iPTCA News

MedRisk's Attempt to Have IPTCA Lawsuit Dismissed Rejected by Judge

Paul Gaspar — Thu, 31 Jul 2025 20:25:37 GMT

https://iptca.org/resources/Ruling%20on%20Demurrer%20to%20SAC_072825.pdf

IPTCA Amends MedRisk Lawsuit from Class Action to Direct Action

Paul Gaspar — Thu, 31 Jul 2025 20:15:32 GMT

In an effort to ensure MedRisk's adherence to California Labor Codes and "Anti-kickback Statutes," IPTCA recently amended it's lawsuit.

https://iptca.org/resources/2025%203-10%20-%20IPTCA%20%20v.%20%20MedRisk%20SAC%20(Final).pdf

Signature Page to Apply for Anthem $80 rate

Paul Gaspar — Tue, 18 Feb 2025 16:25:46 GMT

The link to the signatory page (scroll down to the bottom of the post) needs to be completed and delivered along with a W9, once complete email it to "Olivar, Summer" <summer.olivar@elevancehealth.com>
An agreement will be sent according to the details provided in the signatory page.
Once an agreement is sent it is really important that providers review the agreement and decide if they want to move forward with all tiers of the agreement.
1. Items of note: This agreement opts the provider into all lines of business, Commercial, Government and Work Comp.
2. Medicaid and Medicare plans with BC have some special factors to consider.
  1. Authorization requirements- providers that see Medicaid and Medicare Advantage patients are required to get prior authorization for visits.
  2. Risk adjustment audits- providers that see Medicare Advantage patients will be required to submit medical records for every patient, each year. These requests come in bulk and are labor intensive depending on the volume of patients.
  3. This tier of the contract did not receive the raise; however, it is the costliest population to treat due to the above extra requirements.
  4. Only you can determine if you can shoulder this extra admin burden for $75/visit. ONLY YOU can make the determination if you should opt out of these federal plans. If you wish to do so you will have to make a specific request.

https://iptca.org/resources/Documents/Anthem%20$80%20signature%20page%20pdf.pdf

6 Common Leadership Styles

Fri, 19 Apr 2024 20:37:31 GMT

We recently read this article in the Harvard Business Review and thought it would be great to pass along as the more management tools you have, the better your practice will be.

Rebecca Knight published this article on April 9th. She lists 6 common leadership styles:

Coercive leadership style, which entails demanding immediate compliance.
Authoritative leadership style, which is about mobilizing people toward a vision.
Pacesetting leadership style, which involves expecting excellence and self-direction.
Affiliative leadership style, which centers around building emotional bonds.
Democratic leadership style, which involves creating consensus.
Coaching leadership style, which focuses on developing people for the future.

To read more members should CLICK HERE

HRSA Reporting Due 09/30/2021

Tue, 21 Sep 2021 18:38:16 GMT

If you received PRF (Provider Relief Funds) in April, May or June of 2020 you must complete the HRSA Portal Reporting by September 30, 2021. We've received numerous questions about it and have prepared two tools to assist.

CLICK HERE for the video recording of the Town Hall.

The HRSA Site Tips V2.pdf provides some tips on how to navigate the process. The User Guide you can download from the Portal is helpful and our Tips sheet helps navigate it.

The Personnel Metrics V2.xlsx Excel file will help with counting up the number of people each quarter. Then again, if you staff is in the 20-30 range it might just be easier to use your quarterly payroll reports or the CA DE9C form and just count them by hand.

We are hosting a Town Hall session this Thursday September 23, 2021 at 6 pm to discuss and respond to questions.

CA Law on Discounting

Tue, 29 Jun 2021 17:39:55 GMT

IPTCA asked our attorney to review the California Laws on Discounting by Physical Therapists. Click on the red link below to read for her comments regarding:

Summary of California Law on Discounting
When is it legal to offer a discount to a referral service?
How to avoid illegal discounting

California Law on Discounting by Physical Therapists.pdf

Anthem Coding Problem Fix

Paul Gaspar — Thu, 10 Jun 2021 21:36:09 GMT

Hello members-

As you may know, many CA are experiencing improper denials from Anthem.

