17.2: Reimbursement Strategies for Physical Therapists
NATA approved: #Q102-31

This course covers key issues regarding reimbursement for physical therapists. These include the following: cash-based programs in physical therapy settings; documenting for functional outcomes and optimal payment; compliance program essentials for physical therapists; and Medicare rules and regulations for physical therapists across the healthcare continuum. Upon completion of this course you will have numerous strategies for optimal reimbursement for physical therapy services in today's healthcare environment with direct access, autonomous practice, and the APTA's goals for Vision 2020.

Upon completion of this course, the course participant will be able to:

1. Explain the role of cash-based programs in achieving the American Physical Therapy Association's goals of Vision 2020.
2. Describe how state physical therapy practice acts and physical therapists' interpretation of those acts may influence the development and implementation of cash-based programs.
3. Understand how past and current United States healthcare history influences present beliefs as to who should pay for healthcare costs.
4. Differentiate between and select cash-based programs based on physical space and local demographics.
5. Understand and describe the concept of internal and external cross marketing opportunities with regards to physical therapy and wellness programs.
6. Realize the importance of risk management as it relates to direct access and cash-based programs.
7. Provide an overview of reimbursement systems and how they impact payment.
8. Understand the most common payment methodologies and how current procedural terminology codes are utilized
9. Distinguish between local and national payment policies and how they impact delivery of services. 11. Utilize documentation strategies that effectively illustrate the delivery of medically necessary, skilled rehabilitation services.
10. Understand the general processes of claims submission and responding to denials.
11. Understand the definition, benefits, and key elements of an effective corporate compliance program and it's importance to physical therapists' practice.
12. Identify key risk areas for clinical practice and incorporate effective monitoring and auditing tools into a compliance program to address risk areas.
13. Understand key Medicare rules and regulations governing each segment of the health care continuum and their relevance to physical therapists' practice.

• Overview of Cash-based Programs in Physical Therapy Settings
  James E. Glinn Sr, PT
• Reimbursement Issues: Documenting for Functional Outcomes and Optimal Payment
  Ellen Strunk, PT, MS, GCS
• Compliance, Rules, and Regulations in Medicare
  Debora L. Miller, MBA, PT, CHE

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