at 1-866-376-0949 ext I was a student member in the past; however, my membership expired before graduation. Am I still eligible for Career Starter Dues savings? No, to qualify for Career Starter Dues savings, your APTA student membership must have been current at graduation.

6076 or email us.

Kentucky PT and PTA Programs Accept 2014 Challenge to Raise Funds for Research By: Allison Czaplewski, SPT and Caroline Miller, SPT

A total of 109 schools participated in the 2013-2014 Miami-Marquette Challenge to raise $219,716 in support of the Foundation for Physical Therapy. The Foundation wishes to thank the students of Bellarmine University, Madisonville Community College, Somerset Community College, the University of Kentucky, and West Kentucky Community and Technical College for their strong support of the Challenge. Congratulations to Somerset Community College for receiving an Honorable Mention and the title of “Most Successful PTA School” for raising over $3,000. This title is given to the PTA school who raises the most funds. Since its inception in 1989, 192 different schools have participated in the Challenge, and PT and PTA students have raised a grand total of $2,757,216!

The annual Marquette Challenge is a grassroots fundraising effort coordinated and carried out by physical therapist and physical therapist assistant students across the country to support the Foundation for Physical Therapy’s mission of providing funding opportunities to outstanding physical therapist researchers. Ryan Mizner, PT, MPT, PhD, an assistant professor at the University of Montana, is the recipient of the 2013 Miami-Marquette Challenge Research Grant.

His 2-year project, “A Novel Unweighting Technology to Address Psychological Impairments Limiting Outcomes after ACL Reconstruction,” will look at the effects of a bodyweight reduction instrument to deliver graded exercise (BRIDGE) on the outcomes of anterior cruciate ligament reconstruction. Mizner received both his master’s in physical therapy and PhD in biomechanics and movement science from the University of Delaware. The Challenge also funded a PODS I Scholarship in 2014, which went to Allyn Susko, PT, DPT of the University of Pittsburgh.

For the second year in a row, the first place winner of the Challenge was the University of Miami, whose students raised $31,625. We welcome the University of Miami as co-host again this year for the upcoming 2014-2015 MiamiMarquette Challenge. The University of Pittsburgh won second place, raising $21,119. Sacred Heart University students raised $16,860 and earned the third place title this year.

The Foundation for Physical Therapy was established in 1979 as a national, independent nonprofit organization dedicated to improving the quality and delivery of physical therapy care by providing support for scientifically-based and clinically-relevant physical therapy research and doctoral scholarships and fellowships.

Students of all PT and PTA programs in the State of Kentucky are encouraged to support the Foundation for Physical Therapy and physical therapy research. To learn how you can support the Challenge, please visit the Foundation’s Web site at www.Foundation4PT.org/get-involved/Challenge/, call the Foundation at 800/875-1378, or email Marquette student coordinators at Challenge4PT@gmail.com. Contributions for the 2014-2015 Miami-Marquette Challenge should be submitted by April 16, 2015.

Conquering the Kentucky Student Conclave KPTA hosted its first Kentucky Student Conclave September 12-13 in Louisville, Kentucky. The Board of Directors decided to host the event as part of their strategic plan initiative to increase student involvement. According to KPTA President, Michael Muscarella, PT, DPT “Knowing we had 3 PT schools and 5 PTA programs, I felt that developing a Kentucky Student Conclave (KSC) would be beneficial. I have a heart for our students, our future peers and coworkers and practice owners. Supporting their educational journey through a conclave would teach them early about the benefits of both the KPTA and the APTA. It was meant to help them make the transition from student to employed new graduate easier and optimize their efforts.”

Over 150 students from seven different programs attended the event which kicked off with an exhibit hall, reception & awards ceremony at the Crowne Plaza Louisville. Exhibitors were eager to meet the next generation of therapists and the students were excited to learn about possible career paths. Many exhibitors expressed how valuable the event was to them: “This event was the best value I have been to in years. I had th opportunity to speak to EACH student and they were completely engaged in conversations about their future. In general, the students were ready to listen and talk to those of us that wanted to talk and share,” said Kevin Moser, MBA, MS, ATC, LAT, Director of Sports Medicine & Rehabilitation at Baptist Health Madisonville.

