January 2017 Newsletter

PRESIDENTS COLUMN
CARRIE ABRAHAM PT, DPT, MPH
PRESIDENT, WVPTA

CONTENT
President Carrie
Abrahams Column
Insurance Updates
News from the
Education Committee
Treasurer Update
News from the
Practice Committee
Communications

This past August 16

volunteers of your association got together in

Charleston, WV to discuss the future work of the WVPTA. The result of
those meetings, spanning a day and a half, is the 2016-2018 WVPTA
Strategic Plan. The plan outlines a revised mission statement and 7
strategic priority areas with goals and strategies to guide the future
work of the association. Read on for an outline of the plan! The full
detailed version of the plan can be found in the members only section
of the association website. We are all very excited for what is to come
for the WVPTA and for the profession of PT in WV. Together, we will
make an impact!
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WVPTA Mission Statement

The mission of the West Virginia Physical Therapy Association is to
advance excellence in the physical therapy profession through
education, research, service and advocacy, for the engagement of its
members and the public.

Committee Update
Strategic Priority Areas
1.
Education and Professional Development
Goal: WVPTA will provide opportunities for education and professional development for physical
therapists, physical therapist assistants and students.
2.
Public Relations
Goal: WVPTA will promote awareness and recognition of the value and accessibility of the physical
therapy profession among consumers and professional groups.
3.
Government Affairs
Goal: WVPTA will lead proactive advocacy efforts to influence health policy and optimize access to
physical therapy services and to better the quality of life for patients.
4.

Reimbursement
1

Goal: WVPTA will influence reimbursement models and quality initiatives enabling physical therapists
and physical therapist assistants to continue to provide quality care to patients and communities while
remaining fiscally solvent.
5.
Governance and Structure
Goal: WVPTA will provide an effective governance structure to sustain and advance its mission.
6.
Membership
Goal: WVPTA will increase its membership to become the voice of physical therapy in WV.
7.
Community Outreach and Service
Goal: WVPTA will foster a culture that encourages community outreach and service.

INSURANCE UPDATES
SALLY OXLEY, PT, OCS, CHT, CMDT
WVPTA Payer Relations Committee Chair

Workers Compensation Some of our members have gotten a reduction in BrickStreet payments
due to a network that they are in. If this happens make sure that you have a copy of the contract and read
it to ensure that you are being paid correctly. Keep an eye on BrickStreet EOBs looking for repricing by a
PPO. It is a good idea to check EOBs from time to time to be sure that payments agree with what your
contract says.
There are new networks that we may see Premier that pays a low rate, Northstone and Pinnacle
Point that pay well.
Highmark Highmark presently has subscribers in West Virginia, Pennsylvania and Delaware. They are
bringing in Minnesota. The main office is in Pittsburgh and most decisions are made there now. The new
director of WV is from Pittsburgh. James Fawcett has been named President of Highmark Blue Cross
Blue Shield of West Virginia.
We expect that the West Virginia plan is going to be more closely aligned with the Pennsylvania plan.
Highmark has automated their provider relations department so providers no longer have a provider
representative to assist them. You can e-mail or phone the provider relations department, but responses
are much delayed or non-existent.
Highmark of Pennsylvania was charging 2 co-pays for one PT visit, one for PT codes and if you used
97530, that they consider to be an OT code, the patient would be charged a second co-pay for the same
visit. Pennsylvania passed legislation that insurance companies cannot charge an OT co-pay for a PT visit
since OT is not in our scope of practice. They also passed legislation that states an insurance company
cannot go back more than 2 years to re-coup funds.
Medicaid To recap, fee for service (Traditional) Medicaid patients can receive up to 20 visits of
PT/OT per calendar year without prior authorization, however, prior authorization is recommended for
benefit tracking. An authorization number for billing purposes is needed if a Medicaid member is part of
the Medicaid expansion plan (ABP).

It is up to the providers to be sure of what type of Medicaid the member has. Most of the expansion
patients are in a managed care plan and they can switch back and forth, so it is recommended that
Medicaid patients are re-verified every month. Verification can be done easiest via the web portal
https://www.wvmmis.com/default.aspx.
Medicare The new Value Based Payment Model evaluation codes went into effect January 1, 2017.
97161 Low Complexity Evaluation, 97162 Moderate Complexity Evaluation, 97163 High Complexity
Evaluation, and 97164 Re-evaluation. The payment is the same for all of the initial evaluation codes. All
evaluations will require functional outcome measures. The 4 components that determine the severity
and complexity are: patient history (medical and functional, including co-morbidities); examination and
the use of standardized tests and measures; the clinical presentation of the patient; and clinical decision
making.
Click the links below for information on the new evaluation codes:
http://www.apta.org/PaymentReform/
http://www.apta.org/PaymentReform/NewEvalReevalCPTCodes/
PQRS reporting is no longer required as of January 1st, 2017. In 2019 new methods of reporting the
information will be put into place. Functional Limitation reporting does need to continue to be done.

