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APTA Alt Pmt

APTA Alternate Payment System

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
Created by: 1190550002



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