July 2018 Newsletter

PRESIDENT’S COLUMN
CARRIE ABRAHAM PT, DPT, MPH
CONTENT PRESIDENT, WVPTA

It is now June, officially summer, and I cannot believe how quickly time
• President’s Column moves! We have just come off of another record breaking WVPTA Annual
Conference at Stonewall Jackson Resort at the end of April– and the work
• Signs, Signs, of the chapter is still going strong! Thank you to all who attended and to
Everywhere Signs those who worked so hard to put together the top-notch event. A special
thank you to Krissy Grubler and the Education Committee, Jeff Stevens
• Save the Date and Johnna Gaunch in our WV Chapter Office. It takes a lot of behind the
scenes blood, sweat and tears to pull an even like this off so seamlessly –
• Insurance Updates and they do it consistently! The conference was energized from those in
attendance and I was inspired by the ideas, thoughts, celebrations and
• Nominating concerns that were shared by all of you. Let’s keep the lines of
communication open and busy!
Committee Report
As I am writing this message to you, I am attending Component
Leadership Meetings prior to the start of APTA NEXT and the House of
• Recognizing
Delegates in Orlando. The momentum keeps going! Attending these
Professional Service meetings alongside other component leaders affirms the work that we are
doing in WV and challenges us to think more creatively with our strategic
priorities. I know that somewhere out there, there are physical therapy
professionals in WV with the creative solutions that we need to help our
patients receive - and our practitioners to provide - exceptional physical
therapy services.
The moment that spoke to me the most was during an update from Amy Smith, outgoing PTA Caucus
Chief Delegate – at one moment, the PTA delegation came storming into the room cheering, holding
#PTA10K signs, wearing Mickey Mouse ears, clapping. It was amazing to see such drive, determination
and hope that together, we can overcome any barriers that are holding us back. I spoke to a passionate
young PTA student who is on the verge of beginning his professional journey – we should all want to
work together to assure his future along with the future of our profession! The Florida chapter has
partnered with the APTA and the PTA Caucus to hold a Virtual 10K run/walk. You do it on your time, in
your city! I challenge all of our members, specifically our PTA members to sign up for this run – I did!
You can all register at the following link: https://www.fpta.org/page/PTA10KVirtualRun. Get creative
with it – why not grab a potential association member and run or walk with them and at the same time
talk to them about the value of membership and engagement in your professional association. PTs, grab a
PTA friend and get moving – do this together!! Have fun with it – snap your pictures and share them with
us. We are better together! Let’s make this the year of the PTA as we come up on the 50th Anniversary of
1
the Physical Therapist Assistant in 2019! We can strengthen our resolve to work as a team to promote
the profession of physical therapy as an integral part of the future health of our nation! Let’s go!


SIGNS, SIGNS, EVERYWHERE SIGNS
BRAD PROFITT PT, DPT, OCS, DC, CSCS, CFCE
WVPTA PAC Chair

We all have heard the song, but soon it will be that time of year again where there will be signs
everywhere for those running for office. This November in West Virginia there are 3 physical therapists
running for office and the WVPTA PAC would like to help support their campaigns. What a great
opportunity we have to promote PT in the Mountain state, and who better to do that than a few PTs in
political offices. These candidates are as follows:

Ryan Ferns, PT, DPT – West Virginia State Senate, District 1
Mick Bates, PT – West Virginia House of Delegates, District 30
Eric Tarr, PT, DPT, MBA, OCS – West Virginia State Senate, District 4

The WVPTA PAC has been active this year with hosting the “First Annual Spring into ACTION 5K” at our
annual conference at Stonewall Resort. There were a total of 36 runners and the Marshall University
School of Physical Therapy brought home the Golden Goni & Gait Belt Award for the fastest combined
team time. Wheeling Jesuit had the fastest overall individual time of 17:44 (5:43 pace). That is fast,
folks!!!!

