Physical therapists and physical therapist assistants provide exceptional clinical care in a variety of settings. Year over year, one’s body of clinical knowledge continues to grow, and as a result, treatment techniques are refined. And yet, a therapist’s understanding of how their services is paid for is often seen as less important than obtaining knowledge in specific areas of clinical care. The health insurance landscape is constantly changing. The biggest change in the last ten years has been the payers shifting their payment focus from the volume of services delivered to the value of services delivered. Medicare and Medicaid, the largest payers of healthcare services in the United States, are following. This course will help participants understand the complexities of the regulatory and payment landscape of physical therapy practice. It is not a primer to the nuances of reimbursement. Instead, it is a course that will enable participants to effectively advocate for their patients and for policy changes that are needed.

Course Objectives/Outcomes

By the end of the course, a successful participant will be able to: 

• Correlate the history of health insurance coverage in the United States and its implications for current health systems and the Medicare program  
• Define healthcare coverage and payment methodologies in various settings in which therapist’s practice  
• Examine the role of professional integrity, and the therapists’ responsibility for understanding fraud, waste, and abuse 
• Analyze the shift in focus of care from one of volume to one of optimal outcomes, quality, and value 

Applicability

• Geriatric Certification 

Evidence in Motion is an AOTA Approved Provider of professional development. PD activity approval ID# 7014. This distance learning-independent activity is offered at 7 Contact hours/.7 CEUs Intermediate, Professional Issues. AOTA does not endorse specific course content, products, or clinical procedures.