Message from APTA NH President regarding COVID 19
5.11.2020
Dear Members,
For those of you that are starting to have in-person outpatient therapy services open again, our hope is that you have the tools and information you need to do so safely and successfully. I know as the facility I work at begins this process; we have received a lot of positive feedback from patients who are anxious to access needed therapy services again. As we know, if we remain diligent with our procedures and strictly follow the recommended guidelines for reopening in our settings, we have done everything we can to promote a safe environment for our patients and ourselves. For those of you in inpatient settings, a sincere thank you for your continued frontline efforts to serve those who are in the most vulnerable states. If members are experiencing specific issues in relation to re-opening, please reach out to see if we can assist with your questions.
Aside from the anticipated plans for a gradual ramp up of in-person services, the world of Telehealth continues to evolve, with another significant clarification from CMS regarding billing procedures for facility-based entities such as hospitals. While not perfect (and some would say a process that presents a new challenge at best), the guidance does offer a work around in order for facility-based providers to participate in telehealth for Medicare beneficiaries. CMS also offered guidance on a PTA’s ability to provide telehealth services with criteria for acceptable supervision. Here is a summary of those updates:
Updated NH Insurer Telehealth Worksheet
Guidance for Hospital-based Participation in Telehealth under Medicare Part B
Hospitals could opt for a process to designate outpatients’ homes as “temporary expansion locations” to all for telehealth thru the Hospitals Without Walls waiver. Hospitals could choose tofollow a process that would enable PTs and PTAs who furnish therapy in the hospital outpatient department and whose services are billed by the hospital through the UB-04 claim form to furnish remote care to registered outpatients — provided the hospital registers the patient's address as a temporary expansion location. It is up to the hospital to see if necessary and feasible to temporarily expand provider-based department within this scope and does not run counter to state laws. (for more details regarding this please see page 41 of the CMS interim final rule released on April 30th. located here:
Hospitals must notify their CMS regional office by email of the addresses it plans to identify as temporary expansion locations. Use the DR condition code and the CR modifier.
SNF’s and HHA can’t bill for telehealth services provided by PT or PTA.
Rehab agency use of telehealth will be discussed but for now the answer is no.
APTA and other stakeholders are continuing to advocate for expansion of telehealth provisions to SNFs, HHAs, rehab agencies and other institutional settings.
Here is a link for more detailed information:
PTAs and Telehealth for Medicare Part B
PTA’s can furnish telehealth in the private practice setting under Medicare Part B with services billed by supervising PT. CMS said flexibility could be applied in the context of PT directly supervising PTA in private practice with the language from the April 6 final rule that direct supervision “includes real-time interactive audio and visual communications when use of such technology is indicated to reduce exposure risks for the beneficiary or health care provider". APTA’s advice is to wait for written confirmation before switching over to virtual direct supervision and also must follow state requirements.
Additional News for PTAs This Week
Clarification of Tricare and PTA’s: CPT Codes 97001 and 97002 have been removed and 97010 and 97011 have been added. For more information on this development, click the links below:
Additional Coronavirus Resources
APTA Sections and Academies have compiled a particularly good resource guide for practitioners in various settings on how to best approach care in this time of COVID-19. Please click on the link below for a host of useful resources:
…And Finally a Request to Members
Many of you may have received a Legislative Action Alert email from APTA this week. It has to do with having our voices heard concerning the proposed 8% cut in Medicare reimbursement levels set for physical therapy services in 2021. APTA is asking its members to reach out to our congressional representatives to request their support for inclusion of an amendment to the next COVID Relief Package to prevent these deep cuts from taking effect on January 1st.
It has clear especially now, that this is not the time to implement any payment cuts that will exacerbate the financial instability of healthcare providers’ practices. Please take a few minutes to send a letter off to Congress today by clicking on the link below to have our collective voices heard…thank you.
Stay safe and well everyone…and a Happy Mother’s Day to all you incredible Moms out there…
Let’s all keep up that sense of optimism for a return to some sense of new normalcy and that inspiring resilience I have witnessed in so many ways in these many weeks….we will get there! #BetterTogether
Best to all…Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
5/4/20
Dear Members,
When I consider our current circumstances of the gradual reopening of services around the state over the next few weeks coupled with the gains we are realizing in regard to the expansion of telehealth access for reimbursement, my hope is that each of you is able find a safe and effective method of care delivery for your patients during this time of ongoing uncertainty. Here at APTA NH we will continue to monitor and advocate for the issues that are critical to both our profession and the patients and communities we serve.