The WVPTA is supporting the APTA in their national awareness campaign emphasizing the option of choosing physical
therapy services to help a person manage pain. The APTA website has many resources to assist with this campaign. Go
to http://www.moveforwardpt.com/ChoosePT for more information. The WVPTA Board is working within the state to
promote the APTA #ChoosePT campaign. Please contact the President, Carrie Abraham, or any other member of the
Board in order to find out more about this topic or to learn how you can assist with this campaign.

THANK YOU TO OUR 2016 SPONSORS

NEWS FROM THE EDUCATION COMMITTEE

KRISSY GRUBLER PT, DPT and KIMERAN EVANS PT, DPT
WVPTA Education Committee Co-Chairs

The Education Committee is excited to host the WVPTA 2017 Annual Conference Monday Morning
Management of Neck Pain presented by Chad Cook, PhD, PT, MBA, FAAOMPT April 21-23, 2017 at the
Stonewall Resort. This conference will offer up to 12 CEUs as well as presentations of current research,
networking opportunities, an exhibit hall and a Golf Scramble.
See below some of the exciting opportunities throughout the weekend!
Friday, April 21, 2017: Golf Scramble and Welcome Reception
Saturday, April 22, 2017: Exhibit hall, silent auction; WVPTA annual luncheon and meeting with State of
the Association address; WVPTA committee reports; APTA update from our National Representative
Susan Whitney, DPT, PhD, NCS, ATC, FAPT; WVPTA Awards and Recognitions; 2017 WVPTA election
results; and PT on Tap.
Sunday, April 23, 2017: Poster presentations
Course Details:
Course Description: Examination and treatment of the neck is challenging. Although highly prevalent,
less emphasis is placed on research of the neck and lesser understanding is known with respect to
prognosis and best treatment options for clinical practice guideline recommendations. Conservative
management of neck pain should always be considered the first option for patients but there are rare
occasions when no care or surgery are better selections. This course breaks down the different types
of neck pain, best examination and treatment choices, and the role of management of the patient
throughout the health system.
About our speaker: Chad Cook, PT, PhD, MBA, FAAOMPT is the program director and a professor at
Doctor of Physical Therapy division in Duke University. His passions include refining and improving the
patient examination process and validating tools used in day-to-day physical therapist practice. He
received his BS in Physical Therapy from Maryville University in 1990 and his MBA (1999) and PhD
(2003) from Texas Tech University. Dr. Cook received fellowship status at the American Academy of
Orthopedic Manual Therapy in 2006. Dr. Cook has published over 200 peer reviewed papers and has two
textbooks in their 2nd edition and a third textbook in its first edition. His work has been cited over 4000
times and he has presented over 180 clinical workshops on six continents and 16 countries. He is a
senior associate editor for the British Journal of Sports Medicine and a special topics editor for JOSPT. Dr.
Cook has won numerous awards locally at Duke for teaching, is a recent winner of the top educator
award for the American Physical Therapy Association (Baethke-Carlin award), is the 2008 recipient of
the Helen Bradley career achievement award, and is the 2005 winner of the J Warren Perry Distinguished
Authorship Award. In addition, Dr. Cook is also the 2011 winner and was the 2012 and 2013 co-winner of
the AAOMPT Excellence in Research Award. Dr. Cook is also the Pauline Cerasoli lecturer in 2017.

Course objectives:

Recognize the prevalence, costs, and global disability associated with neck pain.
Review pertinent anatomy and physiological aspects of the neck
Understand selected prognostic factors associated with recovery from neck pain.
Compare and contrast the role of the physical therapy in conservative management of neck pain.
Utilize the examination sequence and evaluate the critical elements of each stage of examination.
Analyze the value of imaging and critique the pros and cons of implementation.
Evaluate present classification of pain models for the neck.
Compare and contrast treatment mechanisms for the neck.
Understand the role of the first point provider and how downstream costs and visits are
influenced by the first health practitioner seen.
Perform a mock examination and treatment using case based examples.

Sign up today for this fantastic continuing education course and opportunity to meet and mingle with old and new
friends of the WVPTA!

TREASURER REPORT
MATTHEW MADRID, MSPT
WVPTA Treasurer

Current Issues or Concerns Raised from executive committee meetings and/or chapter members
(Executive committee conference call 1/11/17)

What is a safe balance to maintain in the WVPTA checking account?

