CSM - New Orleans - February 21-24, 2018!

Aquatic PT News

    posted: March 15, 2018

    APTA Combined Section meeting was a huge success with over 17,000 attendees in New Orleans Louisiana. The Aquatic Section took the time to recognize many dedicated professionals on their contributions to the Aquatic Section at their annual membership meeting.


    2018 Award Recipients


    Congratulations to the 2018 APTA Aquatic Physical Therapy Section Judy Cirullo award for Exceptional Contribution to the Area of Aquatic Therapy winner Diane Platz PT. This Award recognizes a PT’s exceptional contribution to the field of Aquatic Therapy and can include but is not limited to equipment design; innovative programming or patient care, educational contribution. Diane was recognized for her outstanding promotion of Aquatic Therapy as CSM Conference Coordinator.

    Congratulations to the 2018 APTA Aquatic Physical Therapy Section Richard Ruoti Research Award for Excellence winner Lori Thein-Brody PT, PhD, SCS. This award is named for one of the founders of the of the Aquatic PT Section who was dedicated to exemplary research in the area of aquatic therapy, this Award recognizes exceptional research that impacts Aquatic Physical Therapy.


    2018 Aquatic Sections President’s Award

    Presented by Charlotte Norton to the

    Communications Committee

    Christine Schulte PT, MBA Committee Chair

    Michael Murray PT, DPT

    Eileen Ray PT

    Sean Campbell PT, DPT (Not Pictured)

    Service Awards for Alethea Crespo – Outgoing Membership Chair

    Christine Taylor – Outgoing Director of Practice

    Nicole Needles – Outgoing Nominating Chair

    Outstanding Service Award Presented to

    Past President Charlotte Norton

    By Current President Christine Schulte

    As well as a surprise Shark attack to celebrate Charlotte!

    Thank you for your contributions to the Aquatic Section over the past 2 decades



    posted: February 20, 2018

    From: Justin Elliott
    Subject: Therapy Cap: webinar recording

    Dear APTA Component Leaders,

    Yesterday APTA hosted a special edition of Insider Intel for our members that focused on additional details and frequently asked questions related to the Bipartisan Budget Act of 2018 signed into law on February 9. The budget deal included a permanent fix to Medicare’s hard cap on outpatient therapy services, PTA/OTA payment differential, changes to the home health payment system, funding for CHIP, and more.

    A recording of yesterday’s Insider Intel webinar on the Therapy Cap has been posted to the APTA website at:


    (click on the February 15 recording posted under the ‘Archives’ section)

    Please feel free to share this link with members or colleagues who have questions on this issue.


    Justin Elliott

    Vice President, Government Affairs


    posted: January 31, 2018

    Dear APTA Component Leaders,

    Below is the text of a recent announcement from CMS regarding outpatient therapy claims that are impacted by the Therapy Cap.  The link to the CMS website with this announcement can be found HERE.  Also attached please find APTA’s FAQ document on the Therapy Cap.

    APTA along with our partners in the Repeal the Therapy Cap Coalition continue to aggressively push Congress to include the bipartisan proposal to permanently repeal the hard therapy cap in the next congressional spending deal.  Congress must pass a spending deal by the February 8 deadline or risk another government shut-down. Our ongoing grassroots, public relations, and social media campaign (#StopTheCap) will continue to ramp up over the next 12 days.  In addition, our coalition partner AARP launched their national grassroots push this week on repealing the therapy cap, which you can read more about HERE.

    Please stayed tuned for additional updates.  Thank you for your continued advocacy and support.  Let me know if you have any questions.


    Justin Elliott

    Vice President, Government Affairs


    Expired Medicare Legislative Provisions and Therapy Claims with the KX Modifier Rolling Hold

    CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing.  Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural services, payments for low volume hospitals, and payments for Medicare dependent hospitals.  CMS is implementing these payment policies as required under current law.

    For a short period of time beginning on January 1, 2018, CMS took steps to limit the impact on Medicare beneficiaries by holding claims affected by the therapy caps exceptions process expiration. Only therapy claims containing the KX modifier were held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration. During this short period of time, claims that were submitted without the KX modifier were paid if the beneficiary had not exceeded the cap but were denied if the beneficiary exceeded the cap.