This week there was a major development in the access to telehealth for physical therapists. PTs are now recognized as approved providers for telehealth services under Medicare by CMS during this time of COVID-19. This is a big win for physical therapists to be able to finally provide care to our patients who are often most in need of our services. There are, unfortunately, still a few outstanding questions remaining. Importantly, facility-based services again do not have clear guidance from CMS on how to bill for these services on a UB04 form. APTA continues to advocate for this critical guidance and I have been in touch with Senator Shaheen’s office regarding this specific issue, requesting assistance in solving this technical issue. Secondly, it is unclear whether PTAs are covered under this new expansion of services and again APTA continues to advocate for clear guidance from CMS. For more specifics regarding this change please click on this link:
Click Here for the current NH Insurer Telehealth Worksheet
Also, please visit these CPOVID-19 resources that cover the latest information on research, intervention strategies around the globe, and up to date Coronavirus information from both national APTA and APTA NH:
Research Updates:
Coronovirus Update APTA:
Coronavirus Updates APTA NH:
That is all for this week…as always stay safe and healthy everyone. Please feel free to reach out to us if you have specific questions…we are definitely all in this together! #BetterTogether
Best to all…Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
April 26
Hello members…
I hope this email finds you all well and deftly navigating another week of life in the time of COVD-19.
Just a few important updates we wanted to share in particular about telehealth, PTAs/Tricare, and NCCI edits…
First, while Anthem has had billing guidance in place for private practitioners who are utilizing telehealth, for those of you at facility-based clinics such as hospitals, Anthem has not been clear about how to bill in NH. They have finally outlined a clear method for you to bill for telehealth services:
(From Anthem’s COVID-19 policy)
“For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in person visit, and also append modifier 95 or GT.”
Additionally, CIGNA has expanded its coverage for therapy codes:
PT/OT/ST providers can now deliver virtual care for any service if it is on their current fee schedule and if CMS covers it virtually. We have removed the previous guidance that only a select number of codes on the fee schedule could be billed. PT/OT/ST providers should also submit virtual claims with a GQ, GT, or 95 modifier and a face-to-face place of service code (e.g., POS 11).
Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier.
Next, for our PTAs, Tricare has finally added your services for reimbursement to their policy manual:
TRICARE, the health insurance system used throughout the military, announced that it has officially revised its policy manual to recognize PTAs (and occupational therapy assistants) as authorized providers, outlining the rules and requirements governing assistant qualifications, scope of practice, supervision, and reimbursement.
Now it's up to TRICARE contractors to do the same within approximately 30 days.
As reported earlier, beginning with date of service on April 16, PTAs are recognized as authorized providers under TRICARE and thus eligible for reimbursement for covered services rendered to TRICARE beneficiaries. The CQ modifier must be input if more than 10% of a service is furnished by a PTA.
Next, concerning NCCI edits/modifiers:
Prior to the latest change, reimbursement would be denied if, for example, code 97530 (therapeutic activities) was paired with 97116 (therapeutic procedure) without use of the 59 or applicable X modifier. The same was true for pairing 97161-97163 (physical therapy evaluations) with 97140 (manual therapy) and several other common pairings.
Those code pairings have been eliminated. Now PTs working in private practice and institutional settings can pair many codes without adding the 59 or applicable X modifier. Additionally, NCCI edits were lifted that prevented certain emergency department codes to be paired with physical therapy and occupational therapy evaluation and reevaluation codes. These changes are retroactive to January 1, 2020.
Therefore, in private practice and institutional settings, PTs are now able to pair the following code combinations without the use of 59 or X modifiers:
97530 with 97116 97161 with 97140 97162 with 97140 97163 with 97140 99281-99285 with 97161-97168 97110 with 97164 97112 with 97164 97113 with 97164 97116 with 97164 97140 with 97164 97150 with 97110 97150 with 97112 97150 with 97116 97150 with 97164.
For more information regarding COVID-19, please refer to the following APTA resources that are updated regularly:
Coronavirus Update:
Coronavirus Resources:
For up to date information regarding Telehealth, please visit the APTA NH Telehealth Worksheet or ATPA Telehealth resources:
NH Insurance Telehealth Worksheet:
Telehealth Resources:
Also, here is the latest information from APTA concerning more relief funds potentially available to healthcare providers. In particular, the replenishment efforts for the Paycheck Protection Program and additional aid available through HHS and the CARES Act are discussed:
New COVID Relief Package Adds $75 Billion to Funding for Health Care Providers
The $484.4 billion package will shore up the Paycheck Protection Program and make another $75 billion available for provider relief through HHS.
The COVID-19-related grant funds intended for distribution to health care providers will receive another $75 billion as part of a $484 billion "phase 3.5" coronavirus relief bill signed by President Trump on Friday, April 24.
Known as the Paycheck Protection and Health Care Enhancement Act, the $484 billion relief measure focuses mainly on replenishing the U.S. Small Business Administration's Paycheck Protection Program, the loan program that saw its previously allotted $384 billion quickly depleted. This time around, the program will receive $310 billion.
