Legislative & Payment

Humana Still Requires Prior Authorization for Most PT in Hawaii

At the end of 2017, when we learned that Humana would no longer require prior authorization for physical therapy, we rejoiced! But we heard – and have now confirmed – that Hawaii’s Humana administrator, MDX, can and still does require prior authorization for PT (except immediately after hospitalization and surgery). Read the attached chart for…

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Priority Bills Would Advance Telehealth and More

New bills have been introduced in the 2018 Legislative session offering solutions to health care problems, including ways to combat the opioid epidemic, changes to healthcare payment systems, and paving the road to telehealth. Here is a short summary of a few bills we will keep an eye on this session. HAPTA will continue to…

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Med-QUEST Credentialing Frequently Asked Questions (and Answers)

LAST UPDATED:   December 6, 2017 Q:    Who needs to submit the DHS 1139 Medicaid Provider application form? A:    Individual providers with their own Medicaid provider ID number whose services are billed under that number need to fill out and submit DHS 1139 – this includes all private practitioners whether they are an owner or an…

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CORRECTED INFO: DHS Med-QUEST Needs All Providers Who Do NOT Work in a Facility/Institutional Setting to Fill Out DHS 1139

November 22, 2017  (correction of November 20, 2017 posting) –  In mid-October many (but not all) PT providers received a letter from the State of Hawaii Department of Human Services Med-QUEST division requesting completion of a re-credentialing/validation application. The letter asked that you submit this form by Oct. 30, 2017 and provided a link to complete it…

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Recent News and Course Content Reminders of Medicare Billing Requirements

With recent news in Hawaii along with information provided during the Medicare class that HAPTA hosted in early October, we thought we should provide reminders about some Medicare billing areas that continue to cause problems for some providers: In order to bill for physical therapy, services need to be provided by a licensed physical therapist,…

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Bundled Payment Will Require New Solutions

PT practice is changing and much of it comes from external stressors. Especially as we step into new payment models such as bundled payment, we must come up with new solutions. Many physical therapy practices attempt to meet these demands by increasing productivity, driving down costs, and being selective with payers. We must ask ourselves…

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Federal Regulation, Dry Needling and Licensure Compact Highlights from 2017 APTA State Policy and Payment Forum

HAPTA members Joanne Zazzera, Patti Taira-Tokuuke and I (Justin Ledbetter) recently traveled to Detroit, Michigan to attend the annual APTA State Policy and Payment Forum. In addition to Joanne receiving the APTA State Legislative Leadership Award, we learned a lot about what’s going on around the country. Here are some highlights. Federal Regulatory Affairs PTs…

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HAPTA Legislative Activities – Review of 2017

With the recent end of the Hawaii 2017 legislative session, we would like to update our members on what HAPTA did this year and how our efforts turned out. We began 2017 with a contracted lobbyist and some strong strategies. Our plan was for legislators to become familiar with us and to have our voice…

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HAPTA Will Continue to Advocate for Improved Workers’ Compensation Payments

As the Hawaii legislative session draws to a close, we thought members would be interested in an update about our efforts this year to tackle workers’ compensation (WC) issues. It was our priority this year to tackle: 1. injured workers’ access to medical care, 2. the challenges of physicians and physical therapists taking on WC…

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Member Action Helped Avert Workers’ Comp Payment Crisis

On November 17, the Hawaii Department of Labor and Industrial Relations (DLIR) held a hearing on a proposal that would have switched the medical fee schedule back to Medicare plus 10 percent. Doing so would have pushed the clock back to a time when reimbursements for workers’ comp cases were barely sustainable. Due to notice…

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