The 2 reasons for denials have been:

1. Issues getting the Excludes 1 dx denials denied as duplicates when resubmitted electronically as replacement claims

2. Incorrect NCCI edit denials for modifiers

To get paid by Anthem for improperly denied claims, please return the attached spreadsheet (red link below) to Liz Souza, DPT, CHT:

lsouza@gmspt.com:

Please click on the red link and fill out the spreadsheet in the following manner:

Provider Escalation Claim Template.xlsx

Provide 5-10 claim examples of each situation for each employer tax ID number. Once they establish the issue, they will do a claims sweep for that tax ID. So no need to include all claims.
Create a separate tab on the Excel sheet for Excludes 1 dx. and Modifier Denials
Create a third tab with any claims processed correctly with the same code pairings so they can compare.

At your service!

IPTCA Board

Webinar 12/08/2020 Medicare 9% Cuts

Tue, 08 Dec 2020 22:24:23 GMT

Here are the handouts: Click Here for Handouts

Webinar Recording: Click Here to watch the recording

ACTION NEEDED - Medicare 9% Cut

Tue, 29 Sep 2020 21:29:56 GMT

One of our Board Members put together information to share with Medicare Beneficiaries, and for the whole staff, regarding the pending 9% cuts in the fee schedule for physical therapy. Please get your staff & patients active in hounding Congress to step in & save their benefits. the documents are in both PDF and editable formats in case you want to modify. The deadline for comments is Monday 10/5/2020, so act now!

Medicare CY2021 changes Patient In Office Notice Letter R.pdf

Medicare CY2021 changes Patient In Office Notice Letter R.docx

Medicare CY2021 changes Patient In Office Notice Flyer R.pdf

Medicare CY2021 changes Patient In Office Notice Flyer R.pptx

MedRisk Amended Complaint 2020-08-20

Thu, 17 Sep 2020 21:55:52 GMT

Our attorney's have been busy. Click the link below for the most recent amendments to our case against MedRisk.

2020 8-20- PLD - IPTCA v. Medrisk - Opposition to Demurrer (W Tables).pdf

DOL Guidance on School Closure & FFCRA & FLSA

Fri, 26 Jun 2020 21:09:49 GMT

Click on the link below to access information from Carothers DiSante & Freudenberger, Labor Law Attorneys, on "DOL Issues More Guidance on School Closure Issues Related to FFCRA Paid Leave and FLSA Child Labor Limitations"

Blog from CDF Labor Law Attorneys

MedRisk Amended Complaint

Mon, 22 Jun 2020 04:32:51 GMT

The amended complaint against MedRisk can be found here:

2020 6-19 - COMPL - IPTCA v. MedRisk FAC (FINAL for_Filing).pdf

PPP Loan Forgiveness

Tue, 12 May 2020 19:55:44 GMT

This PDF has a number of links on PPP Loan Forgiveness. Remember to get the maximum forgiveness you need to spend 75% or more on payroll costs, up to 25% on rent & utilities. EMR costs do NOT qualify as utilities.

PPP Loan Info.pdf

Here is a 5 minute video on playing "what-if" scenarios on spending the PPP funds in appropriate ways in the 8 weeks using Felder's workbook:

PPP "What-If" Scenarios Video

Felder - PPP HHS Stimulus Tracking Workbook V5.xlsx

2020-05-05 Cinco de Mayo Town Hall

Wed, 06 May 2020 00:32:08 GMT

Happy Cinco de Mayo Town Hall meeting with margarita in hand! Click the links for various calculators & tracking tools.

Miller - HHS Lost Pmt Revenue.xlsx

Felder - HHS Lost Revenue.xlsx

PPS - HHS PPP Tracking.xlsx

Felder - PPP HHS Stimulus Tracking Workbook V5.xlsx

PPP--Fact-Sheet.pdf

HHS Stimulus Attestation link

HHS General Distribution Portal FAQs.docx

2020-04-28 Town Hall Recording

Wed, 29 Apr 2020 03:43:39 GMT

Here is the recording for the iPT Town Hall on April 28th. Key topics were the PPP Loans, HHS Stimulus Round 2 & the tracking workbook for both. In addition there was info on Telehealth billing and the inappropriate redirection of telehealth visits by MedRisk & One Call.

Click HERE to watch the video

MedRisk & One Call Stealing Telehealth

Tue, 28 Apr 2020 23:11:20 GMT

iPT has received multiple complaints that MedRisk and One Call are shifting existing patients to their own telehealth provider - probably because they make more money that way. This is a clear violation of the patient-therapist-physician relationship and cannot be tolerated.