2
The PAC wants to build on the success of this recent fundraiser and is seeking your help. We are looking
for members of the WVPTA to make an election-year donation of $25.00 or more to help ensure multiple
victories this November for our West Virginia PT colleagues. Please go to the following link to make an
easy one-time donation: https://www.wvpta.org/donate.html
Thank you in advance for your support of the WVPTA PAC.

SAVE THE DATE
KRISSY GRUBLER, PT, DPT
WVPTA Education Committee Chair

The Education Committee is pleased to announce the topic and presenter for our Annual Conference
2019!

We are thrilled to announce that Kathleen Sluka, PT, PhD, FAPTA will be presenting on pain mechanisms
and treatment! This topic will fit nicely with the new legislation passed regarding chronic pain treatment
as well as our Payer Forum topic this year, Physical Therapy vs Opioids for Chronic Pain and Pain
Management, “Increasing Care and Decreasing Costs,” which is scheduled for September 25, 2018 from
9:00 a.m. – 3:30 p.m. at the University of Charleston.

WVPTA Annual Conference 2019
April 27-28, 2019 at Stonewall Resort

“A mechanism-based approach to physical therapy pain management”

Presenter:
Kathleen A. Sluka, PT, PhD, FAPTA
Professor
Department of Physical Therapy and Rehabilitation Science
Pain Research Program
College of Medicine
College of Nursing
University of Iowa

INSURANCE UPDATES
SALLY OXLEY, PT, OCS, CHT, CMDT
WVPTA Payer Relations Committee Chair

Highmark - Healthways is giving 12 visits with an authorization request for 2018, rather than the 8
they gave in 2017.

Be sure all practice information has been reviewed and updated with Highmark for 2018. Provider
payments can be withheld if information is not updated.

3

Medicare – Congress failed to pass the repeal of the therapy CAP before they adjourned for the holiday
recess. The CAP will be $2,010.00 for 2018 with no exceptions process, so it is a hard CAP and the KX
modifier does not apply. The allowed amounts are applied toward the CAP, not the amount paid by
Medicare. The allowed amount includes the 80% paid by CMS and 20% paid by the secondary or the
patient. They will be back in session Jan 19th, so may act then. Keep your fingers crossed.


Humana – As of January 1, 2018 timely filing has been updated to 180 days, from the date of services.

Humana Medicare Advantage Plans and Commercial plans no longer require authorization. They will be
following Medicare guidelines where care “must require medical necessity”. Documentation will be
scrutinized so make sure all treatment is related to improvement of life skills/ function. Providers must
pay close attention to policy plan limits, referral requirements and dollar limit maximum.


Tricare – As of January 1, 2018 Tricare North and Tricare South are merging into Tricare East. Providers
must complete new EDI (electronic data interchange) and ERA (electronic remittance advice)
enrollments for Tricare East to submit claims electronically and receive ERAs for dates of service after
January 1st.

Also effective January 1st, 2018 Tricare claims are going to a new payer, Humana Military. Claims filed
prior to January 1st will still go to Health Net Federal. Be sure to check with your clearinghouse to see if
enrollment is required to file Humana Military.

The bill has been signed by President Trump to allow PTAs to treat (and bill) for patient care. However,
PTAs still cannot treat Tricare patients until the Department of Defense makes appropriate changes to
their policies and regulations.

Aetna - Carole Galletta, the payment chair from Pennsylvania, has reported that Aetna has significantly
decreased their payment rates in Pennsylvania, effective for dates of service 10/15/17 ongoing. In some
cases CPT code reimbursement has decreased by 60%. Watch your EOB’s and contact Sally Oxley
(soxley@hptservices.com) of the Payer Relations Committee if you see reductions in your Aetna
payments.

Kentucky’s Orange Envelope Law – In Kentucky if an insurer makes changes to their plan that produces
a decrease in reimbursement to providers, providers must be notified by mail in an orange envelope.
West Virginia is considering similar legislation.
http://www.klsreports.com/ShowDocument.aspx?BTextID=195054
This is the link to Kentucky’s newly passed orange envelope law.