    Starting January 25, 2018, CMS will immediately release for processing held therapy claims with the KX modifier with dates of receipt beginning from January 1-10, 2018.  Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold” of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted.  For example, on January 31, 2018, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 11.  Similarly, on February 1, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 12, and so on.

    Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt.

    FAQ_TherapyCap_2018 Updated.pdf (80.8 KB)


    posted: January 02, 2018

    As you all know, Congress recessed on December 22 without acting on the bipartisan, bicameral agreement for a permanent fix to Medicare therapy cap. They also did not enact a temporary patch or extension of the current exceptions process.  Thus, a hard cap of $2,010 on outpatient therapy services (PT/SLP combined) will be applied beginning on January 1, 2018.   A separate hard cap of $2,010 will be applied to outpatient OT services.  It should be noted that the hard cap will not apply to hospital outpatient clinics (OPs).  Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997.  Hospital OPs were subsequently added to the cap exceptions process in 2012. However with the expiration of the exceptions process on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expires.


    Our congressional champions expected Congress to introduce and pass an omnibus Medicare extenders bill in early December. This bill would have addressed a number of Medicare provisions set to expire the end of 2017, including the therapy cap permanent fix.  Unfortunately, the debate over the tax reform legislation pushed nearly all other issues to 2018. On its way out of town, Congress passed another short term funding bill to keep open the Federal Government through January 19, 2018.  We lobbied our champions to add the therapy cap fix to this spending bill, but congressional leadership made it clear in the waning days of the session that only a select few items would allowed to be added, the most notably being the temporary funding for the Children’s Health Insurance Program.


    Congress returns to Washington on January 3rd and must adopt another spending bill by January 19th.  APTA, AOTA, ASHA and our allies in the Therapy Cap Coalition will continue to keep the pressure on Congress during their recess urging them to take quick action on the therapy cap in early January.  In addition, APTA reached out to CMS requesting guidance for how providers should handle therapy claims during this time of uncertainty under the hard cap.  In years past when Congress failed to act and a hard cap went into effect temporarily, CMS asked providers to hold all claims until Congress enacted a fix.  The fix was then retroactively applied to January 1 of that year.  However we have not been able to secure an assurance that will be the case this time. We continue to seek clarification from the agency.


    Our efforts over the next several weeks will include:


    1) Lobbying & Grassroots Advocacy – APTA will continue our ongoing grassroots advocacy efforts aimed at members of Congress through a variety of mediums including action alerts, phone calls, paid media, and social media.  APTA engaged Revolution Media this fall in targeted online advertisements aimed at social media advocacy with a good deal of success, and we intend to continue this engagement in January.  Our grassroots efforts this fall resulted in over 20,000 emails aimed at members of Congress and we intend to keep this level of engagement as we move into January.


    2) Member education and guidance – APTA will be providing ongoing communication to component leaders, payment chairs, practice chairs, FALs, and general membership on how to manage claims and billing during this uncertain time.  We will be rolling out addition information in the coming days to assist providers and provide further details.  In addition, we will continue to pressure CMS to issue a transmittal that provides guidance to providers on managing therapy claims under the anticipated temporary application of the hard cap.


    3) Therapy Cap Coalition – we will continue coordinating lobbing outreach, grassroots, and media with our partners in the Therapy Cap Coalition, including ASHA, AOTA, NASL, AHCA, , and patient advocacy groups.


    4) Public Relations/Media – APTA and our partners will continue to press this story with media outlets and the Capitol Hill press.


    While we are hopeful that Congress will quickly address the therapy cap when they return in January, nothing is certain given the current environment on Capitol Hill.  However resolution of this issue remains a top priority for us in January. 


    Please stay tuned for further developments.  In the interim please let me know if you have any questions.




    Justin Elliott

    Vice President, Government Affairs


    posted: December 28, 2017

    In a development that leaves patients and providers in the lurch, Congress has recessed without addressing the Medicare therapy cap in any meaningful way. The inaction is particularly disappointing for APTA and other stakeholders given that a bipartisan agreement had been reached to permanently end the hard cap.