The conclave reconvened on Saturday morning at Bellarmine University where nine educational programs were presented over a fifteen track session. Topics were both clinical and practical in nature, ranging from “Activity Based Therapy & Recovery After SCI: From Adults to Children,” presented by APTA’s Maley Lecturer, Andrea Behrman, PhD, PT, FAPTA to “Stop the Snowball: Student Debt Solutions,” presented by KPTA Treasurer, Charlie Workman, PT, MBA. Students also had the option of attending sessions on Emerging Technology in Physical Therapy, ACL Reconstruction, Interview Tips and Techniques, Selecting Your Practice Section, APTA’s House of Delegates, and The Affordable Care Act. Many students even brought their resumes to the conclave where a team of KPTA volunteers provided resume reviews. "I feel very fortunate to have been able to attend the first KPTA Student Conclave,” said Bellarmine DPT student, Nick Beckham, “I learned about a lot of things we don't typically get to learn about in the classroom and had the opportunity to meet and network with fellow PT/PTA students as well as

some very respected clinicians. The biggest thing I took away from the event was it made me excited for the future of Physical Therapy and what is to come for our profession. “ The event made such an impression on KPTA board members that they decided to combine the Kentucky Student Conclave and Fall FUNction into one event next year: an opportunity to bring practicing and future clinicians together for networking, dialogue, education and fun.

Students enjoyed networking with exhibitors during the Kentucky Student Conclave.

KPTA’s 2014-2015 Student Special Interest Group Officers made their debut at the Kentucky Student Conclave. They are (L-R) Chrissy Watson (UK), Jarrod Evans (Madisonville), Adam Dotson (UK) and Nick Beckham (Bellarmine).

Kentucky Student Conclave Photo Album

C O N T I N U E D

The KPTA RehabCare All Academic Team received their scholarships during the Kentucky Student Conclave Reception. They are, from left: Jewell Shope (Area Director of Operations from RehabCare), Courtney Carpenter (Somerset Community College), Callie Eaves (Bellarmine University), Adam Dotson (University of Kentucky), Kaitlyn Flak (Bellarmine University), Kristy Hyden (Somerset Community College) and Erin Stokes (University of Kentucky). Team members not pictured: Shea Wilson (West Kentucky Community & Technical College), Katlyn Nasseri (University of Kentucky), Ashton Curry (Bellarmine University). For information on applying for the 2015 All Academic Team, please contact Sonia Young.

Therapy Alliance Advocacy Day: Putting the Pieces Together The 2015 Therapy Alliance Advocacy Day (TAAD) will be held February 18th from 9:00am-12:00p.m. (EDT) in Frankfort. The event has been expanded to include physical, occupational, speech and respiratory therapists and students for a day of professional collaboration with legislators on common issues. Registration is free and will be on the KPTA website.

Kentucky Health Cooperative Troubleshooting Based on member concerns and feedback, the KPTA Payment Policy Committee recently met with Betsy Roberts, Senior Provider Services Representative and other staff at the Kentucky Health Cooperative. The KHC is eager to fix any claims issues or benefits questions our members have. Following are some important documents which may help members become KHC credentialed providers as well as clarify their reimbursement process for existing providers:   

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Provider Service Representative Territory by County “PSR Territory Assignments.”

Claims issues template: Use this spreadsheet for claims issues. This needs to be turned in to your Provider Service Representative KYHC Portal Access: If your group is already participating through First Health or a direct contract then you can obtain access to the online Provider Portal to check claims status and patient eligibility & benefits. The Provider Portal is a benefit to in network providers only. Please fill out the “Provider Portal Access Request Form” located on the KHC website https://mykyhc.org/healthproviders/Pages/default.aspx and return it to the portal help desk email: KYHC_EDISETUP.usem@cgi.com. Please address any Portal questions or issues to KYHC_EDISETUP.usem@cgi.com.