Jimmo v. Sebelius Settlement Agreement - On January 24, 2013, the U. S. District Court for the District
of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius, in which the plaintiffs
alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making
claims determinations for Medicare coverage involving skilled care (e.g., the skilled nursing facility (SNF),
home health (HH), and outpatient therapy (OPT) benefits). The settlement agreement sets forth a series
of specific steps for the Centers for Medicare & Medicaid Services (CMS) to undertake, including issuing
clarifications to existing program guidance and new educational material on this subject. The goal of this
4
settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing
Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled.

Thus, such coverage depends not on the beneficiary’s restoration potential, but on whether skilled care is
required, along with the underlying reasonableness and necessity of the services themselves. Any
Medicare coverage or appeals decisions concerning skilled care coverage must reflect this basic principle.
In this context, it is also essential and has always been required that claims for skilled care coverage
include sufficient documentation to substantiate clearly that skilled care is required, that it is in fact
provided, and that the services themselves are reasonable and necessary, thereby facilitating accurate
and appropriate claims adjudication.

The settlement agreement is intended to clarify that when skilled services are required in order to
provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot
be denied based on the absence of potential for improvement or restoration. As such, any actions
undertaken in connection with this settlement do not represent an expansion of coverage, but rather,
serve to clarify existing policy so that Medicare claims will be adjudicated consistently and appropriately.

CMS will be updating their manuals and making clarifications.

NOMINATING COMMITTEE REPORT

During the Annual Meeting in April, we welcomed new officers to the WV Physical Therapy Association.
We’re excited to broaden our leadership team for 2018-19.
Kristin A. Phillips, PT/DPT, WCS, CLT-LANA, RYT-200
House of Delegates
Kristin Phillips has been an APTA and women’s health section member since 2012. She is currently an
assistant professor at West Virginia University’s Division of Physical Therapy and she serves on their
admissions’ committee. She is a board-certified women’s health clinical specialist (WCS) and her clinical
practice is solely dedicated to her passion of caring for the women’s health population.
Renee Riffle McGinnis, PT
Nominating Committee
Renee Riffle McGinnis is a Physical Therapist who works with the Department of Human Performance as
an Assistant Professor at West Virginia University. Born and raised in North Central West Virginia, she is
excited to return to her Alma Mater as a faculty member in the Physical Therapy Program. After attaining
degrees in exercise physiology and physical therapy, Dr. McGinnis worked for nearly fifteen years in the
surrounding community as a physical therapist. Her experience working with numerous students over
the years as a Clinical Instructor, Facility Coordinator of Clinical Education, and as an adjunct faculty
member led her to pursue a full time academic faculty position in 2016 with Pierpont Community and
Technical College's Physical Therapist Assistant Program. She joined the faculty at WVU full time in July
of 2017. Dr. McGinnis is recognized as an Orthopedic Clinical Specialist by the American Board of Physical
Therapy Specialists. Dr. McGinnis may be reached via phone or electronic mail at (304)293.0642 or
rriffle@hsc.wvu.edu
5
Caterina (Carrie) Abraham, PT, DPT, MPH
President, second term
Carrie is an Associate Clinical Professor in the Department of Physical Therapy at Wheeling Jesuit
University. She has 24 years of physical therapy practice experience with the last 18 being in the
academic setting. She served as WJU’s ACCE for 7 years and now teaches full time in the program. She
earned a Bachelor’s Degree in Physical Therapy (1994) and a Master’s Degree in Public Health (2004)
from West Virginia University. She earned her Doctor of Physical Therapy degree (2009) from Temple
University. She has served the WVPTA as a member of the Ethics Committee and has been elected to
serve in the offices of secretary, vice president and has just finished her first term as president. She
serves her local community by volunteering with the Ohio County Family Resource Network, serving on
their Wellness Committee and is a volunteer middle school coach for a 7th grade girls basketball team –
Go Devils! She serves as a Federal Legislative Key Contact for the APTA Government Affairs Office. Carrie
is a per diem staff PT for a local hospital system and also provides pro bono physical therapy services at
the WJU Physical Therapy Care Clinic for the uninsured and underinsured. She is a volunteer with Project
Hope, a street medicine clinic in Wheeling and she leads an international medical service learning trip to
Haiti each spring.
Bryanna Ordiway, PTA
PTA Caucus Chair
I have been a member of the WVPTA /APTA since 2010. During that time, I have served as the PTA
Caucus Chair for the last 5 years and am a current board member. I have participated in activities such
as: APTA House of Delegates, the WVPTA Strategic Plan, WVPTA Lobby Day, assisted in starting the
Student Special Interest Group/PTA Special Interest Group and served as the President for the PTA
Special Interest Group for 3 years. I am a current member of the WVPTA Education Committee and have
assisted in raising money for the WVPTA Political Action Committee.
As the PTA Caucus Chair I have traveled to the different Physical Therapist Assistant Programs within the
state in a grass roots movement to speak with students regarding the importance of membership within
the association. I also developed the Physical Therapist Assistant Excellence Award to be given to an
outstanding PTA each year to showcase their efforts and abilities within our profession.
Matt Madrid, MSPT
Treasurer, second term
Matt was born in Wheeling, West Virginia. His claim to fame is that he graduated from John Marshall
High School with Grammy Award winning country singer Brad Paisley. Growing up in Wheeling he
played numerous sports. His interest in sports medicine and physical therapy began at an early age when
he broke his ankle playing hockey requiring surgery and rehabilitation. He received his Bachelor of
Science in Sports Medicine at Alderson-Broaddus College in May, 1997. Matt then continued his
education at Wheeling Jesuit University, where he was voted Vice President of his class and graduated
with a Master of Science degree in Physical Therapy in December, 1999. He became certified by the West
Virginia Board of Physical Therapy in March of 2000. Matt has worked in both hospital and outpatient
settings, over the years gaining experience to become the facility director of two physical therapy clinics.
Since graduating from Wheeling Jesuit University, he has enhanced his clinical skills by attending