Have the patient complain and the PT should also. See the attached document for links & talking points:

MedRisk - One Call Stealing Telehealth.pdf

Version 5 of PPP & HHS Workbook

Mon, 27 Apr 2020 14:00:00 GMT

Guidance from SBA and lenders on what constitutes appropriate expenses is sparse and changing. This REVISED workbook, Version 5, is designed to help you track what we believe are eligible expenses and make it easier for you to produce documentation. Previous versions should be discarded.

PPP HHS Stimulus Tracking Workbook V5.xlsx

2020-04-21 Links & Files

Wed, 22 Apr 2020 00:41:57 GMT

Link to US Chamber of Commerce info on PPP Loans

Recording of Webinar - it is unedited. The audio start at 9:15 into the recording. There are a few areas with a screen share, but most of it is black screen.

April 21st Town Hall Link

Tue, 21 Apr 2020 23:25:30 GMT

Click HERE to register for April 21st Town Hall

2020-04-14 Town Hall

Wed, 15 Apr 2020 00:11:33 GMT

Here are files from today's Town Hall:

2020-04-14 TeleRehab Code Reference List.pdf

2020-04-14 TeleRehab Coding - Billing.pdf

Recording Link

2020-04-07 Town Hall

Wed, 08 Apr 2020 16:59:55 GMT

Here are the files & links from our Town Hall on April 7th:

Recording Link

2020-04-07 TeleRehab Coding - Billing.pdf - PDF version of the Excel file below

2020-04-07 TeleRehab Coding - Billing.xlsx - Contains some links to payer sites in addition to the info in the PDF

4 Cash Flow Estimator.xlsx - May help you estimate your cash flow from old AR and current work

2020-04-07 Town Hall Q and A.pdf - Questions and our best effort answers in this rapidly changing environment

2020-03-31 Q&A Responses - NOT LEGAL ADVICE

Thu, 02 Apr 2020 17:33:37 GMT

This PDF lists our response to the submitted questions, remember, this is NOT LEGAL ADVICE. Check with your attorney or advisors. 2020-03-31 QA Session - NOT LEGAL ADVICE.pdf

Here is a link to the document from the PPS webinar with Tucker|Arensberg Attorneys

Town Hall with Kristin Gaspar 2020-03-31

Wed, 01 Apr 2020 15:03:58 GMT

Many thanks for Supervisor Kristin Gaspar for the excellent Town Hall last night 3/31/2020. Download the presentation: KGaspar Small Business Coronavirus 2020-03-31.pdf

Here is a link to the video.

Small Business Strategies

Wed, 01 Apr 2020 14:54:07 GMT

Clearly small businesses are in for some challenges. In fact, our very survival rests on making good decisions.

I've put together some ideas from various sources, download this: Small Business Strategies 2020-04-01.pdf

I've also created a daily key metric, income & expense tracker to help you stay on top of your cash flow and activity. Download this: Felder Daily Calculator.xlsx

Here is a link to the PPP (Paycheck Protection Program) Application

Hang in there, we will get through this!

COVID-19 Town Hall Files 2020-03-24

Wed, 25 Mar 2020 02:17:25 GMT

Here are the files for the COVID-19 Webinar. A link to the recording will be posted later and will be sent directly to everyone that registered. Sorry we were not able to accomodate all who wanted to get on the webinar.

COVID-19 Town Hall Files

COVID-19 Town Hall Video

COVID-19 Notice You Can Post

Thu, 12 Mar 2020 20:32:09 GMT

We have heard of a variety of efforts that clinics are taking to help reduce any negative impact on patient care, visits or business operations in their clinics.

Chuck Felder drafted this notice for his clients and is happy to share it with iPT's e-mail list. This is meant to be posted in your clinic. You can customize this as appropriate for your office.

Obviously, this is also a key time to place extra efforts on cleaning all surfaces in your office that are frequently touched like counters, door knobs, weights, wands, etc.

Let's do our part to reduce the spread!

COVID-19 Notice.docx

Anthem Denies Claims

Fri, 18 Oct 2019 17:48:08 GMT

Anthem Is At It Again. Why can't they get it right?

We've learned from multiple members that Anthem is once again denying claims for no AIM authorization, even though AIM is NOT REQUIRED at this time.

Complain to DMHC. Hopefully they will push Anthem to fix this NOW!