Claims status, eligibility & benefits can also be checked by contacting 855-OUR-KYHC (855-687-5942). There is an automated line, or you can select the option for a call center representative.

KYHC & FIirst Health Relationship: KYHC currently leases the First Health Provider Network while we are in the process of building our own network. KHC will be phasing out their relationship with First Health now that their network is extensive enough for their Kentucky members.

If you are interested in a direct contract with KYHC to become a PAR provider, please download the Provider Services Agreement and Provider Information Form. Submit completed forms to: Kentucky Health Cooperative, Inc Att: Provider Services PO Box 221255 Louisville KY 40252 Fax: 502-517-0141 Email:providerservices@mykyhc.org .

For questions regarding the credentialing process, email providercredentialing@mykyhc.org or call 502-287-1835.

Kentucky Board of Physical Therapy Executive Director Active in Federation of State Boards of Physical Therapy Scott Majors not only serves as Executive Director of the Kentucky Board of Physical Therapy but is also actively involved with the Federation of State Boards of Physical Therapy (FSBPT). Scott serves on the FSBPT Ethics and Legislation Committee where he is developing a telehealth resource paper. The committee hopes the document will be ready for distribution to member boards early next year. Scott also serves on the FSBPT’s Drafting Team for the Licensure Compact Initiative. The committee hopes to have proposed language together for all member boards to consider at the FSBPT Annual Conference and Delegate Assembly in Orlando next October. If approved at that time, member boards could consider legislative adoption of a national compact for physical therapy starting in 2016.

For more information, contact the Kentucky Board of Physical Therapy.

News From APTA’s Payment Policy & Advocacy Department

ters for Medicare and Medicaid Services (CMS) responded to an inquiry from APTA as to when—and whether— physical therapists should use the new X-modifiers. CMS has advised that the new modifiers have not been implemented, and PTs should not use them at this time.

ICD-10 Testing Dates Announced After several delays, the Centers for Medicare and Medicaid Services (CMS) is now ready to test its International Classification of Diseases, 10th Revision (ICD-10) system with providers before the October 1, 2015, startup date for use of the new codes. APTA is encouraging members to participate in the testing program to make sure their own systems, billing companies, and clearinghouses are ready for the changeover.

The testing program will be held over 3 separate weeklong sessions—1 on November 17-21 this year, and 2 in 2015, March 2-6 and June 1-5. Members only need to sign up for 1 session to find out whether their Medicare administrative contractor (MAC) will be able to accept claims with the new codes. The MACs will post information on how to participate in the tests. More information on the program can also be found in a Medicare Leaning Network bulletin (.pdf).

Final 2015 Physician Fee Schedule Rule Announces 1% Payment Rise, Increase in PQRS Reporting, Delay of VM Physical Therapy Outcomes Registry Pilot Participation for PTs APTA is pilot testing the Physical Therapy OutThe final 2015 Medicare physician fee schedule (PFS) comes Registry, with a limited number of slots remaining rule released by the Centers for Medicare and Medicaid for participation. Pilot participants will be fully funded Services includes an aggregate increase in payment for through 2015. If you are interested in participating in the physical therapy services of 1%--provided Congress stops pilot, please e-mail registry@apta.org. implementation of a payment cut due to the flawed SGR formula by March 31. In addition, despite objections from The registry is a data collection system that will improve APTA and other organizations, it increases the number of practice and support quality compliance requirements Physician Quality Reporting System (PQRS) measures resuch as PQRS. Registry participants will be able to success- quired for reporting of physical therapists (PTs) in private fully meet regulatory requirements, and will receive data practice and other health care professionals to as many as and benchmark information on performance at individual 9.