6
numerous continuing education courses stressing outpatient orthopedic treatment strategies and manual
therapy techniques including spine and extremity mobilization. He is currently a member of the West
Virginia Physical Therapy Association and the American Physical Therapy Association Orthopedic
Section. Matt resides locally with his wife Tina, oldest daughter Jenna, and twin girls Kinsey & Kira.


RECOGNIZING PROFESSIONAL SERVICE: IT IS AN HONORABLE ENDEAVOR
D. SCOTT DAVIS PT, MS EdD, OCS
WVPTA Vice President

While most physical therapists serve their patients and community
on a daily basis, a few individuals also dedicate their lives to the
service of the profession. As the Vice President of the WVPTA, it is
my privilege to oversee the honors and awards of our valued
members. It is truly amazing to observe the dedication and passion
of individuals who work selflessly and tirelessly to advance our
profession for future generations. Let’s work together to identify
these stalwarts and thank them for their years of service.
Starting this fall, the WVPTA will be accepting nominations for the
Nancy Tonkin Distinguished Service Award to recognize and
honor an outstanding West Virginia Physical Therapy Association
member who has provided exceptional and enduring value to the
Physical Therapy profession. Eligible candidates must have been a
member of the WVPTA (PT or PTA) for no less than 10 years and have made a significant contribution to
the profession in one or more of the following areas: 1) Leadership, 2) state or national recognition, 3)
service to the physical therapy profession through education, practice, research, or advocacy, 4) served
as a role model or mentor to help a WVPTA member reach their highest potential. Please see the call for
nomination at https://www.wvpta.org/ The nomination deadline for the Nancy Tonkin Distinguished
Service Award is December 1, 2018.