The U.S. Department of Health and Human Services will also get an infusion of cash to be used for provider grant programs. The CARES Act enacted in late March carved out $100 billion for health care provider assistance; the latest package adds another $75 billion. The additional funds are intended to be used to support "eligible health care providers" that include public entities, Medicare or Medicaid-enrolled providers (including PTs), and nonprofit entities that diagnose, test, or care for individuals with possible or actual cases of COVID-19.
To date, HHS has designated about $30 billion for deposit directly into providers' bank accounts or via paper checks. More information on that program is available in this PT in Motion News story published when funds were released:
Two follow-up reports — one on how providers can verity if they're to receive the money: https://urldefense.proofpoint.com/v2/url?u=http-3A__www.apta.org_PTinMotion_News_2020_04_17_CARESReliefInstructions_&d=DwMFaQ&c=9fZnZOgPWmHmvevlab4V4ACvAaDFtZMPz_DO6BvzAJI&r=0VgJ85lkpxUq6ObTfkw_4quAYZ4YDQ78NVXGKNjJ8Co&m=mjOQ0ykBaV3FHfGx06k2zfX4h-QSDY18wumD3RJsdcg&s=Y0A5cuyfsEHpLuH90ccoImKWvhvdNU4MnHXKDChQnJo&e=
And another that addresses more details of the program: https://urldefense.proofpoint.com/v2/url?u=http-3A__www.apta.org_PTinMotion_News_2020_04_22_CARESActDetails_&d=DwMFaQ&c=9fZnZOgPWmHmvevlab4V4ACvAaDFtZMPz_DO6BvzAJI&r=0VgJ85lkpxUq6ObTfkw_4quAYZ4YDQ78NVXGKNjJ8Co&m=mjOQ0ykBaV3FHfGx06k2zfX4h-QSDY18wumD3RJsdcg&s=h7OXDEntilyV_6NEA0c2rGsaO_qEN5bu0Xcr3-FRrsE&e=> .
With additional funding now provided to these programs, Congress can now focus on the next COVID relief package, known as COVID Phase 4, which could be considered as early as May. APTA is continuing our advocacy efforts to include our policy recommendations in the COVID Phase 4 relief package. Those recommendations from APTA are spelled out in a letter to both chambers of Congress that outlines seven steps lawmakers should take to ensure patient safety and protect health care providers:
APTA also continues to urge members and stakeholders to join the association in a grassroots effort to press lawmakers for changes. Some are temporary, others lasting — that will protect patients and support providers both during the emergency and in years to come. Among the changes recommended: a permanent recognition of PTs and PTAs as approved telehealth providers under Medicare, a suspension of requirements that CMS believes forces it to make significant payment cuts to more than three dozen health professions, and more support for health care providers with small businesses.
Finally, I continue to both see and hear amazing stories of selfless healthcare workers and inspiring stories of those that have overcome the odds to survive COVID-19. One such story I am familiar with happened to a patient, and Marine, at a NH hospital last week who was finally well enough to leave the hospital. This is his send off and just one example that highlights how so many have pulled together to make a difference during this extraordinary time…here is a moment to celebrate one of the victories over this virus:
Thank you all for all that you do to care for the patents we serve. #BetterTogether
Best to all…Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
4/20/20
As always, I hope this message finds you and your family well and continuing to find some sense of normalcy in your everyday lives. While most of us have settled in to our “pandemic routines”, we all look forward to the time that we can emerge from our stay at home measures to once again treat our patients and work with our colleagues in person. Here are the latest updates:
Telehealth
Telehealth is still an important tool during this crisis for us to connect with and treat our patients. We have attached an updated worksheet of how insurers are covering for our services in NH. Changes still occur each week and frequently, so please utilize this as a guide to the information we believe to be accurate as of this writing. Medicare continues to be stalled in its declaration of PTs being listed as providers for telehealth services and both APTA and APTA NH continue to advocate for this inclusion with both CMS and our congressional representatives. I also have included the link to the latest telehealth and coronavirus information available through the APTA and APTA NH for you to review:
Telehealth Information via APTA:
Latest Coronavirus Information via APTA and APTA NH:
Upcoming Educational Opportunities
Journal Club: We have a journal club meeting on Tuesday, April 21st at 7 pm with the article topic of Telehealth Assessment of Gait and Gait Aids: Validity and Interrater Reliability. This event is free to members. Please click on the link below for more information regarding this specific event and how in general our Journal Club offerings are structured. The journal club is a great way to interact with and discuss timely topics of interest with fellow therapists:
COVID 19 Resources for PT Q&A: Pulmonary Evaluation, Examination, and Interventions. This will be a valuable Q&A session planned for Wednesday, April 22nd at 7pm. This session will be led by Sean Collins, PT, ScD who is a professor and program director of the DPT program at Plymouth State University. He is also the Editor-in-Chief of the Cardiopulmonary Physical Therapy Journal, and an Academic Editor for PLOS One for Physiology, Rehabilitation Medicine, Sports and Exercise Medicine. This event is free to members. For more information and to sign up for this educational opportunity, click on the link below. After signing up, we ask that you review the outlined materials listed in the link prior to attending, as these will help prepare you for the session. We hope you can join us:
Today I want to leave you with some “good stuff”. There are always great things that are happening in the world of physical therapy and the link below will bring you stories of how therapists are getting the word out about how therapy can adapt and make an important difference in the time of COVID-19:
Stay well and positive everyone…remember, we here at APTA NH are available to assist with your questions and needs. #BetterTogether
Best to all! …Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
4/13/20
Hope you all are staying healthy, active and productive during our ongoing time of social distancing, uncertainty and rapidly changing environments. We here at APTA NH are continuing to work on your behalf to advocate, inform and support you.