Based upon examination of yearly financial statements and net revenue, should we
transfer/contribute money to the WVPTA Morgan Stanley Investment Account?

Response to questions from executive committee meetings and/or chapter members. Currently assessing yearly
checking account balance information, yearly generated revenue, and prior amounts of contributions.

Recent Treasurer Activities Oversee audit of chapter finances and procedures for FY 2015 initiated
9/20/16. Awaiting report from Tetrick & Bartlett PLLC.
Financial Position (12/31/16)
Current Assets
Cash & Cash Equivalents

61,911

Marketable Securities

62,090

Total Current Assets

124,001

Total Liabilities

----- 0 ------6

Unrestricted Net Assets

Total Net Assets
2016 Total Liabilities & Net
Assets
2015 Total Liabilities & Net
Assets

124,001
124,001
$124,001
$114,478

Final Comments: Net revenue over expenses for 2016 was $8,581.62
Annual Operating Budget 2016

Revenue for 2016 exceeded projections and totaled $86,195 of the projected $86,000. This
included $5,029 of new revenue from golf sponsorships and golf players during the Spring
Conference Golf Scramble at Stonewall Resort.
Expenses for 2016 came in under budget and totaled $77,614 of projected $79,751. This included
an unbudgeted expense of $1,337 from the Strategic Planning Meeting in Charleston, WV.

The WVPTA Executive Committee approved a budget for 2017 that includes spending of $80,351, with
expected revenues totaling $94,200. Please feel free to email me with any direct questions you may have
at Madrid.AffiliatedPT@gmail.com.

NEWS FROM THE PRACTICE COMMITTEE

RHONDA HALEY PT, DPT
Practice Committee Chair

New Year New Codes New Medicare Cap Amount

The scope of practice for Physical Therapists in the state of West Virginia includes evaluation of patients.
Beginning January 1, 2017, there is a new step involved in this process. Physical Therapists now need to choose
between three different evaluation codes based on the patient presentation. The appropriate evaluation code
chosen should take into consideration the following components: History; Examination; Clinical Presentation;
Clinical Decision Making.
The new evaluation codes are 97161 (low complexity), 97162 (moderate complexity), and 97163 (high
complexity). Even though there are variable evaluation codes to use, no tiered payment values have been adopted.
CMS held in the final rule to its original proposal for a single payment value. One change in payment, an increase,
does occur with the reevaluation code. The code for a reevaluation was also changed and is now 97164.
There are many resources available to assist with this new step to guide the Physical Therapists choice for the
correct evaluation code. The West Virginia Physical Therapy Association has information posted under the tab of
WVPTA News. The link http://www.apta.org/PaymentReform/NewEvalReevalCPTCodes/ can be accessed from
this information. It takes the reader directly to the Payment Reform section of the APTA website where additional
information and education can be found. Here are some of the resources available to assist Physical Therapists:

Quick Guide to the 3 Levels of Physical Therapy Evaluation

New Evaluation Codes for 2017 - Self-Paced Course
Online Course From MedBridge
7

Live Webinar: New Evaluation Codes: Q and A Session

Recorded Webinar: Proposed Medicare Payment and Coding System
Webinar Handouts: Evaluation Codes for Physical Therapy
Compliance Matters: New CPT Evaluation Codes
Documentation Considerations Supporting Evaluation Code Selection
The Decision-Making Process to Determine Evaluation Complexity
New CPT Codes Result in Payment Increases From Medicare
APTA Fact Sheet on 2017 Fee Schedule

Also in the Payment section of the APTA are the 2017 Medicare changes. The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA), the law that established a framework to move Medicare from a largely feefor-service program to a program that bases payment on quality and improved outcomes, extended the therapy
cap exceptions until December 31, 2017. The therapy cap amount for 2017 is $1,980 (up from $1,960) for physical
therapy and speech language pathology combined, with a separate $1,980 cap for occupational therapy.

COMMUNICATIONS
COMMITTEE UPDATE
BRANDON BEACOM DPT
Communications Committee Chair

Dont forget about the WVPTA 4th

ANNUAL GOLF SCRAMBLE ON APRIL 21st,
2017 @ THE PALMER COURSE
STONEWALL RESORT!
Its the perfect time to hit the green,
especially if you are already planning on
attending the WVPTA Annual Conference @
Stonewall Resort that same weekend.
Refer to the image to the right for more
information. Visit
http://wvpta.org/events.html#golfscramble-registration to register you and/or
your team!
For more information, please contact
Johnna Gaunch at info.wvpta.org OR
Brandon Beacom at
beacom2012@gmail.com.