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APTA Alt Pmt
APTA Alternate Payment System
Question | Answer |
---|---|
Reform Payment for OP PT Services | To improve quality of care Recognize & promote clinical judgment of PT Provide policymakers/payers w/ accurate payment system that ensures integrity of medically necessary services |
Fee for Service vs. APS | FFS: procedural-based payment system APS: per-session based payment system |
APS Characterizes pt's based on | Condition severity Intensity of Interventions |
Characteristics of APS | Reflect professional clinical reasoning/judgment & devision making by PT Improves provider compliance Reduces admin burdens of current model of reimbursement Enhances payer recognition of value of PT-directed care |
Going to a new coding system would mean what to a PT? | PTs learn significant changes to codes Elimination of numerous existing codes (decreased admin burden) Could result in more appropriate valuation of PT services (better reflect pt's condition/clinical judgment of PT) |
3 Evaluation Codes & 9 Exam & Intervention Codes | Eval Codes based on level of complexity: Limited, Moderate, Significant Exam & Intervention codes: based on severity of pt's condition + intensity of PT intervention: Limited, Moderate, Significant |
Factors Used to Determine Severity | Pt safety, Age, Time since onset, MOI, Current condition, Current LOF, Progression, Probable outcome, Co-morbidity, Cognition, Physical environment, Psych support, Goals/Agreement, Time to achieve goals, Prognosis, Pt mood, Intervention, Risk of procedure |
Codes: Pt case scenario | http://www.apta.org/APS/ |