Telehealth
This week saw continued clarification on telehealth from commercial insurers but still no movement on therapists being listed as providers for Medicare services via telehealth. The Chapter had a call yesterday with a Projects & Policy staffer from Senator Jeanne Shaheen’s office to review a range of issues affecting PTs in the State of NH during this time of COVID-19. We had a particular focus on seeking support from the Senator to help with this ongoing technical issue with Medicare. It was a positive call and a great opportunity for us to educate the Senator’s office on how this pandemic is
affecting NH therapists on many fronts.
I have attached our latest Telehealth Worksheet for NH insurers with our current understanding of the billing landscape. We continue to seek clarification for services
offered via facility-based clinics as some insurers still report a requirement of including a POS 2 indicator on the UB04 claim form when there is no option on the form to input this code. Understandably, this is yet another source of confusion surrounding being able to confidently offer and bill for telehealth services.
For those of you that have been able to take the leap into telehealth…kudos to you! We have gotten positive feedback from therapists in the state in regard to its treatment effectiveness and the impact that being able to reconnect with their patients has had on them to regain some sense of normalcy.
From the patients’ perspective we have heard how truly thankful they are for the opportunity to have an access point to continue their rehabilitative therapy care. Please visit APTA’s Telehealth resource page for the latest information on all things telehealth:
Patient Management
Here is another good resource that reviews many aspects of patient care management during this pandemic in multiple treatment settings:
The Chapter is working on offering a Pulmonary-focused Evaluation and Intervention educational opportunity with the expertise of PSU DPT Program Chair, Sean Collins. More information to come.
Here is a link to the presentation that will be the basis for the educational information sharing and discussion.
Federal Relief Packages Update
As part of the CARES Act pandemic relief package, the Department of Health and Human Services has begun sending out checks to qualifying providers and facilities that participate in the Medicare program.
For specifics of the program and to see if you may qualify, click on the link below:
Jurisprudence
Many therapists have received an email in regard to the upcoming jurisprudence exam required for PT/PTAs to pass in order maintain licensure in the last 1-2 weeks. The timeframe of the exam to be taken has been moved from April, May, June to June, July, August for this cycle (jurisprudence exams are required for licensure in years ending in 0 or 5). Here is a link to the specifics for this year’s exam (jurisprudence information is located about half way down the page):
I thought I would leave you today with some humorous thoughts that were forwarded to me. During an incredibly stressful time it is sometimes good to take a moment, breathe and have a chuckle. Maybe not particularly “association appropriate” news but these are extraordinary times!
Half of us are going to come out of this quarantine as amazing cooks. The other half will come out with a drinking problem.
I used to spin that toilet paper like I was on Wheel of Fortune. Now I turn it like I'm cracking a safe.
PSA: every few days try your jeans on just to make sure they fit. Pajamas will have you believe all is well in the kingdom.
I don't think anyone expected that when we changed the clocks, we'd go from Standard Time to the Twilight Zone.
This morning I saw a neighbor talking to her cat. It was obvious she thought her cat understood her. I came into my house, told my dog...we laughed a lot.
I hope the weather is good tomorrow for my trip to Puerto Backyarda. I'm getting tired of Los Livingroom.
Day 6 of Home schooling: My child just said "I hope I don't have the same teacher next year"...I'm offended.