PT and practice levels that they can use to enhance patient care and justify services to payers. For more information, The new PQRS rules were opposed by many other profesplease visit www.apta.org/registry. sional health care provider organizations and APTA, which provided CMS with comments when the rule was first proCMS Says Keep Using 59 Modifier for Now posed. The PQRS change will increase the number of indiIn August, CMS issued a transmittal describing new modifi- vidual measures required to be reported in order to avoid ers—XE, XS, XP, and XU—intended to be used to define the 2017 2.0% PQRS penalty, from 3 to as many as 9, desubsets of the 59 modifier. However, until you receive fur- pending on whether the provider is using claims ( 6 ther notice, continue using the 59 modifier in reimbursemeasures available for 2015), or registry (9 required, or as ment claims to indicate that a health care common proce- many as apply to the provider). As in 2014, providers must dural code (HCPCS) represents a service that is separate report on at least 50% of eligible Medicare patients. and distinct from another service to which it is paired under the Correct Coding Initiative (CCI) program. The Cen(Continued next page)

News From APTA’s Payment Policy & Advocacy Department (continued) While the new reporting requirements are moving forward as proposed, CMS delayed the inclusion of nonphysician eligible professionals (including physical therapists) in the value-based modifier (VM) program until 2018, instead of its proposed 2017 implementation date. The delay is intended to allow the nonphysician professionals to familiarize themselves with PQRS and VM systems.

Other changes include: · The 2015 therapy cap will be $1,940, up $20 from the 2014 cap. · The $3,700 manual medical review expires March 31, 2015, consistent with the expiration of the agency's authority to provide therapy cap exceptions. Congress will need to act before March 31 to allow an exceptions process.

In other rules announcements, CMS issued final rules on the methodology for adjusting the DMEPOS feel schedule payment amounts, and the establishment of alternative payment rules for a phase-in of a competitive bidding program.

APTA will post detailed summaries of the new rules in the coming weeks.

CMS Eases Reassessment Requirements in 2015 Home Health Rule Beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will adopt a change suggested by APTA and others, and replace a requirement that home health therapy reassessments be performed at the 13th and 19th visits with one that requires a reassessment every 30 calendar days by each therapy discipline. The new requirement is part of a set of finalized changes to the Home Health Prospective Payment System rule announced by CMS on October 30.

Under the final rule, set to be implemented January 1, 2015, physical therapists (PTs) must "perform the needed therapy services, assess the patient, measure progress, and document objectives and goals at least once every 30 calendar days during the home health episode of care." The reassessment policy applies to physical therapy, occupational therapy, and speech-language pathology, and must be conducted by a qualified therapist from each discipline. In the case of physical therapy, "qualified therapists" would be limited to PTs. CMS had originally proposed that the reassessment be performed every 14 calendar days, but increased the requirement to 30 days after receiving comments from the public, including APTA. CMS also announced that it will eliminate the mandate for a "narrative" to be supplied by a physician in order to comply with a physician "face to face" requirement. APTA supported this change, expressing concerns that the current rule creates an undue burden on the home health community. The physician (or nonphysician practitioner) will still be required to certify that a face-to-face patient encounter occurred in order to meet the requirements for the home health stay. That encounter must take place no more than 90 days before the start of home health care or within 30 days after it begins.

Final Rule on Outpatient Prospective Payment Includes 2.2% Rate Increase The final rule for the outpatient prospective payment system (OPPS), released by the Centers for Medicare and Medicaid Services (CMS) on October 31, includes a 2.2% increase in payment rates to hospital outpatient departments beginning January 1, 2015.

The rule includes the packaging of payment for certain ancillary services provided in the hospital as well as comprehensive payments for a list of 25 primary services. The comprehensive payments include adjunctive services and supplies that support delivery of the primary service, which may include some physical therapist services that occur in the perioperative period. Further, the rule requires physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.

