Full Course Description

This course will present to the physical therapy clinical doctoral learner methods to remain current in coding and payment policy issues.  These strategies are vital to thrive in today’s healthcare environment. Changes in payment policy, coding, documentation and compliance with pertinent regulations among all third-party payers (federal, state and commercial) and cash services will always remain.  The course will include material to assist the physical therapist in daily practice and the profession as it prepares for the future.


Upon successful completion of the course, the participant will:

  • Articulate 2 of the most significant events in each decade in American history that set the stage for the current US health care system.
  • Compare the role of the pre-acute, acute and post-acute care segments in the US continuum of care.
  • Choose the appropriate reimbursement methodology for physical therapy services in a given case study.
  • Compare 3 methodologies utilized by 3rd party payers for reimbursement of physical therapy services.
  • Articulate the methodology Medicare uses to reimburse for therapy services for the following settings: acute care, SNF, IRF, home health and outpatient
  • Analyze the impact of key federal legislation and health policy in the last 20 years on physical therapy practice.
  • Articulate key Medicare outpatient therapy regulations for documentation, supervision, billing, and coding.
  • Evaluate the influence of the Medicare program on the key payment policies of private payers.
  • Articulate the process involved in the development and maintenance of AMA’s CPT codes for physical medicine and rehabilitation services, including the use of modifiers.
  • Articulate the impact of ICD-10 codes on the reimbursement process, including demonstration of medical necessity.
  • Compare documentation for the disablement vs the enablement model.
  • Articulate the basic construct of documentation under the ICF model, emphasizing the essential elements that impact function.
  • Analyze the impact of fraud, waste and abuse on the delivery of outpatient physical therapy services.
  • Articulate the impact that fraud/abuse violations and false claims act have on physical therapy practice.
  • Distinguish at least 5 audit review flags that alert reviewers to potential problems with the provision of or billing for physical therapy services.
  • Articulate the proper appeals process steps for a Medicare or other third-party payer challenge to the provision and billing of physical therapy care.

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