Anthem Revised Contract Dated 08-12-2019

Fri, 06 Sep 2019 23:26:07 GMT

Our attorney reviewed the revised contract from Anthem date 8/12/2019. Click on the link below:

Anthem Revised Contract Analysis 08-26-2019

2019 Medicare & Work Comp Calculators for Members

Fri, 23 Aug 2019 21:08:00 GMT

We've heard from members that they want to know what the Fee Schedule is for Medicare and CA Worker's Compensation for their locality. There are 32 localities in California, organized by COUNTY. In some cases multiple Counties are combined into one locality.

We have created a Medicare & Work Comp allowed amount calculator for each locality in CA. The files are organized by Medicare Locality number.

Most Northern & Central California Localities start with 0111...

Most Southern California Localities start with 0118...

Use the Medicare & CA WC Allowed tab to play "what-if" scenarios so you can see what various code combinations pay.

This workbook can be quite helpful in determining if you should accept a contract requiring discounts off the Medicare Fee Schedule or the Official Medical Fee Schedule (OMFS) for California Worker's Compensation.

Members CLICK HERE to go the Calculator page.

Non-members CLICK HERE to jump to the Join Now page.

Anthem Step-by-Step Contract Review & Talking Points

Wed, 24 Jul 2019 16:39:04 GMT

This is an updated version of information shared with Anthem, DMHC and the Department of Insurance and is designed to assist practice owners in determining if signing the new Anthem contract is in the providers, or their patients, best interests. It is a rather lengthy document as it discusses the rationale and compares specific sections of the contract to existing law.

CLICK HERE to download your copy

Anthem Contract Analysis

Mon, 15 Jul 2019 14:40:53 GMT

This analysis of the Anthem Blue Cross contract due 8/1/19 was prepared by our legal counsel. It is NOT legal advice, you should seek input from your individual advisers.

However, this contract raises some significant concerns. We strongly urge you to review it and the contract to determine if signing this contract is in your best interests. Click HERE to download.

AIM Patient Notice

Fri, 28 Jun 2019 00:26:56 GMT

Use this help your patients understand how the Anthem - AIM pre-authorization process affects their care.

CLICK HERE to download the sample Patient Notice Word doc that you can modify as desired

AIM Authorization Process

Tue, 25 Jun 2019 17:43:54 GMT

This handout is from AIM regarding the authorization process.

CLICK HERE to download the PDF.

Cigna & ASH Settlement

Thu, 20 Jun 2019 16:17:51 GMT

Cigna and American Specialty Health Agree to Pay $11.8 million
in Settlement with Chiropractic Care Centers

In another blow to middleman rationing activities we recently learned that in April Cigna & American Specialty Health (ASH) agreed to an $11.8 million settlement that will resolve litigation with a proposed class of chiropractic care centers whose patients were denied claims.

One of the allegations in the case was that ASH's utilization management policies violate the Employee Retirement Income Security Act of 1974 (ERISA) as applied to chiropractic. ASH imposes a pre-authorization requirement after the first 26 visits, which violates the terms of the underlying employee health plans. The chiropractic centers filed a motion asking the judge to approve the agreement that requires American Specialty Health and Cigna to pay monetary compensation for claim denials and to make other changes to its business.

According to the motion, the nearly $11.8 million settlement amount equals a substantial portion of what the centers would have received had Cigna approved and paid in full the claims that are the subject of the litigation. American Specialty Health also agreed to make certain business reforms, including adding more chiropractic associations or out-of-network providers to its Professional Affairs Health Advisory Committee and offering more free continuing education to providers. According to Mr. Hufford, the American Chiropractic Association now has a representative on the ASH Committee, on which the Illinois Chiropractic Society has had a representative for several years.

American Specialty Health and Cigna have denied the allegations of the complaint and declined to comment on the settlement agreement. However, this resolution, if approved by the court, provides some compensation for ASH's failure to follow the terms of the affected patients' health plans.

The attorneys involved in this case came to our 2017 Unencumbered Meeting in Long Beach seeking input on similar situations involving physical therapy centers.

FINALLY PAYERS & MIDDLEMEN ARE BEING HELD FINANCIALLY ACCOUNTABLE FOR THEIR ACTIONS THAT DELAY, DENY AND INTERFERE WITH PATIENT CARE. PERHAPS THIS WILL SPUR CHANGES IN THEIR BEHAVIOR.

In any case, iPT and our members will stay diligent in monitoring how Cigna & ASH delay, deny and interfere with patient care in our physical therapy world.