Except for a small subset of ‘‘sometimes therapy’’ services delivered without a certified therapy plan of care, most physical therapist services provided in the outpatient hospital department are paid under the Medicare physician fee schedule (PFS), not the OPPS. CMS provides an annual update of these “sometimes therapy” services that are paid under the OPPS and subject to direct supervision requirements. (continued next page)

News From APTA’s Payment Policy & Advocacy Department (continued) CMS Issues Final 2015 Rules for Inpatient Prospective Payment System The Centers for Medicare and Medicaid Services (CMS) has issued final rules for prospective payment systems for acute care and long-term care hospitals (LTCHs), the net effect of which will be to decrease payments to acute care hospitals paid under the inpatient prospective payment system (IPPS) by $756 million and increase payment to LTCHs by 1.1% under the LTCH prospective payment system.

Despite comments from stakeholders, the rule avoids changing the "2-midnight" policy or policies for short stays. The rule also finalizes the use of 5 readmissions measures for assessing readmission penalties, incorporating methodology changes supported by APTA related to hip and knee arthroplasty.

Among other changes set for 2015: 

Hospitals in the top quartile for the rate of hospital acquired conditions—those with the poorest performance— will have their Medicare IPPS payments reduced by 1%.

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CMS will distribute $7.65 billion in uncompensated care payments, a decrease from the $8.56 billion estimate in the proposed rule.

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CMS will assess hospitals’ readmission penalties using 5 readmissions measures endorsed by the National Qualify Forum (NQF): heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and hip/knee arthroplasty. CMS has finalized an updated methodology to take into account planned readmissions for these 5 existing readmissions measures, as well as refinement in the hip/knee arthroplasty readmission measure methodology.

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CMS provides guidelines for implementing the Affordable Care Act's provision requiring transparency in hospital charges. Under these guidelines, hospitals should publish either a list of their standard charges or their policies for allowing the public to view a list of those charges in response to an inquiry.

In addition to the changes for 2015, CMS finalized the addition of 2 quality measures related to function for the 2018 LTCH Quality Reporting Program. ATPA supported the measures, titled "Functional Outcome Measure: Change in Mobility among LTCH Patients Requiring Ventilator Support," and "Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function."

APTA participated in the comment period for the 2015 rules when they were proposed by CMS earlier this year, and will publish a summary of the changes online in the coming weeks.

SNF, IRF Final Rules for 2015 Released by CMS Rule changes for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) will increase payments by 2% and 2.2%, respectively, in 2015. In addition to the increases, the new rules issued from the Centers for Medicare and Medicaid Services (CMS) will make changes to a host of reporting, coding, and data collection models, as well as establish definitions of various therapy models in IRFs. The payment increases amount to an additional $750 million for SNFs, and an increase of $180 million for IRFs. IRF rules changes (.pdf) include the following:     

Removal of 10 status post-amputation diagnoses codes from the list of codes that meet presumptive compliance criteria Beginning October 1, 2015, addition of an item in the IRF patient instrument (PAI) to record the amount and mode of therapy delivered by each therapy discipline for the first 2 weeks of the IRF stay Creation of definitions for "individual therapy," "co-treatment," "concurrent therapy," and "group therapy" to align with current SNF Part A definitions Addition of a yes/no check-off in IRF-PAI that would indicate whether prior treatment and severity requirements have been met for patients with arthritis Addition of IRF quality reporting measures that would include outcome measures related to MRSA and clostridium difficile infection (CDI)

News From APTA’s Payment Policy & Advocacy Department (continued) The final rule changes for SNFs (.pdf) involve a provision that will allow SNFs to use a “change of therapy other Medicare required assessment” (COT OMRA) to reclassify residents formerly but not currently in a therapy resource utilization group (RUG) into a new RUG. CMS will continue to prohibit the use of the COT OMRA for initial classification of patients into a therapy RUG. Additionally, the SNF final rule includes a statement from CMS that acknowledges the comments it received around the development of an alternative therapy payment model. The agency states that several models are being explored, and that the changeover to a new model must be timely and incorporate stakeholder feedback that addresses problems in the current SNF payment structure. CMS has not set a date for implementation and is still accepting input on the issue.