    The bottom line: beginning on January 1, 2018, the $2,010 hard cap on physical therapy and speech-language pathology services combined will be instituted, and the exceptions process that currently permits medically necessary services above the cap through use of the KX modifier will no longer apply.

    In late October, Congress seemed poised to enact a permanent repeal of the hard cap and included that change in a package of Medicare "extenders." Had those extenders been approved, it would have ended Congress' continual tradition of late-year scrambling to come up with a short-term exceptions process. Instead, Congress recessed without approving the extenders or enacting a temporary exceptions process.

    Over the past several months, thousands of APTA members called and tweeted their members of Congress, and generated over 20,790 emails to Capitol Hill urging Congress to pass the permanent fix for the therapy cap

    "Congress’ inaction creates the worst-case scenario for patients and providers," said APTA President Sharon Dunn, PT, PhD. "Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers."

    The therapy cap is just 1 of several issues left unresolved by Congress. A number of other critical Medicare extender policies that needed action, but also will now expire on December 31, include everything from special payments for ground ambulances, to reauthorization of special needs plans, to an extension of the State Health Insurance Health Programs.

    There is a chance the cap could be short-lived. Congress returns from its recess on January 19, and APTA’s congressional advocates and other patient and provider groups that are part of the Repeal the Therapy Cap Coalition will work to get the bipartisan agreement included in the next "must-do" bill to be taken up.

    "Congress is well aware of the negative ramifications of the therapy cap, which is why there is bipartisan support to repeal it," said Justin Elliott, APTA's vice president of government affairs. "It is imperative that Congress take action as soon as possible in January, and we will keep up the fight."

    APTA also will provide additional information and resources to help practitioners prepare for the application of the hard cap on January 1.

    posted: December 05, 2017

    By now, most physical therapists (PTs) have heard the news: the final 2018 Medicare Physician Fee Schedule (PFS) released in early November by the US Centers for Medicare and Medicaid Services (CMS) included some significant variations from the PFS proposed in July. Instead of finalizing CPT code values that were the same as—and occasionally larger than—current values, CMS opted to offer up a more complicated combination of cuts and increases that could affect PTs in different ways, depending on their case-mix and billing patterns.

    So what should PTs do in the wake of the new PFS? Here are APTA's top 4 suggestions.

    1. Know the design process for the fee schedule. It's important to understand what led to the changes to provide context, a slight sense of relief, and a reminder of why payment needs to move toward value-based models and away from fee-for-service.

    The PFS now set to debut January 1, 2018, is the CMS response to an American Medical Association (AMA) committee's recommendation on potentially "misvalued" codes associated with a wide range of professions, not just physical therapy. When the process began in early 2016, many predicted that the final outcome would be deep cuts to nearly all valuations—as much as 10% or more overall. APTA and its members fought hard to substantiate the validity of the current valuations, and even the need for increases in some areas. The end result was a significant improvement from where things were headed at the start of the process.

    That's not to say it's been an entirely satisfying process from start to finish. This recent PT in Motion News story goes into more detail about the sometimes-frustrating journey from points A to B.

                2. Understand what's being changed. Just about everything that happens at CMS is complicated, and the process that led to the new CPT code valuations is no exception. Still, a working knowledge of how CPT codes are valued is helpful in understanding why the PFS contains such a mix of positives and negatives.

    One important thing to understand is that code valuation is actually a stew of 3 separate elements, known as relative value units (RVUs). These are estimations of the labor, expense, and possible professional liability involved in performing any given treatment or evaluation task associated with a CPT code. The 3 types of RVUs are known as "work," "practice expense" (PE), and "professional liability." The coding valuation differences between the proposed and final PFS were due to changes to the PE RVUs only.

    This wasn't part of the proposed rule. While the AMA Relative Value Scale Update Committee Health Care Professions Advisory Committee did recommend changes to PE RVUs, CMS initially opted to not adopt those suggestions. When the final rule was released 3 months later, CMS—without seeking input from APTA or any other stakeholders—did an about-face and adopted the changes to PE RVUs.

