Physical Therapy Reimbursement

billion annually due to fraud and abuse of the system. Physical therapists can play a major role in

The article that I chose was published by Mayo Clinic School of Health Science, the title of the article is “Physical Therapy”. The article informs the reader on the roles, goals, as well as the overall definition of a physical therapist. According to the article, “Physical therapists (PTs) work with patients who have impairments, limitations, disabilities, or changes in physical function and health status resulting from injury, disease or other causes.” Therefore, a physical therapist works directly with the population that has a form of impairment in their movement, whether it is from an injury or an illness. The roles of a physical therapist are examination, evaluation, diagnosis, prognosis

25% or more of one’s income going toward health care is too much for today’s economy this

Another reason for the rising cost of healthcare is the cost of physician care, according to the American Hospital Association “the cost of physician care, both to insurance and patients, has risen 1.3% during the past year.” Because of this increase doctors are put in a corner, they are already locked into an agreement with the insurance companies and do not have much ‘wiggle’ room to negotiate fees and rates. So because of this the patients and consumers are forced to pay a much larger sum. Since there are higher costs and the insurers will not cover them, they are distributes to the customers through higher deductibles, co-insurance, and

The day-to-day writing in the field of Physical Therapy varies depending on the audience. The audience determines the purpose of the writing and writing style. Physical Therapists (PT) use evidence-based exercises and activities to rehabilitate their patients in order for them to reach their unique goal. Since PT’s work with both medical professionals and patients, they must adjust their writing to be able to communicate effectively. PT’s are just one of the many people in the medical field that may work with a particular patient so it is important that the communication between the different layers of the medical field are precise and clear. Writing to a patient is also important because they are the person who is being directly affected

Historically, payment in the outpatient physical therapy setting has been based on billed therapy units (BTUs), billing that is based on minutes and correlated with a Current

Although the Affordable Care Act (ACA) has increased the number of insured, the problem of access to primary care still remains an issue due to the large pool of individuals who are now receiving coverage. Nonetheless, even if the current health care reform debate increases insurance coverage, residents in areas with inadequate physician supply will still have greater difficulty receiving timely and appropriate clinical care (Walker et al. 2010). Over the last decade the healthcare system has continues with relatively the same level of access to care for most Americans, and although there is an upwards of 84% of Americans have some form of insurance, the rising cost of care, the large group of uninsured and underinsured, and the lack of focus on

In 2010, The Affordable Care Act (ACA) was signed into law by President Barack Obama. The law was established in order to address essential issues within the US health system such as the high and rising cost of care, inadequate access to health insurance and health services and the diminished quality of care.1 Although this law was intended to help millions of Americans, many Americans are being effected by this same law. As a future physical therapist, there are many issues with this law that are bothersome in contemplating my future in a small outpatient privately owned clinic.

The Affordable Care Act has drastically changed reimbursement (and subsequently patient care) for better and worse. While healthcare has become more accessible, quality of care and doctor-patient interaction has decreased. Statistically, hospitals have seen an improvement in compensation, but this doesn’t include private practice and outpatient centers. Government-run healthcare is slow healthcare, and to make up for this physicians have to work faster and longer. My mom’s work as a physical therapy assistant has her working 10-12 hour days in the off season months of summer, and my own work as a secretary at her office opened my eyes to the consolidation of providers to get better reimbursements, which leads to fewer private practices. While

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

While there has been large media coverage about the insurance impacts of the Affordable Care Act (ACA), there has been a smaller amount discussed of the law’s changes to provider reimbursement policy, reforms to the delivery system, and investments in programs to improve the quality of care and constrain long-run growth in health care costs. And yet, the elements included in the ACA directed at cost and quality is possible to affect the practice of care for nearly every provider across the country. Although cost containment policies and initiatives are largely applied through federal health programs which including Medicare and Medicaid; cost containment in these programs has important cost-saving spillover effects to private health care markets through changes in health care practices and pricing across sectors of care.

With the continued transformation of the healthcare system, an increased emphasis on consumerism and quality-based reimbursement will be observed. This could lead to challenges for all managed care stakeholders. One example of an industry change that might occur is that patients’ out-of-pocket costs could increase. The cost of healthcare continues to rise faster than inflation, generating increased incentives for insurance companies to offer plans with high deductibles and small networks. In the article “The Top Changes MCOs Should Expect in 2016” Joel Brill (2015) states that:

Occupational therapists in Pennsylvania are required to obtain 24 contact hours every two years in continued competency activities to maintain their licensure (Pennsylvania Department of State, 2013). In addition, the National Board of Certification in Occupational Therapy (2016) requires practitioners to obtain 36 units of continued education every three years. LIU 12 provides financial resources in the form of tuition reimbursement for occupational therapists to continue their education and meet their licensure and certification

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

Under capitation, physicians are given incentive to consider the cost of treatment. Pure capitation pays a set fee per patient, regardless of their degree of infirmity, and gives physicians an incentive to avoid the most costly patients (Miller, 2009). Providers who work under such plans focus on preventive health care, as there is greater financial reward in prevention of illness than in treatment of the ill. Such plans avert providers from the use of expensive treatment options. The proponents of this method of payment especially insurance companies argue that when health care providers are not paid extra for additional office visits any associated medical expenses, they are likely to be more conservative with their treatment assessments