Welcome to the Reimbursement Web Page! Reimbursement Roles and Contact Information Advisory Panel on Reimbursement Insurance Specialists Assistant Director: Reimbursement Reimbursement Forms On-line Problem Payer reporting form On-line High Co-Pay form Reimbursement FAQs Billing Medicare No Fault Workers' Compensation Other Questions APTA Reimbursement FAQ Reimbursement Resources Recovery Audit Contractor Contract Primer Increase in Medical Authorization Request Threshold Applying for Your National ProviderIdentifier Reimbursement Forum Reimbursement News NYS Workers’ Compensation Medical Treatment Guidelines Have your workers' compenstion or no-fault payments decreased? The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 NGS Medicare to Hold Claims for 10 Days as of April 1, 2010 United Healthcare Modifies Manual TractionReimbursement Policy Important Information Regarding Palladian Health Medicare Audits PT’s in Private Practice in NY Understanding the RAC Process Are You Billing Workers' Compensation and No Fault Insurance Correctly? Informed Consent  RAC Permanent Program Moves Forward Summary of Meeting with Mohawk Valley Physicians Health Care (MVP) Advanced Beneficiary Notice of Non-Coverage: Did you know? Are You Being Profiled or Tiered by an Insurance Carrier? Summary of follow-up meeting with Empire Blue Cross/Blue Shield Third Party Payers Brooklyn/Staten Island Catskill Eastern Finger Lakes Greater New York Hudson Valley Long Island Southern Tier Western Payer Websites and Additional Sites of Interest Advisory Panel on Reimbursement To provide advice and counsel to the Executive Committee (EC) and Board of Directors (BOD) regarding activities or policies that can enhance the position of physical therapists in the current or in future reimbursement environments. This advice and counsel addresses both the appropriate reaction to reimbursement issues, as well as the proactive planning for and promotion of appropriate methods of reimbursement in the future. As appropriate and at the direction of the EC and BOD, the Panel will undertake tasks that are consistent with its purpose. Look at trends to identify issues across insurance companies for potential legislative or regulatory action. Tasks: Address relevant issues and trends in the current environment (internal and external) affecting reimbursement of physical therapy. Identify potential changes/evolution in the reimbursement environment and recommend techniques, positions or policies to address these changes and to promote changes that will benefit physical therapists. Identify and address risk management considerations of changes in reimbursement regulation and provide advice and counsel to the EC, BOD and Chapter Office staff regarding risk management implications and changes in reimbursement regulation. Advisory Panel on Reimbursement (1/07) Cathy Anastasio, Chair ridge.pt@verizon.net Jeffrey W. Hathaway Jeffh@proactiveptclinics.com Marcia Miller-Spoto mspoto7@naz.edu Corey Simon coreysimon@roadrunner.com Elaine Rosen Elaine.rosen@hunter.cuny.edu               Advisory Panel on Reimbursement Procedure Manual Insurance Specialists The Insurance Specialist is responsible for representing the chapter when requested by the chapter in response to individual member issues related to a particular payer that the Specialist has an established relationship with and assists the Reimbursement Director (RD) in determining whether the issue is an industry-wide trend that impacts physical therapy reimbursement throughout the state. In addition, Insurance Specialists are the front-line with their respective insurer(s) – because of the relationship they have with the insurers and their peers in the community, they will most likely become aware of issues with their insurers first; share issues relative to their respective insurer with the RD; provide background information and discuss issues with RC to determine next steps; assist in resolution of issues as needed (determined by RD). If there is a need for a face-to-face meeting with the insurer and the RD cannot attend in person, the Insurance Specialist would attend the meeting, while the RD calls into the meeting. Tasks: Gives input as to whether the issue needs review by the Advisory Panel on Reimbursement Assists the Reimbursement Director in keeping an ongoing communication with insurance company contacts that they establish Assists the Reimbursement Director in the completion of reimbursement-related charges from the Board, as needed Upon being given issues by the Reimbursement Director for their specific payer, they meet with the payer to determine what remedies can be achieved Identify issues that can impact the physical therapy throughout the state Provides input for needed updates for the Reimbursement FAQ page of the web site May serve as a member of the Advisory Panel on Reimbursement Insurance Specialists (5/29/08) Cathy Anastasio Medicare/Empire ridge.pt@verizon.net Jeffrey Hathaway HealthNow jeffh@PROactivePTclinics.com Catherine Hill HealthNow chillpt@rochester.rr.com Ann Duffy UHC/ACN ann@duffyandbracken.com Joe Maccio CDPHP, MVP, BSNENY jmaccio1@nycap.rr.com Lori Monson Oxford LMonson@bradleymonson.com Rich Orsini Aetna & Orthonet ptskither@msn.com Elaine Rosen GHI Elaine.rosen@hunter.cuny.edu Marcia Spoto Excellus Preferred Care mspoto7@naz.edu Michael Suydam Workers’ Comp suydampt@optonline.net Gary Willner BCBS gswillner@aol.com   Assistant Director, Reimbursement:   Kelly Garceau kgarceau@nypta.org The Assistant  Director, Reimbursement is responsible for the chapter’s response to individual member issues and industry-wide trends that impact physical therapy reimbursement.   Takes individual member concerns to sent to the Chapter Office and determines the most effective way of handling the issue, including but not limited to direct resolution of the issue Direct response to the member Referral to a Insurance Specialist Referral to the Advisory Panel on Reimbursement Referral to the Executive Committee Communicates with the membership as to the disposition of their concern Identifies industry trends for review by the Advisory Panel on Reimbursement Keeps ongoing communication with insurance company contacts that are established by the Insurance Specialists Oversees the setting up of appointments with insurance representatives for the Insurance Specialists Oversees the completion of reimbursement-related charges from the Board. Provides a report of activities for each Board meeting Serves as a resource to Federal and State regulatory questions from the members Is responsible for the content and updates to a Reimbursement FAQ page on the members- only section of our web site Include in every issue of the Chapter newsletter a “question of the month” with a message that more Q&A are found on our web site Serves as a resource to all Chapter committees 4/13/10