It's HERE: Bold Legislation to Curb WC Middlemen

Mon, 08 Apr 2019 15:08:09 GMT

iPTCA & CPTA Announce Work Comp Legislation to Control the Middlemen.

SB 537 (TPA/Middlemen Workers' Compensation Reform Bill)
will be heard in the Senate Labor, Public Employment and Retirement Committee on Wednesday April 10, 2019 at 9:30 am, State Capitol, Room 2040.

SB 537 would:

Provide that contracted Workers' Comp reimbursement rates shall not be less than the applicable Medicare fee schedule payment
Prevent middlemen from illegally meddling with treatment decisions made by treating physicians and PTs
Force middlemen to post the names of contracted PT clinics and their phone numbers on the MPN internet directory
Prohibit middlemen from upcoding PTs' bills
Allow the Administrative Director to investigate and punish middlemen for non-compliance with Labor Code statutes

Watch your email for calls to action to support this much needed legislation.

This legislation will focus on limiting the interference that TPAs & Middlemen (bill review companies) can exert on the work comp system along with providing limits to how much they can discount the fee schedule.

Many PTs are not even aware of the extent of the changes in the work comp fee schedule as the middlemen have rigorously guarded how much they take out and pressured clinics to accept low paying contracts while also increasing your administrative burden.

Learn just how much the fee schedule has changed since 2014 by downloading the Excel workbook 2019 Calculator...for your locality.

Members just need to log in at www.iptca.org, choose MEMBERS > MEMBER ONLY > CALCULATORS to download the Excel calculator for their locality to be able to run their own examples. There are also two short videos on how to get the most out of the workbook.

Anthem - AIM March 25, 2019 or Not?

Wed, 13 Mar 2019 23:31:08 GMT

Anthem is supposed to implement the pre-authorization requirement with AIM on 3/25/2019 but Anthem reps appear to be unaware of it based on feedback we've received from some PT clinics. AIM reps are a bit confused also, and one said it starts April 1, 2019 (or is that an April Fool?).

See the attached document from Anthem. Anthem Prior Auth begins March-25-2019.pdf

Summary of iPT vs One Call Settlement

Thu, 30 Aug 2018 03:50:48 GMT

Summary-Notice-1 provides a summary of the settlement from the One Call suit.

iPTCA Details Compliance Dispute Process of Align Networks Settlement

Paul Gaspar — Sat, 17 Feb 2018 22:18:24 GMT

On December 22, 2017, iPTCA won a federal lawsuit settlement with Align Networks. Both sides were confident that the business practices Align pledged to change would be beneficial to PTs and their patients.

For the full compliance dispute process agreement, click HERE

Since then, iPTCA has received dozens of communications regarding the process of compliance with the settlement and potential complaints, moving forward.

In short, a top level executive at One Call has been appointed to handle the complaints individually. If the complaint cannot be resolved, a PT may contact the Compliance Dispute Officer chosen by iPT during the settlement process. PTs may do this independently OR by contacting Chuck Felder, Executive Director, iPTCA for assistance (cfelder@hcsconsulting.com).

In accordance with the settlement terms, One Call must pay for the costs of the compliance officer for all compliance disputes made in good faith.

Headline Story - iPTCA and One Call/Align Networks Settle Federal Lawsuit!

Fri, 22 Dec 2017 13:33:42 GMT

Headline Story

iPTCA and One Call/Align Networks Settle Federal Lawsuit!

On December 22, 2017, The Independent Physical Therapists of California (iPTCA) announced it reached a resolution of the lawsuit brought in April 2017 by the iPTCA regarding One Call’s business procedures.

Per the terms of the settlement agreement, One Call will make various changes to certain of its business practices in California, which iPTCA believes will result in improved service to the state’s injured workers and physical therapists. These changes include:

Modifications to One Call’s patient referral and authorization process;
Increased transparency of how One Call ranks and scores the quality of physical therapists;
An enhanced electronic billing and payment system for physical therapists.

For a summary of these practice changes, please click here for the Summary-Notice-1.pdf

We are pleased with the resolution of this case and the improvements it promises for injured workers, PTs, and employers.

We will be setting up an iPTCA meeting after the first of the year to discuss this settlement. Thanks for all your support! Here's to your excellence and patient advocacy!

Merry Christmas!

Paul D. Gaspar, DPT, President, iPTCA
Chuck Felder, DPT, Treasurer, iPTCA
Simon Gibson, PT, Director, iPTCA
Sandy Sheklow, PT, Director, iPTCA