TPTN PROVIDER NEWSLETTER - WINTER 2012

Transcription

1 Physical Therapy Network TPTN PROVIDER NEWSLETTER - WINTER 2012 Our latest results are in! Our overall member satisfaction rate is 99% According to the World Health Organization s ranking of causes of disability, headache disorders are one of the 10 most disabling conditions for men and women. The International Headache Society has classified headaches into 13 major categories. One of the categories includes cervicogenic headaches, which are headaches that originate from the cervical spine. These headaches in particular, benefit from physical therapy. Cervicogenic headaches are due to dysfunction with upper cervical disc segments, tight or limited upper cervical joints, and/or sympathetic nervous system involvement. Individuals may have any of the following symptoms: The Benefits of Physical Therapy for Patients with Cervicogenic Headaches By Sarah Jensen, PT, MPT, DSc, COMT, CEAS Pain in the neck and back of the head (occipital region) Pain that may project to the forehead, orbital region, temples, or ears Pain that increases with neck movements and sustained postures Changes in neck muscle contour, texture, tone, or abnormal tenderness of neck musculature Pain that radiates into the shoulder/arm area Decreased ability to move head and neck Often times headache sufferers are extremely limited with daily activity due to pain A comprehensive evaluation is performed by a skilled licensed physical therapist to determine the pain generating structure. Success of treatment is largely based on a thorough physical therapy exam and the execution of a patient-specific comprehensive treatment plan. Inside This Issue: Contributing Article Medicare Authorization TPTN Authorization Team Members Member Satisfaction Survey Provider Accolades Claims Submission Protocol Health Awareness Updates

2 Page 2 CONTRIBUTING ARTICLE (cont.) Physical therapy procedures focus on normalizing the soft tissue or mechanical dysfunction that causes headaches. These techniques are fairly specific, highly skilled and include such techniques as mobilizing the C0-C2 segments, mobilizing the C5-6 segment for a facet disorder, performing a sub occipital release technique or mobilizing the first rib. For headache sufferers where it is not contraindicated, such as with rheumatoid arthritis, physical therapists can do manual or mechanical traction procedures to provide decompression. Even headache sufferers with spinal columns beginning to fuse, like those with ankylosing spondylitis, can be helped with physical therapy. If the spine has already fused, physical therapy's role is limited. But strengthening can get as much pressure off that area as possible, relieving pain. If the column is not yet fused, physical therapy helps the patient maintain mobility, strength and posture. If the spinal column spontaneously fuses, physical therapy can help prevent it from fusing in a flexed posture. Other treatment may consist of the following: Specific manual therapy techniques such as joint mobilization and soft tissue massage Exercise and stretching Postural education and body mechanics Pain relieving modalities such as ultrasound and electric stimulation Pharmaceuticals also play a role in treatment, but physical therapy can enhance and prolong their pain-reducing effects. Patients need medications to help relieve the symptoms and give them some relief but medications alone often do not resolve the headaches caused by mechanical or soft tissue dysfunction or postural causes. Physical therapy in conjunction with medications will ensure a better chance of a good outcome over a long period of time versus getting temporary relief. Clinical outcomes show that many patients will experience a decrease in the frequency and intensity of their headaches within the first month of treatment. This ultimately allows the patient to return to functional, work and recreation related activities that they were limited with or had to modify due to pain and headaches. About Accelerated Rehabilitation Centers Accelerated Rehabilitation Centers embrace a PATIENT FIRST philosophy which focuses on patient outcomes, commitment to manual therapy and upholding our reputation in the community as a leader in providing treatments that include a comprehensive manual and functional exercise component. Part of this commitment includes providing advanced training to our clinicians. TPTN has a strict credentialing process to ensure our valued members have access to licensed professionals providing a high level of care. Accelerated has been a TPTN provider since August 2005, and has over 75 certified manual therapists across Illinois, Indiana, Iowa, Michigan, Missouri, Ohio, Wisconsin and Arizona. For further questions please feel free to contact Sarah Jensen at Mrs. Jensen is the Chief Clinical Officer for Accelerated Rehabilitation Centers and has been a practicing physical therapist for eleven years. She earned her Bachelor of Science degree in Engineering from Michigan State University in 1994 and her Master of Science degree in Physical Therapy from Midwestern University in She received her doctorate from the University of Maryland School of Medicine in Furthermore, Mrs. Jensen is a certified manual therapist through the North American Institute of Orthopaedic Manual Therapy. In addition to her clinical accomplishments, Mrs. Jensen also serves as adjunct faculty in the physical therapy department at Midwestern University, instructing doctoral physical therapy students in orthopedic evaluation and treatment as well as gross anatomy. When it comes to eating right and exercising, there is no "I'll start tomorrow." Tomorrow is disease ~ Terri Guillemets ~

