State Payer Advocacy Resource Consortium (SPARC)
A joint initiative brought to you by:
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APTA, AOPT and APTA Private Practice are collaborating to bring you new materials to help you succeed with payer advocacy in your state. These resources are being provided as part of a new joint initiative (the State Payer Advocacy Resource Center or SPARC) to arm you with the tools you need to succeed in advocating for your patients with state-regulated payers.
Watch this space for more resources to help with prior authorizations, utilization management hassles, denials and appeals, and more to come as the SPARC grows. And always remember that when using these materials, we are here to help! APTA and APTA Private Practice have developed model payment bills for use in state legislatures to address utilization management, prior authorization, and more at the state level. Talk to your state chapter to get engaged or contact advocacy@apta.org for more details. Please feel free to contact payer advocacy staff at APTA (advocacy@apta.org) or APTA Private Practice (info@ppsapta.org) to lend a helping hand with your advocacy efforts.
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Contracting for Smart PTs: Strategic Contracting Series
This new on-demand series will empower you with the knowledge, tools, and resources to thoughtfully assess and independently determine which payer contracts you should negotiate. This six-module series will equip you with the tools and information you need to advocate for yourself and your patients.
Module 1 Available Now! Free to ALL!
Module 1 is available to watch in video form or download the audio version and listen on the go.Register
Prior Authorization/Utilization Management
- Webinar: Fighting for Your Patients: Best Practices to Reverse Insurance Coverage and Payment Denials
- Brief History of UM
- Common Challenges Created by UM
- Current Reasons for UM Prevalence
- Fixing Prior Authorizations
- Insurance Commissioner Template
- Patient Grievance Template Letter
- Patient Notice Template for UM
- Sample Data Collection Tool
- UM Definition
- APTA Template Letter - Consumer Letter to Legislator - Basic
- APTA Template Letter - Consumer to Payer for Denial Based on Code Exclusions
- APTA Template Letter - Letter to Employers
- APTA Template Letter - Patients Be Your Own Advocate (Know Your Rights)
- APTA Template Letter - Provider to Payer to Request Code Exclusions Policy Change
- APTA Template Letter - To Legislator Regarding Medicaid Benefits Issues with Managed Care Organization
- APTA Template Letter - To Legislator Regarding Medicaid Issues with Managed Care Organization (Medicare)
- APTA Template Letter - To Legislator Regarding Subcontracted Company Causing Issue - Outpatient Services
- APTA Template Letter - To State Medicaid Office (Medicaid beneficiary)
- APTA Template Letter - To State Medicaid Office Regarding Issue Managed Care Organization
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Denials, Internal Appeals and External Reviews
Internal Appeals and External Review Resources Video
- Webinar: Fighting for Your Patients: Best Practices to Reverse Insurance Coverage and Payment Denials
- PowerPoint Presentation: Fighting for Your Patients - APTA Private Practice Payment Policy Committee
- Interested Parties Memo
- Sample External Review Request Letter
- Sample Internal Appeal letter
- Utilization Management Appeals and Review Talking Points
PTA Differential
- An Ongoing Effort
- APTA Opposes the PTA Differential
- Commercial Payers and the PTA Differential
- Correct Coding More Clinical Scenarios and Documentation
- Determining Whether the PTA Differential Standard is Exceeded
- History of the PTA Differential Rulemaking Process
- Important Ideas to Consider
- APTA Template Letter - Model Patient
- PTA Differential Resources
- Rural Area and Workforce Concerns with the PTA Differential
- Summary of Final PTA Differential Policy
- The PTA Differential and the Medicare Claims Processing Manual
- Where the PTA Differential Started
Multiple Procedure Payment Reduction
Title and Term Protection Information
Title and Term Protection Information Resources Introduction Video
- Statement from APTA on Digital Health Technology and Physical Therapy by APTA President Robert Herr, PT, MPA
- APTA Resources on Term and Title Protection
- APTA Resources on Term and Title Protection Advocacy
Model Contract Language
Model Contract Language
- Resource: Medicare Advantage Billing Rules
- Tool: Checklist of Key Issues for Managed Care Provider Agreements
- Webinar: Payer Contracting for Physical Therapy (June 2023)
Medicaid
The APTA State Medicaid Payment Rate Guide is a member-only benefit that offers information on the Medicaid fee-for-service payment rates for PT services provided by state Medicaid programs. The guide includes payment rates for selected CPT codes used by PTs under states' Medicaid programs as well as links to the Medicaid manuals for all 51 U.S. jurisdictions.
Payment and Value Resources
The Economic Value of Physical Therapy in the United States
Choosing physical therapy helps Americans live better lives and could save the health care system millions of dollars annually, ultimately providing more resources for better services to individuals and communities nationwide. Physical therapy helps Americans avoid complications from surgeries, long recoveries, and the risks of overuse of prescribed opioids and other medications.
Learn more and download the report