For most PTs, coding for service charges is kind of an afterthought—something they do at the end of the day, after they’ve finished up all of their paperwork. It’s a task that—while not the most exciting endeavor—is fairly straightforward: find the CPT code that matches the service provided, calculate the correct number of units, record everything appropriately, and move on to bigger and better things (i.e., treating and healing patients). But, in less than a year, that mundane-yet-simple process could get a whole lot more complicated. That’s because on January 1, 2017, the evaluation portion of the APTA’s proposed Physical Therapy Classification and Payment System (PTCPS) is slated to take effect—with the intervention portion tentatively following close behind on January 1, 2018.

In parts one and two of this three-part special report, I detailed the history and philosophy behind PTCPS and provided a breakdown of the concerns it has generated among industry leaders. Of course, discussion around any healthcare reform-related topic can easily spiral into an endless rabbit hole of speculation and theorization—two things that most time-pressed PTs just don’t have room for in their schedules. So, in this final post of the series, I want to focus on the absolutes—that is, the facts therapists simply can’t afford to ignore. So, without further ado, here’s why rehab therapists should care about PTCPS:

Suppressing Sticker Shock: How to Handle Your Patients High-Deductible Health Plans - Regular BannerSuppressing Sticker Shock: How to Handle Your Patients High-Deductible Health Plans - Small Banner

1. It will require training and software upgrades.

Make no mistake about it: this is not merely a CPT coding refresh. It’s a whole new system with a whole new set of code options and a whole new code selection logic. For the first time ever, therapists will have to consider the severity and complexity of their patients as they code for the treatments provided—and that means therapy providers are going to need in-depth training on how to make accurate and appropriate code selections. Plus, with any new system comes new rules and regulations, and the burden of complying with those regulations rests on the providers using the system. It’s a massive educational undertaking—one that should be on therapists’ radar now. Furthermore, the impending change already should be on the radar of EMR and billing software companies, as they’ll need to update their systems to accommodate the new codes. (And that might prove tricky considering that the codes themselves have yet to be released to the public.)

2. It will change the way therapists document and bill.

Documentation already plays a crucial role in supporting the services—and the medical necessity of those services—that therapists provide and bill for. But, PTCPS adds another layer of coding criteria: patient severity and complexity. And that, in turn, adds another layer to therapists’ documentation requirements. Furthermore, according to Jeff Hathaway, the president of the Physical Therapy Business Alliance (PTBA), the proposed system removes the time element from service coding—which brings up concerns over how Medicare and other payers will manage the new, session-based codes. After all, many existing regulations are based on time. “The concern is that Medicare is going to assign time,” Hathaway said. Whether these factors will make documentation a more arduous undertaking has yet to be seen (though, as I explained in part two, that’s the effect many industry leaders are predicting). What is certain is that documentation will change—and that alone could prove arduous enough to throw a major wrench in clinic operations.

3. No one knows how it will impact payments.

The basic idea behind the severity/complexity aspect of PTCPS is that it will allow providers to “better demonstrate [to stakeholders] how therapists go about their clinical decision-making,” Carmen Elliott, APTA’s senior director of payment policy, recently told WebPT. Theoretically, that would allow payers to recognize the true value physical therapists provide. But many say the link between severity/complexity and value is weak, at best—which actually could lead to decreased payment rates. “No one has been able to articulate exactly how [this proposal] moves us closer to showing our value or moves us to a better place to play in the value-based payment systems,” Hathaway and PTBA board members Larry Benz and John Childs wrote in a joint statement to WebPT. “[It] may lead to lower payment…[and] may set back our ability to showcase our value in alternative payment systems based on value.” And according to Hathaway, that should should raise more than a few eyebrows among those in the therapy community. “When you look at the cost landscape of PT and ask people, ‘What is the number-one thing you’re concerned about?’, the answer you’re typically going to get is, ‘Payment,’” he said. “Well, the core of how we get paid is CPT coding...and here, we have a fundamental shift to coding and no one can answer how it will impact payment. That puts a lot of things in limbo, and it should be a serious concern to every practitioner.”

4. It will set the tone for future payment reform efforts.  

Value is a hot buzzword in today’s healthcare arena. In fact, it forms the basis of the so-called triple aim of healthcare reform: higher-quality care at a lower cost with better patient satisfaction. Thus, many PT industry leaders believe it should form the basis of any physical therapy payment reform initiative. That way, PTs can be sure they’re evolving their profession in a way that sets them up for success in the long term. But, considering that the proposed coding system does not directly account for value (i.e., by incorporating outcomes as a payment factor), some question whether it will lead PT payment reform efforts down a path that will prevent rehab therapists from participating in the value-driven payment and care delivery models of the future.

“[PTCPS] rewards the wrong thing,” Hathaway said. “It all comes down to dollars, and our biggest ROI in terms of care is preventing unnecessary care. With the intensity/complexity model, that’s not rewarded.” And while adding an outcomes element to the proposed system is something that, in Elliott’s words “could be considered [in the future],” Hathaway doesn’t see a reason to wait: “I think [outcomes] should be part of it from the beginning, because my experience with this field is that what we hope to do doesn’t happen,” he said. That’s why he urges those in the therapy community to take an interest—and a stand—on this issue. “If the majority comes to some sort of conclusion, that has to be listened to,” he said. “It’s your duty to ensure the profession is viable…[and] if we can take a giant step, why not?”

Inspired to make your voice heard? Check out the Take Action section of the Alliance for Physical Therapy Quality and Innovation (APTQI) website. (PTBA recently joined this organization, which advocates for payment reform rooted in value and quality.) Have a question or comment? Share your feedback in the comment section below, and let’s keep the payment reform conversation going.