CMS Fact Sheets on PFS, HHPPS, OPPS and DMEPOS Rules Available APTA will post detailed summaries of the physician fee schedule (PFS), home health prospective payment system (HHPPS), outpatient prospective payment system (OPPS), and the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) rules in the coming weeks. In the meantime you can view the CMS fact sheets on the final rules here.

Upcoming audio conferences: 2014 Postacute Care Compliance Seminar: The program will be presented by Ellen Strunk, PT, MS, GCS, CEEAA, Cindy Krafft, PT, MS, COS-C, Roshunda Drummond-Dye, JD, and Anita Bemis-Dougherty, PT, DPT, MAS, on November 15, 2014, from 8:00 am to 4:30 pm. Participate in person at APTA’s headquarters or via virtual live stream, and earn 0.9 CEUs.

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If you enjoyed this edition of KPTA’s Newsletter, consider advertising in our next edition. Our newsletter is e-mailed to over 1,400 PTs, PTAs and students throughout the Commonwealth and is archived on our website, www.kpta.org. Contact the KPTA office to make arrangements for your facility to be featured in our next edition, and get the attention you deserve!

KPTA Brings Exceptional Education to 2014 Fall FUNction

Above, Chuck Hazle, PT, PhD teaches a lab technique to participants in “Out-Think Being Out-Sized: Manual Therapy Approaches for the Not-So- Large Clinician.” Right, Matt Lee, PT, DPT, OCS, FAAOMPT, demonstrates additional techniques.

KPTA featured a hands-on lab course, “Out-Think Being OutSized: Manual Therapy Approaches for the Not-So- Large Clinician ,” presented by Charles Hazle, PT, PhD and Matt Lee, PT, DPT, OCS, FAAOMPT at the 2014 Fall FUNction held at Baptist Health Lexington. Additional programming included “Functional Outcomes Across the Continuum of Care,” presented by Pam Heissenbuttel, PT, MSPT, ACHCE; Eric Mooney, PT, MPT, Cert. MDT, MBA; Mathew Nicholls, MD, PhD; Andrew Ryan, MD and Charlie Workman, PT, MBA and “Research Updates: Enhancing Practice & Patient Care,” presented by KPTA members.

A special thanks to our Fall FUNction host facility: Baptist Health Lexington!

KPTA Welcomes New Student Liaison Sonia Young, PT, DPT, EdD recently accepted the position of KPTA’s Student Liaison. As Student Liaison, Sonia will work to ensure students across the Commonwealth are informed and engaged in KPTA activities. Sonia Young is a practicing physical therapist who currently serves as Student Liaison. She graduated from the University of Louisville’s Physical Therapy Program in 1997. She later received a transitional Doctorate of Physical Therapy degree from Shenandoah University and an Education Doctorate in Educational Leadership from University of the Cumberlands. She has practiced rural physical therapy in multiple settings in Kentucky including nursing homes, acute care hospitals, an inpatient rehabilitation center, school systems, outpatient centers (private and hospital based), and as an independent provider for First Steps. In the clinic, she served as a clinical instructor for physical therapist and physical therapist assistant students. She also was an in-house Center Coordinator for Clinical Education. She has worked in higher education for five years; first as an Associate Director and Associate Professor in the Physician Assistant Program at University of the Cumberlands and currently as an Associate Professor at Western Kentucky University’s Doctor of Physical Therapy Program. She finds great satisfaction in practicing pediatric physical therapy, teaching Neuroanatomy and Neurological Rehabilitation and interacting with PT and PTA students. She and her husband Stephen reside in Bowling Green with their three sons after recently moving from Williamsburg, Kentucky. Feel free to contact Sonia at Sonia.young@wku.edu.

KPTA Members Elected to APTA National Positions

C O N G R A T S Join us in congratulating Terry Brown, PT, DPT (left) on his election as APTA Private Practice Section President and Jarrod Evans, SPTA (right) on his election as APTA Student Assembly SPTA Delegate.