Hope you and your families continue to stay well and positive. This week when many of us are observing either Passover or Easter, it is a great time to reflect on what is important and that which we are thankful for. #BetterTogether (by #BeingApart)
Best to All…Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
April 5
I hope this email finds you healthy and coping well with the challenges of uncertainty that each day brings. The old adage that the only thing constant in life is change was never more applicable than it is to our current circumstances. Each time that I write one of these updates I am struck by how much has changed in our lives, even since the last time we communicated. Every day offers a new test of our fortitude to not go stir crazy, to try to offer homeschooling for our children, to calm our family’s and our own fears, to continue with necessary social distancing, to try and figure out the best way to manage finances, adjust to new job positions, and overall deal with the nagging sense of not knowing what will happen next. We all share in these experiences and emotions so please know that from all of us at APTA NH, we will to continue to offer support, information and guidance as best as we can in the hope that our shared experience of constant change will be a little more bearable. With that said…onto the updates…
Telehealth:
This week saw an overall shift in how insurers are responding to the COVID-19 crisis in terms of expanding coverage and clarifying their stance on telehealth. Now that is not to say that the questions are answered for all insurers particularly in terms of HOW to bill, but at a minimum the picture is becoming clearer. Please access the attached grid for our latest understanding of who is covering what in terms of telehealth, however please be aware that even by the time I post this message something may have changed, updates occur that quickly. You are best to utilize this grid as a guide as to where an insurer is on the spectrum of telehealth coverage as best as we know at this moment, but checking with the specific insurer in regard to your particular setting is recommended. The largest area of uncertainty that I heard about this past week has to do with how to bill in a hospital setting versus private practice as some expert opinions have diverged in their interpretations. Our hope is that you find this information helpful at clarifying at least some areas of uncertainty.
Click Here for access to Telehealth Worksheet
· One of the more significant changes this week is Anthem changing from their stance of covering only evaluation and re-evaluation codes to expanding telehealth coverage to the therapy CPT codes of 97110, 97112, 97530 and 97535.
Among the many voices advocating for this change was APTA NH. Our NH chapter sent a letter to Anthem on behalf of our members earlier this week to request an expansion to include treatment codes and we are delighted that this appropriate adjustment to coverage has occurred.
· Another significant change is that Aetna has evolved from e-visit coverage only to now covering telehealth. The therapy CPT codes that will be covered are: 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. More specifics can be found by clicking on this link:http://www.apta.org/PTinMotion/News/2020/04/02/AetnaTelehealthCOVID/
· As of this writing, Medicare still has not formally recognized PT as providers of Telehealth despite the inclusion of therapy codes for telehealth coverage. We are aware this is a source of ongoing confusion (and frustration) but in the meantime, APTA advises members to assume that PTs are not recognized as telehealth providers by CMS, and the association calls on member to press the agency to expand telehealth waivers, using an APTA-developed template letter.
In addition, the association is pushing for permanent inclusion of PTs in telehealth through advocacy for the CONNECT Act. PTs continue to have access to e-visits as an option through Medicare.
Federal Assistance Relief Packages
In case you thought things could not be more complicated, the information surrounding unemployment, extended leave benefits and support of practices through loan programs made headlines this week. On balance, good news for many practitioners, but not necessarily for all depending upon your specific employment situation.
· Per PT in Motion on 04/02/20, The recently signed CARES Act “contains important provisions related to unemployment that include relaxing some of the qualifications to receive benefits, allowing for circumstances specifically related to the pandemic, and adding $600 to weekly benefit checks.” This important expansion offers the potential for therapists to access unemployment benefits that they otherwise may not qualify for. Part of the qualification is that you must be able to prove that you can no longer work due to the various ramifications of the COVID-19 crisis. For more information, start here:
· There is some uncertainty surrounding the possibility of PTs/PTAs being exempted from receiving additional leave benefits as part of the response to the COVID-19 crisis. Depending upon your employment situation, your employer could opt out of this provision based upon wording in the Families First Coronavirus Response Act. If you are unsure of how your employer is handling this exemption, we encourage you to ask. Here is a starting point as a resource:
· The Paycheck Protection Program, or PPP, is available through the Small Business Association that offers most businesses with less than 500 employees the opportunity to apply for a forgivable loan with deferred loan payments in order to be able to continue to pay their employees during the COVID-19 crisis. I’ve attached a fact sheet offered through the Treasury Department, that seems to do a good job explaining many of the aspects of this program. If you are a practice owner who may benefit from this program, it is well worth considering. Ability to apply began on 04/03/20. Click Here for the PPP Fact Sheet.
Here is an APTA resource that reviews even more information in regard to the CARES Act and small business opportunities for relief:
· On 03/30/20 the Federal Communications Commission announced a COVID-19 Telehealth Program to support health care providers responding to the ongoing coronavirus pandemic. As part of the CARES Act, Congress appropriated $200 million to the FCC to support health care providers’ use of telehealth services in combating the COVID-19 pandemic. If adopted by the commission, the program would help eligible health care providers purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services. Click here for more info.