3 Page 3 MEDICARE AUTHORIZATION Should I obtain an authorization for physical therapy services for a member who has Medicare primary? The easy answer is YES! Obtaining prior authorization through TPTN will ensure you receive the maximum benefit. The benefits of obtaining prior authorization when Medicare is primary and the cap has not been met are: It will decrease the chance of receiving a denial for failure to prior authorize. This is because it is the provider s responsibility to determine when the cap has been met. If you are waiting on an EOB from Medicare to state that the Medicare cap has been met, it is possible that the member has had additional visits before receiving the EOB showing that the Medicare cap has been met. If the visits, after the Medicare cap has been met, have not been prior authorized, TPTN will not retro-authorize any visits due to the provider not being aware the cap had been met. It will decrease the chance of receiving a denial for lacking medical necessity. When requesting authorization TPTN does review all medical records for medical necessity. If you do not request an authorization until the cap has been met a review of the medical records will be done from the start of care. If it is not medically necessary the visits will be denied. REMEMBER It is the provider s responsibility to determine when the cap has been met. TPTN will not retro-authorize any visits due to the provider not being aware the cap had been met. Denials for this reason will be subject to our regular appeals process. The cap does NOT reset for each diagnosis-it is an annual per-beneficiary cap. Your TPTN provider is there to assist you with all your benefit questions. You can also contact TPTN: Utilization Review Department at 888-NET-TPTN ( ). Thank you for providing the highest quality care for our members!

4 Page 4 TPTN AUTHORIZATION PHONE AND FAX HOURS Monday Thursday 8:30am 6:30pm (EST) Friday 8:30am 6:00pm (EST) Any messages left after hours will be returned within 24 hours. You may check claim status and eligibility 24 hours a day through our automated fax back process. Call and follow the prompts. You may send authorization requests 24 hours a day to the Utilization Review Department at All authorization requests will be responded to within 48 hours. Customer Service 888-NET-TPTN ( ) Authorization Request Fax MEET OUR DIRECTOR OF HEALTH SERVICE Lori Cookinham Director of Health Service Lori joined TheraMatrix as Health Services Director in As a registered nurse with over 15 years in the health care industry, her previous experience includes: utilization management, quality improvement, sales and marketing, HEDIS data abstraction, business and program development, fund raising and community relations. As Director of Health Services, she is responsible for the oversight of daily operations for the utilization review and case management team. DIRECTOR OF MARKETING AND SALES Andigoney Peseski Director of Marketing and Sales Andigoney Peseski joined TheraMatrix in January She has over 20 years of leading, managing, and growing healthcare sales organizations, including pharmaceutical, medical device, and medical capital equipment sales. Andigoney has a broad knowledge base of the principles and methods within the healthcare systems, and has been recognized for building strong customer relationships and her focus on outstanding customer service. Andigoney has extensive experience leading large regional sales teams, and has successfully marketed 27 different pharmaceutical and medical diagnostic equipment products into highly competitive markets. She has a solid comprehension of vendor, distributor, and hospital supply management with leadership and management positions at both district and regional levels all of which is highlighted in primary care, specialty care, managed care, hospital-based, and procedure-based environments. Andigoney has a Bachelor of Science in Medical Technology and is ASCP-MT certified. There are no secrets to success. It is the result of preparation, hard work, learning from failure. ~ Colin Powell ~

