Host: Tammy Richmond MS OTRL FAOTA
October 16, 2012

Introduction

This monthly 30 minute webcast is going to cover the latest news and current events in policy, practice and payment.

The format is meant to be informal, interactive and hopefully very informative!

The first 15 minutes will be dedicated to current news

The last 15 minutes for a guest speaker and Q/A.

Mute your phone until you are ready to speak .
Go2care.com

Today’s guest speaker is Melinda Peloquin, CEO of Creative Billing Services and our in-house billing and coding expert and consultant. She will go over some important news in regards to
OPTUM Health and Medicare. Then she will take your billing questions.
Melinda@creativebillingservices.com
Go2care.com

First, lets take a look at the result of 2 years of legislative policy wrangling that ended Sept 29 with Governor Brown signing and vetoing several health care laws.
Go2care.com

Policy Updates




AB 783 (Hayashi) Professional Corporations: Licensed Physical
Therapists; “ CA POPTS” bill.
AB 783 would legalize the employment of PTs and OTs by physicians and podiatrists in their professional corporations.
APTA and CPTA opposed referral for profit and physician ownership of physical therapy services for many years, taking the position that such arrangements pose an inherent conflict of interest impeding both the autonomous practice of the physical therapist and the fiduciary relationship between the therapist and patient. The ethical, business and legal aspects of these types of relationships are being closely scrutinized in terms of restraint of trade and competition, and interference with consumer choice.
California Assembly Bill AB 783 failed to pass out of the Senate
Standing Committee on Business, Professions, and Economic
Development. June 2011. DEAD
Go2care.com

Policy Updates





SB 924: Direct Access and Professional Corporations
(Steinberg) Feb 2011
Drew the attention of CMA, podiatrists and chiropractors.
Required a signed plan of care and diagnosis from a physician or podiatrist was required to continue treatment after the initial 30 business days or 12 visits provided via direct access
Referred SB 924 to the Assembly Rules Committee and not removed in time
Bill: DEAD
Go2care.com

Policy Updates







AB 136: Telecommunications; universal disabilities; speech disabilities. 10/2/2011
Included those with speech disabilities to qualify for assistance to purchase speech generating devices and equipment and provide services at no extra charge. Public Utilities Commission.
SB 946 Health Care Covereage: mental illness, pervasive developmental disorder or autism. Passed 10/9/2011
Required health care service plan contracts and health insurance policies to provide coverage for behavioral health treatment for those with pervasive developmental disorder or autism.
SB 1273 Athletic Trainers
Failed out of committee and therefore, no licensure or regulations for athletic trainers.
AB 2370 Mental Retardation: change of term to intellectual disabilities PASSED 9/22/2012
Go2care.com

Policy Updates
The Telehealth Advancement Act of 2011 (AB 415)

AB 415, which became law Jan. 1, 2012, updated California’s telehealth law and removed policy barriers to the use of telehealth technology for delivering health care services.

The following are key elements from the Telehealth Advancement Act:







Replaced the term, “telemedicine” with “telehealth”
Allows all “healing arts” professionals to provide telehealth services (OT, PT, SLP)
Eliminated the requirement for “in person” evaluation
Allows for verbal consent and does not require a written consent for services
Removed limits on physical locations where telehealth services can be provided
Allows for services provided by emails or telephone to be included as telehealth
Allows hospitals to establish credentialing of providers


HOWEVER, AB 415 does not mandate the use of any telehealth services by health plans or providers. Reimbursement depends on contracted negotiations and/or policy between health plans and providers
(Assessed on 10/11/12 at: http://www.connectedhealthca.org/policy-projects/telehealthadvancement-act )
Go2care.com

Policy Updates

AB 415 SUMMARY: OT, PT, and SLP can provide telehealth services. There needs to be a verbal or written consent. No “in person” evaluation or intervention is required. However, reimbursement is not guaranteed and has to be negotiated with the insurance carriers. (Note: Medicare policies does not allow OT, PT, SLP to provide telehealth services).
Go2care.com

Policy Updates
Assembly Bill No. 1733 Logue (Health)
Approved by Governor September 29, 2012. Filed Secretary of
State September 29, 2012.




SECTION 1.
Section 686 is added to the Business and Professions Code, to read:
A health care practitioner licensed under Division 2 (commencing with Section 500) providing services via telehealth shall be subject to the requirements and definitions set forth in Section 2290.5, to the practice act relating to his or her licensed profession, and to the regulations adopted by a board pursuant to that practice act.
(Assessed on 10/11/12 at: http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201120
120AB1733 )
Go2care.com

Policy Updates

AB 1733 SUMMARY: Allows the Boards of OT, PT, and SLP to establish regulations with regards to telehealth without the need to legislatively open up their practice acts. Any regulations established would be enforced or punished according to regulatory adoption by the respective boards.
Go2care.com

From the “Inbox”
Go2care.com

Practice Updates
Private Practice


Working as a Independent Contractor



Can immediately take money; Sole Proprietorship
Can change tax structure
Sole Proprietorship, Corporation, LLP, LLC


Recommend: establishing a separate bank account
$400 min./file federal tax return

*State: All earned income is taxable.
*https://www.ftb.ca.gov/index.shtml?WT.mc_id=Global_Home_Tab
Go2care.com

Practice Updates
Social Media Plays a Bigger Role


Nearly one-third of survey respondents (32%), including half of people under the age of 35, have used social media channels for healthcare purposes, such as connecting with health organizations and other people with shared health interests.






Social media outlets used:
Facebook: 18%
Youtube: 12%
Blogs: 9%
Google Plus: 8%
Twitter: 6%
*Pricewaterhousecooper’s Health Research Insititue: http://www.healthdatamanagement.com/resourcecenter/?id=43623
Go2care.com

Guest Speaker: Melinda Peloquin
Creative Billing Services, Inc
Go2care.com

Payment Updates
·
·
·
·
·
Here are some claim processing reminders that OPTUM Health shared with us during a recent, sit-down meeting. They are as following;
Call the (888) 329-5182 to verify if the GROUP# requires clinical authorization prior to starting care AND
Call 877-842-3210 or call the number on the back of the participants
ID number to verify benefits and coverage.
OPTUM Health provides additional tools, resources and tutorials for claim submission and processing at: www.myoptumhealthphysicalhealth.com
Once you log in, there are icons across the top of the account homepage and along the left margin that contain valuable information. PSF submission forms are also found at that same web link.
If anyone experiences difficulty in receiving reimbursement for care rendered and submitted according to their contracted relationship and required claim procedures, please send a contact email to the OTAC
OPTUM Health Advisory members; Melinda Peloquin
( Melinda@creativebillingservices.com
or tammy@go2care.com
.
Go2care.com

Payment Updates

Medicare Thresholds

Anthem Blue Cross

Assigning codes to disciplines

How many listeners are experiencing similar BX issues?

Others ?
Go2care.com

Q/A:
Go2care.com

Events:

Telehealth Webinar Series: 3 courses



Starting Oct 23, 2012
8:30 -10:30 am
Register: http://www.go2care.com/solutions.aspx
Next Month: November 13, 2012
Guest Speaker: Blue Marble Gaming

Email for inquiries: tammy@go2care.com
Go2care.com