Reimbursement Efforts

Blue Cross Blue Shield Audits impact IPT's
Independent Physical Therapists (IPT) may be aware that Blue Cross Blue Shield of Michigan, on February 28, 2007, sent out a repayment demand to 1,000 IPT's for audit claims from Feb 2005 through Sept 2006. The amount of repayment ranged from a few thousand to $200,000 dollars.

Upon knowledge of these audit recovery letters the MPTA Reimbursement Relations Committee met with high-level BCBSM personal and has worked continuously on this issue. Updates have gone to members on March 9, 13, 14, 16, 22, 23,and 27th. All interested parties should contact the MPTA office to make sure they are receiving these and all future updates.

Progress had been made in obtaining information on MESSA policies which resulted in reductions for some IPTs. See the transmittal on March 14, 2007. Also on March 27th the Special Report to Membership identified the following:

1. A 30-day extension was granted (meaning the due date is now the end of April versus end of March).
2.The greater of $10,000 or 25% must be repaid by the extended due date.
3.The "loan" will be interest free for 90 days following the extended due date.
4.The interest rate after the 90-day interest free period will be at the Prime rate. (Current Prime rate is 8.25%).

Read the Special Report to members on Independant Physical Therapist (IPT) issues faced by Blue Cross Blue Shield Recorvery Audit. (

PDF: 223kb)

View the sample letter to Managerial Level Conference (MLC) (

PDF: 223kb) to dispute the audit and repayment demands (noted in the 3/22/2007 update)

MPTA is will be actively exploring other options that may be available to members dealing with the repayment letters. Of particular interest is a similar case that we hope could serve as a precident for denying the recovery through the administrative process. We will report any progress as soon as possible.

Mark D. Beissel, PT, DPT, OCS, FAAOMPT
Chair, Reimbursement Relations Committee MPTA
March 23, 2007

Action Steps...
To all PTs interested in making progress on reimbursement issues or questions.

1. Make sure you are receiving the latest in reimbursement news by being a member of MPTA/ APTA and looking at email updates and Shorelines.
2. If you are not a member or know of non-members who would like updates have them join the MPTA listserv or contact the MPTA office for updates on issues.
3. Look to the MPTA website for updates on reimbursement news.
4. If you have specific questions contact the MPTA Reimbursement Relations Committee or MPTA office

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Webmpta.com MPTA Mission The Michigan Physical Therapy Association is a professional organization representing physical therapists, physical therapist assistants and students who have joined together to assure that high ethical professional standards are maintained and that quality health care in the areas of prevention, education and rehabilitation of movement dysfunction and wellness are received for all consumers in the state of Michigan.	Home > Reimbursement > Reimbursement Efforts Reimbursement Efforts Blue Cross Blue Shield Audits impact IPT's Independent Physical Therapists (IPT) may be aware that Blue Cross Blue Shield of Michigan, on February 28, 2007, sent out a repayment demand to 1,000 IPT's for audit claims from Feb 2005 through Sept 2006. The amount of repayment ranged from a few thousand to $200,000 dollars. Upon knowledge of these audit recovery letters the MPTA Reimbursement Relations Committee met with high-level BCBSM personal and has worked continuously on this issue. Updates have gone to members on March 9, 13, 14, 16, 22, 23,and 27th. All interested parties should contact the MPTA office to make sure they are receiving these and all future updates. Progress had been made in obtaining information on MESSA policies which resulted in reductions for some IPTs. See the transmittal on March 14, 2007. Also on March 27th the Special Report to Membership identified the following: 1. A 30-day extension was granted (meaning the due date is now the end of April versus end of March). 2.The greater of $10,000 or 25% must be repaid by the extended due date. 3.The "loan" will be interest free for 90 days following the extended due date. 4.The interest rate after the 90-day interest free period will be at the Prime rate. (Current Prime rate is 8.25%). Read the Special Report to members on Independant Physical Therapist (IPT) issues faced by Blue Cross Blue Shield Recorvery Audit. ( PDF: 223kb) View the sample letter to Managerial Level Conference (MLC) ( PDF: 223kb) to dispute the audit and repayment demands (noted in the 3/22/2007 update) MPTA is will be actively exploring other options that may be available to members dealing with the repayment letters. Of particular interest is a similar case that we hope could serve as a precident for denying the recovery through the administrative process. We will report any progress as soon as possible. Mark D. Beissel, PT, DPT, OCS, FAAOMPT Chair, Reimbursement Relations Committee MPTA March 23, 2007 Action Steps... To all PTs interested in making progress on reimbursement issues or questions. 1. Make sure you are receiving the latest in reimbursement news by being a member of MPTA/ APTA and looking at email updates and Shorelines. 2. If you are not a member or know of non-members who would like updates have them join the MPTA listserv or contact the MPTA office for updates on issues. 3. Look to the MPTA website for updates on reimbursement news. 4. If you have specific questions contact the MPTA Reimbursement Relations Committee or MPTA office	Reimbursement Resources Basic Reimbursement Steps Advocacy Information on CERT Documentation Requests-All Providers Reimbursement Efforts Medicaid Medicare Code of Federal Regulations new Reimbursement Resources FAQ Page New Questions Added!
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