Terry Rehabilitation & Testing | Physical Rehabilitation and Functional Testing

Does Dad Really Have Medicare?

A son or daughter (or in-law) will frequently have to take over care for an elderly relative, without any advance notice. Due to the number of alternative plans available today, well-meaning relatives could easily find themselves buried by a mountain of medical bills. Read more

APTA Comments on Cigna/ASH

The American Physical Therapy Association (APTA) has released it’s statement regarding the transition from Cigna to American Specialty Health physical therapy contracts:

APTA sent a comment letter to CIGNA summarize concerns regarding the Cigna National Physical Medicine Clinical program’s use of American Specialty Health (ASH). Here are some of the points APTA shared with Cigna:

  • ASH has limited physical therapy experience and it does not have the requisite expertise to render appropriate clinical decisions regarding medically necessary physical therapy services.
  • The ASH Provider Agreement (Agreement) is overly complex, difficult to follow, and will not be readily understood by most therapy providers.
  • The Agreement’s payment methodology imposes a burdensome and one-sided appeals process.
  • The ASH provider tiering mechanism as described in the Clinical Performance System is unduly complex and arbitrary, and it is not keyed to clinical outcomes.
  • The Agreement’s administrative features are burdensome, including the MNR process and the obligation to check the Medicare exclusion list monthly.
  • Utilization management under the Agreement calls for non-PTs to review appeals of adverse decisions, and it is not truly evidence-based, since it relies on Clinical Practice Guidelines (CPGs) selected by ASH via a process that does not meet APTA standards.

Alert: Cigna/ASH Patients

Cigna terminated all contracts with physical therapists in this area on September 1, 2014. We are now required to go through a third party company – American Specialty Health (ASH) – to obtain authorization and payment for physical therapy. Although this has been in process for months, we received our welcome packet only last Friday, and have yet to be provided with a full online account and instructions on how to obtain authorization and treatment for Cigna patients. Read more

Terry Rehabilitation & Testing | Physical Rehabilitation and Functional Testing