Educational Opportunities
There continue to be many free educational opportunities for therapists to access during the COVID-19 crisis. Many offer information and guidance on how best to handle various aspects of the crisis or best practices in various treatment settings. Here is a link to explore many of the offerings:
Also, for those of you that may find yourself in the ICU, this course “Lines, Tubes, Ventilators, and Diagnostic Screening for Stability v. Instability” has been well-received bytherapists that I have spoken with. Here is the link to access:
Another Telehealth learning opportunity on Tuesday, April 7 from 2-3pm:
Finally, please make sure you take a moment to access our COVID-19 resource page at www.nhapta.org. There are several links to resources specific to your practice setting as well as general information to help you get through this time period. We are updating content regularly. Let’s continue to support one another and as always, I encourage you to reach out if you have any specific questions. Also, because this is a time of social distancing and continued disruption of our daily routines, this is a great time to reach out to those you may know who are more isolated to ensure they are doing okay and have what they need. I know many of us have reached out to our more vulnerable patients to check in on them and they have been really appreciative…our caring spirit is definitely one of the things we do best. #BetterTogether
Best to all…Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
March 31
Dear Members—
Last night Medicare made the decision to cover physical therapy services as part of telehealth coverage. That is great news but comes with a technical issue…we are not formally listed as providers by Medicare to offer telehealth services. I have attached the coverage memo sent out by CMS as well as the current understanding of how it is interpreted by APTA outlined below. There is a link highlighted in yellow for therapists to help advocate to CMS to get this issue rectified quickly so that we can access the therapy codes we need to appropriately treat our patients.
Please join me in sending a message to CMS regarding this important issue…Thank you.
Although CMS announced on March 30, 2020, that it would add PT, OT, and SLP services to the list of services covered under the Medicare Physician Fee Schedule when furnished as telehealth, CMS did not expand the types of providers eligible to furnish telehealth. CMS noted in the interim final rule (page 35) that current Medicare law does not allow telehealth services to be furnished by PTs, OTs, and SLPs under 1834(m).
Thus, telehealth services furnished by PTs are still not covered under Medicare as of today.
That said, while this law doesn’t allow therapists to furnish telehealth under Medicare, this rule was written prior to the passage of CARES Act, which amended the 1135 waiver authority, and would allow CMS to waive additional telehealth restrictions if they so choose (doesn't require them to do so).
APTA is urging CMS to use its 1135 authority, amended by CARES, to expand providers eligible to furnish telehealth under Medicare, as is AOTA and ASHA.
We also are encouraging individuals to use the CMS template letter to send an email to CMS, urging them to use their 1135 waiver authority, which can be found on this page: https://www.apta.org/telehealth/
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
We wanted to make you aware of the volunteer opportunities / databases as a health care provider during the COVID 19 crisis. Please consider adding your name to one of these.
For the State of NH: www.nhresponds.org
APTA is working with other organizations and members to connect volunteers with facilities that need physical therapy services.
3/29/20
Dear Members,
As always, I hope this email finds you healthy and fairing as well as you can in this ever-changing healthcare landscape. Many of us are settling into a new reality whether it be offering our services via telehealth, looking for ways to keep busy and positive during a time of social distancing, adjusting and planning for a time period of fewer work hours available, attempting to manage our waning caseloads of in-person priority patients, switching up traditional therapy roles to help our hospitals manage the exponentially increasing stressors of the COVID crisis, analyzing the best path forward so our private practices can survive, and in general just trying to find some sense of normalcy in uncertain times. We are a resilient bunch though and can look forward to the day when our sense of true normalcy returns.
With all of this disruption, as is expected, more questions arise than are readily available and verifiable answers, particularly related to coverage for telehealth. My hope is that many of you have already taken advantage of resources available to discover the basic tenets of telehealth and e-visits, and now we are moving into phase of the mechanics of how we can actually be reimbursed for this important service to our patients.
At APTA NH we are still working on a plan to provide accurate information pertaining to commercial insurer payments. As of this writing:
· Medicare and Aetna are still covering e-visits only
· United Healthcare has changed their stance from covering only e-visits and they are now covering telehealth
· Anthem has been the least responsive insurer to date as to guidance (and are not included in list below because of that)…In addition, at this moment they are still planning to continue with the Medicare Advantage rollout on April 1, 2020 which we believe is a mistake and are advocating to block
Click here for the beginning of what insurers in NH are identifying as requirements for telehealth coverage. Please understand this is a moving target and could change, but at least it offers the current understanding of how/what can be billed for telehealth services. We will continue to modify and update as information becomes clearer.
