Blue Cross Blue Shield of Michigan sends out audit notification letters Feb.28th
Dear MPTA Members and Interested PTs,
You may know that Blue Cross Blue Shield of Michigan (BCBSM) had sent out a repayment demand to 1,000 IPT's for an audit of claims from February 1, 2005 through September 30, 2006. These letters went out on February 28, 2007. The amount of repayment ranges from a few thousand dollars to $200,000 dollars. This is a big amount for any small practice; I am told it amounts to about $8 million.
The reason is a BCBSM "systems error" in which payments were made over the "cap". The biggest single source that I can find is MESSA, which has always paid charges once the out of pocket maximum is met. Many IPT's have tried to confirm this during this period and have reported to me that BCBSM provider inquiry has always said that the payment was correct. No one is alleging fraud or over utilization, however the amount demanded will put some people out of business.
The MPTA Reimbursement Relations Committee has been actively meeting with Blue Cross Blue Shield of Michigan (BCBSM) regarding these letters. Also, you should know that the MPTA was not advised of this problem at any time before the letters went out on February. 28, 2007. MPTA regularly meets with BCBSM to identify issues, have open communication and improve the relationship of physical therapists to BCBSM.
Please contact the MPTA Office to obtain more information. Thank you for your cooperation and assistance in addressing this matter. If you know of member or nonmember physical therapists affected by the BCBSM payback notice, who can help us, and who are not already on our list of affected PT's, you are invited to pass this notice on to them.
Please continue to email or contact the MPTA office if you would like to share any specific comments.
Peter V. Loubert PT, PhD
President, Michigan Physical Therapy Association
Mark D. Beissel,PT,DPT,OCS,FAAOMPT
MPTA Reimbursement Relations Committee Chair
Announcement to MPTA membersThe Michigan Senate Bill 380 has been signed into law and has taken immediate effect as Public Act 0281 of 2005 as of December 21, 2005.
SB 380 is a short bill that modifies the PT practice act by removing the subfield exception to whom we can accept prescriptions. What this means is that starting immediately physical therapists can accept referrals from a person who is an MD, DO, DPM, DDS or any subfield license of the respective practice acts of those professions. The only subfield that presently exists is Physician Assistants. Therefore as of now physical therapists can accept referrals from physician assistants.
This change was supported by MPTA and is consistent with our overall objective for Direct Consumer Access to Physical Therapy Services. More than anything else, Direct Consumer Access to Physical Therapy Services means that physical therapists can accept referrals from any person, including patients themselves. Passage of SB 380 is a small but notable step in that direction. Even more importantly it removes an unnecessary barrier for patients who need physical therapy services.
If you would like any more information or have any questions please contact the MPTA office at 800-242-8131 or by e-mail mpta@mpta.com
APTA Advocacy makes an impact for your patients and the Physical Therapy Profession!December 9, 2006 - Congress Passes Bill including extension of Therapy Cap Exception Process, Fee Schedule Provisions. Over December 8th and 9th, the US House of Representatives and the US Senate passed HR 6111 Tax Relief and Health Care Act of 2006. This legislation impacts more than a half million Medicare beneficiaries who would have had their services limited by an arbitrary cap will not face that restriction. Physical therapists will avoid payment cuts that would threaten to jeopardize the services they could offer to Medicare beneficiaries. Without the provisions of HR 6111, physical therapists would have seen the cap go into effect and payment cuts at or above 10.1% for 2007.
APTA members made a difference by taking action! They generated more than 2,500 phone calls through APTA's Action Line in 7 days during the week of November 13. APTA members generated more than 6,000 e-mails in the past month to members of Congress. This grassroots initiative, combined with extensive advocacy efforts from APTA, kept the therapy cap exceptions process extension a "must do" for Congress before adjourning for the year. Learn more about the Medicare Therapy Cap.
Thank you to every member of APTA! Your membership made a difference to speak out for your profession and your patients. Now it the time to tell all in the Physical Therapist profession about membership is MPTA/APTA.