Optimal Care Management in a Changing Regulatory Environment

presented by Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC, RAC-CT

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Disclosure Statement:

Financial: Ellen R. Strunk receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Nonfinancial: Ellen R. Strunk has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 82 Minutes; Learning Assessment Time: 40 Minutes

Most physical therapists and physical therapist assistants don't go to physical therapy (PT) programs to learn about payment models and regulatory issues. In fact, a therapist's understanding of how PT services are paid for is often seen as less important than obtaining knowledge in specific areas of clinical care. Unfortunately, rules and regulations are constantly moving targets that quickly become out-of-date, which makes it challenging to stay abreast of these important issues. No matter how long they have been practicing or what setting they work in, clinicians have a responsibility to maintain compliance with the rules and to advocate for appropriate care for their patients. This course will address the bigger picture so clinicians can clearly understand the context of payment systems in order to design appropriate plans of care, demonstrate compliance and integrity in clinical practice, and identify resources for accurate information to guide practice.

Meet Your Instructor

Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC, RAC-CT

Ellen R. Strunk has worked in various roles and settings as a clinician, manager/director, and policy expert. Ellen is an expert at helping customers understand the Centers for Medicare and Medicaid Services (CMS) prospective payment systems in the skilled nursing facility and home health settings, as well as outpatient therapy billing for all provider types.…

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1. Health Insurance Coverage in the United States: Past and Present

If you provide therapy services to older adults, it is critical to have an understanding of government programs and payment policies. This chapter will give an overview of the history of health insurance coverage in the United States and dicuss the complexity of the public and private benefit structure, which has implications for the challenges facing the current health system and the Medicare program.

2. How Rehabilitation Is Paid For Across the Care Continuum

This chapter will help participants understand the health insurance programs for older adults and the complexities of reimbursement methods, as well as recent reforms to control costs and improve quality. It is not a primer on the nuances of reimbursement regulations. Application of this knowledge will enable readers to effectively advocate for patients/residents/clients and for older adults as a population.

3. Professional Integrity

The consequences of improper actions can range from payment denials to corporate integrity agreements to indictments and loss of licensure. This type of publicity breeds distrust of the public toward clinicians, including physical therapists and PTAs. This chapter will examine the role of professional integrity and the therapist’s responsibility for understanding fraud, waste, and abuse.

4. Quality, Outcomes, and Value

The US health care delivery system has been and continues to be plagued by issues of quality and cost. The toll it takes on the health status of Americans is difficult to quantify. This chapter will take a look into what the payment model of the future might look like and how the shift to a payment system based on outcomes, quality, and value will happen.