Here is a resource with more specifics regarding Medicare billing and e-visits (as well as telehealth in general…don’t forget to tell Congress to support expansion of coverage to telehealth):
It is also important to be aware of the relaxation of requirements/reporting deadlines around the Medicare Quality Reporting Program. Specifics are contained in this document:
And related to reimbursement and telehealth, here is the national Matrix Tracker offered by APTA as of this moment. It has some useful information but is still a work in progress:
APTA Telehealth Payment Chart Tracker:
And finally, here is another educational opportunity to learn about telehealth and maybe even more importantly to ask questions as it is offered through Facebook Live. It is tomorrow, Monday, March 30th at 3 PM…
Facebook Live Event: Implementing Telehealth into Practice Q & A Opportunity:
I also want to share what amazing work the Sections and Academies are doing at APTA. Many have created COVID-19 resource pages that are open to anyone, not just members of that section or academy. Another example of how APTA has pulled together, risen to the occasion and has understood the need to get this vital information out to members. I am attaching links to the various section/academy websites that have useful information related to your practice area. Please visit these pages for more specifics:
Academy of Acute Care Physical Therapy Resources:
COVID-19 Practice Guidelines for Acute Care Therapists:
Academy of Pediatric Physical Therapy Resources:
Academy of Physical Therapy Education Resources:
Health Policy and Administration Section Resources:
Home Health Section Resources:
Private Practice Section Resources:
Finally, here are the latest updates from APTA regarding COVID-19 as well as the link to a pretty comprehensive listing of COVID-19 information:
APTA Coronavirus Update (03/37/20)
Comprehensive Resource for Coronavirus
My thoughts and hopes are with each of you that you are able to keep positive and work successfully through this stressful time. Here at APTA NH we are here to support and offer the best info we can in an attempt to make all of this just a little bit easier. Please do not hesitate to reach out with questions or just to talk…we are here for you. #BetterTogether
Best to all...Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
(603) 548-3554
3/24/20
Hello Members…
I hope this post finds you healthy and weathering this ever changing landscape well. As many of us shift our practice patterns and consider if the use of e-visits and/or telehealth services is right for our circumstances, I wanted to provide an update as to what current information is available.
As we know per the NH governor’s executive order last week coupled with guidance from the OPLC, we are included as providers for telehealth services during this emergency period related to COVID-19. Reimbursement rates are supposed to be the same as in-person rates (remember telehealth is different from e-visits/e-visits have a different reimbursement structure and just three defined codes that can be used with the delivery of care). The therapy codes utilized are supposed to have an identifier and/or modifier that is added to denote that it is therapy delivered via telehealth and insurers are supposed to honor that charge…BUT, the insurers have the latitude currently regarding which modifiers they require, which codes we are limited to, and how the services are billed.
Currently, Aetna is not covering telehealth and as we know Medicare is not as well, they are both covering e-visits. Generally, on some claim forms there will need to be an identifier of 02 in the Place of Service (POS) section to denote that the service is being delivered via telehealth. If an insurer’s policy states that modifier 95 is required to be reported with the code, our typical therapy codes will not work at this time. These are just a few of the confusing qualifiers out there currently. Specific to this situation though, I was informed today by APTA that there should be a national payer matrix out shortly that may help with this confusing state surrounding insurer coverage. Below is the link to the main telehealth page at APTA that explores many of the questions that therapists have, with the understanding that there are still questions that remain.
APTA continues to advocate for telehealth inclusion by therapists and coverage for therapy services from all insurers, including Medicare. Again, if you have not already, I encourage you to send a message to Congress and CMS regarding the need for telehealth services. As this continues to look more like a marathon, it may make sense to consider incorporating telehealth into your practice areas if you are able to do so. Having all the tools we can at our disposal offers us the best chance to offer skilled care to the patients we serve. If you follow this link and click on the Legislative Center on the APTA website you will be brought to a page with four actionable items listed, all worthy of our support, and two specifically targeting the COVID-19 crisis…telehealth and therapy relief for patients and providers.
Also, please remember that there is a webinar specific to Telehealth implementation on Thursday afternoon offered free to members through APTA. Please consider joining in to learn more.
I’m attaching the today’s update from APTA that in part speaks to the steadily decreasing amount of PPE available to healthcare providers as utilization spikes to treat patients. APTA is joining the call for Congress to explore and exhaust all possibilities to increase production and supply as well as advocating for more consistent guidelines surrounding use. This is a problem all around our state, and many states, that hospitals and providers are grappling with to maintain the safety of our healthcare workforce.
One more thing to consider today…how we can have a vital role in pulmonary health particularly during this time of COVID-19. Sean Collins, the DPT Program Director at PSU is holding zoom meetings regarding pulmonary patient exams for physical therapists. I’m sure this will be valuable information for anyone currently practicing in this area or considering incorporating this into your practice. The next zoom is tomorrow Wednesday, March 25th at 12:00. Here is the link to both resources and zoom information: Thank you to Sean for offering this information and for setting up this learning opportunity.