Download your evaluation complexity quick guide.

Enter your email address below, and we’ll send you a super-simple chart to help you decide which level of complexity—and thus, which CPT code—is appropriate for any given patient evaluation.

Please enable JavaScript to submit form.

  • 7 Shades of Coding Controversy (PTCPS Special Report, Part 2)  Image

    articleFeb 11, 2016 | 16 min. read

    7 Shades of Coding Controversy (PTCPS Special Report, Part 2)

    In the first post of this three-part series, I provided an in-depth look at the history and philosophy behind the APTA’s proposed Physical Therapy Classification and Payment System (PTCPS). If adopted—and as of now, that looks pretty likely—this CPT coding overhaul would completely change the way physical therapists code for the services they provide. The kicker? PTs could be required to begin using the new codes—some of them, anyway—as early as January 1, 2017, with full implementation …

  • The Complete History of the New PT Payment System (PTCPS Special Report, Part 1) Image

    articleFeb 9, 2016 | 14 min. read

    The Complete History of the New PT Payment System (PTCPS Special Report, Part 1)

    If you’re a PT, then the numbers 97001, 97110, 97140, and 97530 probably are as deeply ingrained in your memory as the average person’s street address, phone number, or birthday. Well, what if I told you that in less than two years’ time, those numbers—and the CPT codes they represent—actually could become nothing more than a memory? If that sounds like crazy talk to you, then allow me to introduce you to the APTA’s proposed Physical Therapy …

  • How Outcomes Tracking Fosters Quality Care Image

    articleFeb 3, 2016 | 4 min. read

    How Outcomes Tracking Fosters Quality Care

    You know you do darn fine work as a rehab therapist—and we do, too. But when asked to prove your value as a healthcare provider to patients, payers, and the rest of the healthcare industry, do you resort to anecdotal evidence of patient improvement, or do you have at your disposal cold, hard, irrefutable facts (a.k.a. outcomes data) about the results you and your patients achieved? Unfortunately, many PTs and OTs are still relying on the former—and …

  • Luck o' the Outcome: Which OMT Are You? [Quiz] Image

    articleMar 8, 2016 | 1 min. read

    Luck o' the Outcome: Which OMT Are You? [Quiz]

    Whether you’re Irish or simply Irish-at-heart (hey, even St. Patrick himself didn’t hail from the Emerald Isle), March 17 is reserved as a day to bust out your best jig; don every imaginable shade of green; and partake in some delicious food and drink—even if only for nostalgia’s sake. So, in honor of St. Patrick’s Day, we’ve decided to combine two—no, three—of our favorite things: OMTs, holidays, and quizzes. So, plant a smooch on the ol’ Blarney …

  • Founder Letter: Why Data is Only One Part of the Value Story Image

    articleMar 9, 2016 | 7 min. read

    Founder Letter: Why Data is Only One Part of the Value Story

    Over the past several months, I’ve talked a lot about how therapists can prove their value (namely, through tracking outcomes data ). But, even though data provides the value proof we need, it’s not the end of the story. It’s up to us to turn that data into something meaningful—something we can act on that will actually help us demonstrate the value of our care. And that means using data in conjunction with defensible documentation to inform …

  • Channeling Your Inner Chuck Norris: How to Master the Art of Outcomes Image

    articleFeb 17, 2016 | 6 min. read

    Channeling Your Inner Chuck Norris: How to Master the Art of Outcomes

    When I was growing up, I stayed at my grandparents house after school. This meant I spent the better part of my youth tuning into whatever my grandpa watched on TV. And because he watched a lot of Walker, Texas Ranger, I watched a lot of Walker, Texas Ranger. Chuck Norris was basically my afterschool nanny. (Don’t tell him I said that.) Each afternoon, I watched this karate-kicking cowboy fight off bad guy after bad guy. He …

  • Founder Letter: Why I’m Betting on Outcomes Image

    articleFeb 4, 2016 | 5 min. read

    Founder Letter: Why I’m Betting on Outcomes

    I’m not much of a gambler. Some folks enjoy the rush that comes with putting all their chips on the table and risking everything on a single roll of the dice. Well, no offense to all you card sharks out there, but if I’m going to go all in, it better be on something I’m pretty darn sure of. So, when I say I’m betting on outcomes, you know I’m not bluffing. In fact, I’m 100% confident …

  • WebPT + Outcomes: A PT Software Love Story Image

    articleMar 7, 2016 | 7 min. read

    WebPT + Outcomes: A PT Software Love Story

    Developing and launching WebPT Outcomes has been a labor of love—one that’s lasted about 15 months. At times, it felt more like the kind of love you’d have for a sibling—after he or she pushes you off the bunk bed and you split your lip open. You know, that kind of love. But, after lots of triumphs—and just as many fat lips—it’s been wonderful seeing the fruits of our labor come to life. Hello, WebPT Outcomes: the …

  • Common Questions from Our Patient Sticker Shock Webinar Image

    articleMar 31, 2017 | 33 min. read

    Common Questions from Our Patient Sticker Shock Webinar

    From copays and deductibles to payer contracts and benefits verification, understanding all the nuances of third-party insurances is tough enough for healthcare providers—let alone their patients. In WebPT’s most recent webinar— Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans —co-hosts Heidi Jannenga, PT, DPT, ATC/L, the cofounder and president of WebPT, and WebPT CEO Nancy Ham provided a lot of great advice on how to have productive conversations about healthcare costs with your patients—without …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.