    So what? The answer is twofold: first, the tweaks to PE RVUs mean it's difficult to make many sweeping generalizations about how the new PFS will affect individual practices and clinics; second, it's worth noting that individual work RVUs either remained unchanged or increased.

    A more detailed explanation of how the codes were affected is available in an APTA fact sheet on the 2018 PFS (listed under "APTA Summaries and Fact Sheets"). For a more complete explanation of RVUs and the differences between the 3 types, check out this APTA podcast on the CPT valuation process.

                3. Get a sense of how you might be affected. A sense of history and understanding of detail are all well and good, but the  bottom line is your bottom line.

    Here's the complication with the 2018 PFS: because of the wide variation in upward and downward adjustments, it's hard to make statements about how PTs in general will be affected. CMS estimates the overall impact at a 1%-2% reduction, but a lot depends on the types of patients a PT or clinic typically sees and what interventions are commonly used. Some providers could see increases.

    In an effort to clear up some of the uncertainty, APTA offers a calculator than can help you see how your typical case-mix would fare in the new PFS. The calculator, offered in Microsoft Excel, allows you to enter different codes to see what changes to expect, given your Medicare service area.

                4. Keep learning. There's much more to understand about the PFS—not just in terms of the details of how the new rule will work, but in terms of APTA's work to safeguard CPT codes throughout the misvalued codes review process.

    One great way to learn more about what to expect is coming up in December, when the association hosts a free webinar on Medicare changes for 2018 on December 6 from 1:00 pm to 2:00 pm ET. The webinar will be presented in a "flipped" format, meaning that when you register, you'll be provided with a prerecorded presentation to listen to in advance. That way, more of the actual session can be devoted to live interaction with the presenters. Be sure to sign up—and listen up—soon.

    Another opportunity is available December 13, when APTA hosts an "Insider Intel" phone-in session that will cover many of the same topics, albeit in a pared-down 30-minute session, from 2:00 pm to 2:30 pm ET. Instructions for signing up for this session are on APTA's Insider Intel webpage.

    To view the news story, please see: http://www.apta.org/PTinMotion/News/2017/11/21/PFSTipsNovember2017/

    posted: May 21, 2017

    You asked for it, and we delivered!  The Aquatic Section is proud to offer membership the ability to post Aquatic-specific job openings, clinic equipment for sale, or Practices for sale on our new Classified System.

    Please visit here for introductory pricing and placement! http://www.aquaticpt.org/classifieds/



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Journal of Aquatic PT

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Current Volume: Summer 2017

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The Journal of Aquatic Physical Therapy is the primary peer-reviewed, indexed resource for dissemination of research and scholarly work related to the field of aquatic therapy. With an emphasis on implications and applications for therapy practice, the journal promotes the integration of evidence into theory, education, research, and practice related to the field of aquatic therapy. The journal is dedicated to the development advancement of aquatic therapy through publication of research and scholarly work related, but not limited to, scientific bases, integration of theory into education, translation of clinically relevant knowledge, clinical application, and education of clinicians.

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Jeffrey Royce Royter, PT, MPT   |   Jacob Francis Brewer, PT, DPT, Ph.D., NCS   |   Robert E Donaldson, PT, DC   |   Trupti Bakshi, PT   |   Jaclyn M. Metro, PT, DPT, GCS   |   Diane Elizabeth Madras, PT, PhD   |   James D Schill, PT   |   Heather Renee-Gleason Jennings, PT, DPT, NCS   |   Ilana Nicole Kellogg Waasdorp, PT   |   Rachel Torlak, PT   |   Maria Penksa, PT   |   Shanelle Lynn Middleton, SPT   |   Megan Jones, PT   |   Andrea Trinidad Walker, PT   |   J.K. Nelms, PTA   |   Jonathan Bellizio, PT, DPT   |   Robert L Arledge, PT   |   Anne Frances Dziuba, PT   |   Emily Colleen Tarlini, PTA   |   Cynthia Dawn Golembiewski, PTA   |   Sharif Magdi Nafeh, PTA   |   Megan Zann, SPT   |   Marilyn D. Phillips, PT, MS, CAE   |   Brian Paul Van Valkenburg, SPTA   |   Andrea Christine Pettit, Andrea Pettit, PTA

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