I realize that many of us feel inundated with the constant flow of information that is coming at us coupled with messaging from multiple sources that makes it hard to know what is accurate and what is not. Please know that APTA NH is striving to offer you the best up to date information that is available even though it does change quickly. Keep doing what you can to keep you, your families and your patients safe…we will get through this! #BetterTogether
Best to all…Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
3/21/20
Dear NH PT Community,
I hope this post finds both you and your families well. As we continue to face the unprecedented challenges and uncertainties posed by COVID-19, I wanted to update you on what responses have occurred at the state level this week as well as the ongoing resources that are available through APTA.
Before we get to the updates though, I want to take a moment to acknowledge and reflect on the dizzying pace of changes that have occurred, enormous disruption to our daily lives, and general sense of uneasiness that COVID-19 has brought to bear. I've heard from several clinics around the state who have had to make difficult choices regarding their daily operations and staffing as we all try to navigate how we can best protect our patients and ourselves in uncertain circumstances. I want to share with you that from the stories I have heard how proud I am to be part of a profession that has responded in so many amazing and thoughtful ways. As we know it is in times of challenge and strife that our characters are most revealed, and from what I have heard and seen, PTs/PTAs has risen to the challenge despite the painful decisions that needed to be made. Our commitment to patient-centered care is more evident than ever. We have been an exemplar of how to respond in a crisis and I wanted to offer a moment of thanks and for all of us to reflect and highlight how proud you all should be of your collective response.
Now onto the updates…On March 18th Governor Sununu released an Executive Order that along with Guidance from the State of NH Office of Professional Licensure and Certification (OPLC) that appears to provide guidance for utilization of telehealth by physical therapists in NH. Both documents are attached here for you to review.
While the executive order from the governor does not explicitly detail physical therapists, the additional OPLC guidance states that “effective immediately, the Governor has ordered ‘all medical providers[…] be allowed to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media, to treat the residents of the state of NH for all medically necessary services.’” The guidance goes on to assert that “The State’s temporary expansion of telehealth services applies to all medical providers including but not limited to those professions licensed, certified, or registered by the Office of Allied Health Professionals, ….”
We have heard from a representative of the NH PT Governing Board that services offered via telehealth are within our scope of practice.
We should all have reason to believe from the reading of these documents that physical therapists utilization of telehealth is not only allowed now but should have reimbursement attached to the service. I know some around the state have already either started to use or are investigating the use of telehealth in their practices. With that being said, there are still questions to be answered regarding implementation and levels of coverage by insurers and we are researching to get more clarity on those questions. Please consider participating in an upcoming webinar offered by APTA that will review strategies on how to effectively implement telehealth in our practice settings. It will be offered on Thursday, March 26th at 2:00 – 3:30.
It is important to note the distinction of “e-visits” that have been approved by Medicare and this temporary expansion of telehealth services as they are not the same thing. I have attached the latest information that delineates between the two and offers guidance on how to pursue utilization of e-visits.
In relation to e-visits and Medicare, if you have not yet done so, please make sure that your voice is heard by CMS and Congress regarding inclusion of physical therapists as providers of telehealth services to Medicare beneficiaries.
I am also attaching links to the latest information on Coronavirus offered by APTA that may be helpful for you and your practice:
In closing, I want you to know that here at APTA NH, we will continue to work on your behalf and update you as this situation continues to evolve. Please reach out to us if you have specific questions and we will do our best to either answer or provide direction on where to find the answer. Please feel free to share any of these resources with non-members as well. We are in this all together and how great is it that we have each other to rely on for support during these most challenging of times…#BetterTogether (in a way that honors social distancing recommendations of course)
Best of health and safety to all…
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
3/18/20
Dear Members,
As we all try to navigate this uncertain time, I want to share the most up-to-date information that APTA has to offer regarding COVID-19. It is an excellent resource for information surrounding COVID-19 and outlines information that is readily applicable to practice in this rapidly changing environment. Below is a list of links with the most recent updates, most notably in regard to telehealth coverage for “e-visits” by PT approved by CMS. I am confident that we will continue to find ways that help us to creatively meet the needs of the patients we serve. We are all in this together and our united voice is helping to create positive change. #BetterTogether
Stay safe and healthy everyone!
Mark
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
COVID Resources:
http://www.apta.org/Coronavirus/
Telehealth and PT:
http://www.apta.org/PTinMotion/News/2020/03/17/E-VisitsCMSCoronavirus/
COIVD Infection Control and Protective Equipment
http://www.apta.org/PTinMotion/News/2020/03/11/CMSCoronavirusGuidance/
Patient Care and Practice Management
http://www.apta.org/Coronavirus/
CAPTE Response regarding Students
Coronavirus Update: March 17, 2020
http://www.apta.org/PTinMotion/News/2020/03/17/CoronavirusUpdateMarch17/
Students: Statement from CAPTE
http://www.capteonline.org/uploadedFiles/CAPTEorg/Homepage/CAPTEResponsetoCOVID19.pdf
