Robert Hall

Consortium Area of Work 1 of 3: Administrative Burden

For many physical therapy practices, decreasing administrative burden feels like a losing fight.  APTA surveys show that administrative burden, whether through peer reviews, prior authorization, or unsupported denials, is a top concern and impediment to quickly providing care to patients. In the context of administrative burden, the objective of the Payment Consortium is for patients to enjoy unfettered access to high quality physical therapy. To accomplish this goal, the following Key Results have been targeted. 

  • Pass prior authorization/Gold Card legislation (no signed POC or prior auth required by commercial payers) in 10 states by end of 2026.
  • Change prior authorization policies with local payers with direct meetings in 25 states by the end of 2026.
  • Pass fair co-pay legislation in 10 additional states by end of 2026.  
  • Develop and field a webinar on how to hold payers accountable to contract terms and what steps to take when they do not comply with contracts.
  • Advocate for payers to use Medicare’s credentialing process and timelines which would grant the ability to provide immediate care under a newly licensed provider and hold claims while credentialing processes conclude (generally 30-60 days). 
  • Work with the Big 5 commercial payers to adopt APTA/AOPT Clinical Practice Guidelines (CPGs) as the primary standard for quality care.  
  • Produce an APTA-AOPT-APTA Private Practice consensus statement on prior authorization and UM reform principles by end of 2025.

These goals will not be achieved without organization, resources and hard work from members of APTA, AOPT, and APTA Private Practice, as well as the organizations themselves. We want to make it easy for physical therapists to advocate as efficiently as possible, and also make it clear that PT advocacy is critical for the best patient care. The Payment Consortium is committing to:

  • Create prior authorization resources and an advisory-support task force to assist Chapters.
  • Create fair co-pay resources and an advisory-support task force to assist Chapters.
  • Establish communication and a robust learning network for the delivery of resources and sharing of best practices with Chapters.
  • Support a new initiative to encourage private payers to use the Medicare process to speed credentialing.
  • Update and package Clinical Practice Guidelines (CPGs) in a user-friendly format for providers and payers.
  • Actively negotiate with the Big 5 payers to incorporate CPGs as sole standard for quality care.
  • Deliver a consensus statement on prior auth and UM.

Together, we can fight back against payers’ proclivity to clog practices with paperwork so that physical therapists can provide the best care for their patients.