5 Page 5 MEMBER SATISFACTION SURVEY RESULTS Our latest results are in! 700 surveys were sent NATIONALLY to members treated from October 2011-December 2011, and our response rate was 44% Our overall satisfaction rate is 99% Overall Satisfaction 7% 2% 1% 0% Detail of Survey Results: 90% Very Satisfied 90% Somewhat Satisfied 7% Neutral 2% Somewhat Dissatisfied 1% Very Dissatisfied 0% Life is not merely being alive, but being well ~ Marcus Valerius Martialis ~ PROVIDER ACCOLADES TPTN is appreciative of the efforts of our network providers to continuously render quality medical services to our membership. As evidenced by TPTN s outstanding customer satisfaction scores, you continue to meet and exceed our membership s expectations as it relates to their outpatient physical therapy. Below are a few member comments that were submitted during our most recent satisfaction initiative. Wonderful service and great staff. I am treated with respect and they take real concern and consideration of the patient. I can't say enough good things about this entire staff! A TheraMatrix Physical Therapy, Middlebelt, Livonia, MI The treating therapist made me comfortable and was very patient. He explained everything clearly to me. The rest of the staff there was super nice and they all made my exercise therapy rewarding and beneficial to me. I can't thank them enough, from the receptionist to the great staff there! Accelerated Rehabilitation Centers, 5099 E. 81 st Avenue, Merrillville, IN Great facility. I am very glad physical therapy has helped! Family & Sports Physical Therapy Prairie Falcon Rd. Ste. 100, Las Vegas, NV We have used this physical therapy practice for several years and they are the greatest. People come from miles away to this place! Wadsworth Family Physical Therapy, 145 Smokerise Lane, Wadsworth, OH All the therapists are very professional and understanding. They have your recovery to good health first and foremost in mind. Rehabilitation Consultants, Inc., 1317 Cooper Foster Pk. Rd., Amherst, OH Congratulations to all TPTN providers for adhering to such high standards of patient care!

6 Page 6 REMINDER TheraMatrix Physical Therapy Network (TPTN) Claims Submission Protocol A recent audit has shown that submitting multiple claims each month increases health care costs. These costs must be absorbed or passed on to our customers. In an ongoing effort to curb rising health care costs through administrative efficiencies, TPTN implemented its Claims Submission Protocol. This notice serves as a reminder that TPTN Protocol, as outlined in your Provider Affiliation Agreement, requests that claim submission occurs once a month. Claims may be submitted at any time during the month and this will not effect the expedient turn around time on claims payment. You may also realize a cost savings as a result of this change if you pay per claim for EDI. If you have any questions regarding this process please contact our Customer Service Department at (888) and a representative will be available to assist you. HEALTH AWARENESS UPDATES Below is a calendar of health awareness events taking place thru April Use the contact listed to obtain materials to pass out at your facility. February 1-29 Heart Month American Heart Association 7272 Greenville Avenue Dallas, TX (800) March 1-31 National Nutrition Month American Dietetic Association 120 S. Riverside Plaza, Ste 2000 Chicago, IL [email protected] April1-30 Occupational Therapy Month American Occupational Therapy 4720 Montgomery Lane Bethesda, MD (301) (301) Fax April1-30 National Autism Awareness Month The Autism Society 4340 East West Highway, Ste 350 Bethesda, MD (800) 3 AUTISM ( ) (301) (301) Fax [email protected] -autism-awareness-month/ March 5-11 National Sleep Awareness Week National Sleep Foundation 1010 North Glebe Road, Ste 310 Arlington, VA (703) onalsleepawarenessweek%c2%ae March 27 American Diabetes Alert Day American Diabetes Association 1701 North Beauregard Street Alexandria, VA (800) DIABETES ( ) TheraMatrix Physical Therapy Network 900 Auburn Avenue Pontiac, MI