Medicaid Programs in Kansas

In Kansas, the Medicaid program is covered by three insurance companies. These are Amerigroup Kansas, Inc., Sunflower State Health Plan, and UnitedHealthcare Community Plan of Kansas. Each one of these groups have slightly different requirements that must be met in order to treat and receive reimbursement. From the www.kancare.ks.gov website, a provider can find information that will be useful in practice. Also, from this website, a provider can get to any of the insurance companies that run the Medicaid program in Kansas. These websites will be equally important when needing to find out the finer details of each program.


Here is the Physical Therapy chapter from Contexto Media's coding book. It has CPT and ICD-9/10 Codes.
http://www.codingbooks.com/Assets/MEDPT11_Sample.pdf

Medicare Physician Fee Schedule
https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

This link explains how to bill for timed codes using the 8-23 minute rule.
http://www.cms.gov/transmittals/downloads/R1019CP.pdf

This link leads to the CMS.gov website, particularly for therapy services. It can guide professionals to other resources on the subject of rehab therapy services, coverage requirements, payment systems, and various contacts if more information is desired.
http://www.cms.gov/Medicare/Billing/TherapyServices/index.html


APTA Health Policy and Reimbursement

http://aptahpa.org/displaycommon.cfm?an=6
This website is the APTA Health Policy and Administration website that offers links to different websites that will provide you with all the companies that reimburse for physical therapy services. For example, there is a link to Medicare’s website and private insurance companies. There is also a current news link that will keep therapists updated on rulings and changes with reimbursement.

Medicare Payment and Reimbursement

http://www.apta.org/Payment/Medicare/
Here is another good link from APkA that covers Medicare coding and billing, benefits, coverage issues, denials, audits, appeals, enrollment, credentialing processes, pay for performance, and discusses the supervision (use of students, aides, and PTA's). This looks like a really good resource if we have any questions in regards to medicare. It also had Additional Information that go into more debt such as the "medicare advantage" and "medicare claims audits."

Private Insurance Payment and Reimbursement

http://www.apta.org/Payment/PrivateInsurance/
This is a good link for reimbursement and payment from private insuracnce compaines. Since we work a with a lot of different companies and policies, this is a good place to look at collective information. It gives a list of major insurers, payment by setting, and links to various articles that have information regarding current issues. If you click on an insurance company, it takes you to their webpage where you can find policy/enrollment information, provider information, and claim information. There is a FAQ section for audits, denials, and appeals which would be a great resource for figuring out what to do if there was a problem with an insurance company.

Functional Limitation Reporting
http://www.apta.org/payment/medicare/codingbilling/functionallimitation/
As of January 1st, 2013, CMS (Centers for Medicare and Medicaid Services) has set forth a new mandate that functional performance needs to be included on claims forms for all therapy settings that provide outpatient services. Nonpayable G codes and modifiers will be utilized to report this. This must be done at eval, at minimum every 10th visit, and at discharge. This link is to the APTA website regarding the new functional limitation reporting. It provides a good overview of the new policy changes, general information, case studies, examples, and documentation guidelines. A large portion of the information provided is for members only so this link is best for APTA members.

Overcoming Physical Therapy Reimbursement Challenges

http://pttalker.com/2011/03/overcome-physical-therapy-reimbursement-challenges-2/
I've posted this site before because it is a very versatile resource. It has everything from treatment to administration. Here is an excerpt from the site in regards to reimbursement in PT.

Tricare Payment and Reimbursement

http://www.tricare.mil/tma/rates.aspx
http://manuals.tricare.osd.mil/DisplayManual.aspx?SeriesId=REIMBRSMT
Tricare is insurance coverage for current members of the U.S. military, retirees, and military families. It is administered by the Defense Health Agency (DHA) under the supervision of the Department of Defense (DOD). The first link is to the homepage for Tricare's rates and reimbursement. The second link is to Tricare's latest reimbursement manual, updated on April 3,2013. It is not uncommon to have patients with Tricare insurance coverage in outpatient clinics, including active service members. It is important to be familiar with Tricare's authorization and reimbursement methods in order to provide treatments to beneficiaries that are effective and supported by the Defense Health Agency.

Tips for getting reimbursed under new Healthcare trends

This first site provides several helpful strategies to help you be sure that you will be reimbursed for your services in our current healthcare climate. As policies change, the physical therapy industry must change and adapt with it so as to stay financially stable. These are practical hints that can be easily incorporated into a practice.
http://physical-therapy.advanceweb.com/Features/Articles/Top-4-Reimbursement-Strategies.aspx
This second site breaks down what a physical therapist needs to know in relation to the changes associated with the Affordable Care Act. It is a quick resource that help you navigate all of the confusing jargon so that you can have a good handle on the basic changes and how they affect reimbursement.
https://www.oxfordphysicaltherapy.com/blog/affordable-care-act-what-you-need-know