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Audio: Winning Strategies for Overturning Denials and Getting Visits Approved (Recorded)
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Presenters: Gwen Simons, Esq, PT, OCS, FAAOMPT and Carmen Elliott, MS

$99 Member | $169 Nonmember
0.2 CEUs (2.0 contact hours/CCUs) will be awarded upon successful completion of a multiple choice test. You must complete the online posttest with at least 70% accuracy in order to claim CEU credit.
Course Level:
Date Recorded:
June 2012
Date Published:
July 2012
Delivery Method:

  Audio Conference

APTA's audio conference recordings bring the experts to you! Earn Continuing Education Units (CEUs) while listening at your own pace to recorded live audio conferences.

Course Completion Requirements


Course Information | Objectives | Presenter Bios | CEU Information | Course Completion Requirements | Technical Requirements
Course Information

Are your patients being wrongfully denied medically necessary treatment when they have not met their benefit limit for PT services? Is your care interrupted or delayed by overly burdensome pre-authorization requirements every few visits? Did you know there are new federal claims processing and appeals rules under the Affordable Care Act that entitle your patient to internal and external appeals when medically necessary services are denied or even partially denied?

Arm yourself with winning strategies to get visits approved and denials overturned by using the new federal rules for health plans on Internal Claims and Appeals and External Review Processes. Join Gwen Simons, Esq, PT, OCS, FAAOMPT, author of Using the Laws to Get Paid, and Carmen Elliott, MS, director of payment and practice management at the American Physical Therapy Association (APTA) for an eye-opening audio conference that will shed light on how you can easily and successfully set up your appeals procedures to overturn denials (even partial denials) get paid! You’ll learn how to hold payers and utilization review entities accountable for processing your pre-authorization and payment requests in accordance with state and federal laws. You’ll also learn how to file complaints against payers who violate the laws that protect you and your patients.

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Upon completion of this audio conference, you will be able to:
  1. Distinguish whether federal laws and/or state laws apply to the health plan so you know which appeals rights apply.

  2. Describe how to find valuable information in the patient’s Summary Plan Description (SPD) and how to use it in your appeals procedures.

  3. Identify specific information to demand from the payer and utilization review entity (and that they are required by law to provide you) to help you prepare your best appeal.

  4. Identify whether the patient should file his/her own appeal, or whether you should appeal as the Provider or as patient’s Authorized Representative.

  5. Summarize how to file complaints against payers with the proper government agency (state insurance department or U.S. Department of Labor) when the payers don’t comply with applicable laws.

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Presenter Bio (s)

Gwen Simons, Esq, PT, OCS, FAAOMPT,is an attorney and physical therapist in Scarborough, Maine. She practices law at Simons & Associates Law, where she represents a large number of private practice PTs, advising providers on everything from practice management and Medicare compliance to business law/reimbursement issues. Simons is a former private practice owner herself and still serves as an expert witness in medical-legal cases. She has recently written an e-book, Using the Laws to Get Paid, which instructs providers on how to use state and federal laws as a strategy to combat unduly burdensome and bad faith claims handling practices. Simons is a past president of the Kentucky and Maine chapters of the American Physical Therapy Association and a member of the Private Practice Section. She teaches a legal issues course for the Evidence in Motion Executive Management Program and a health policy and legislation course in the transitional DPT program at the University of New England.

Carmen Elliott, MS, is the director of payment and practice management at the American Physical Therapy Association where she develops and implements strategies to advocate for payment policies for physical therapists services, provides leadership to the private payment area, and communicates with APTA members about payment and practice management issues, including physical therapy coverage, payment, coding, managed care contracting, and auto liability coverage. Prior to joining APTA, Elliott was a practice administrator for a large physical therapy practice in Southern Maryland, where she oversaw the daily operations for 5 outpatient clinics. She also worked as a network development specialist for a managed care organization, where she oversaw the development of a provider network and contracted with providers. Elliott received her BS from Bowie State University in Maryland and her MS in health care management from Marymount University in Virginia.

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CEU Information

On successful completion of the examination, 0.2 CEUs (2.0 contact hours/CCUs) and a certificate of completion will be awarded. The American Physical Therapy Association has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. Provider (#380).

Many state agencies recognize APTA as a recognized or approved provider for continuing education. The following state agencies have granted prior approval for this continuing education offering:

  • Ohio State Board of Physical Therapy: 14S2230
  • Oklahoma Board of Medical Licensure & Supervision: 2 Category B Hours
  • Texas Physical Therapy Association: 1609016TX
  • Nevada Board of Physical Therapy Examiners: 0.2 Units
  • California Physical Therapy Association: CPTA2014-2015
  • Pennsylvania: Denied

Please note: Licensees should verify with their state licensing board for acceptance of continuing education units by reviewing the relevant state practice act and/or administrative code.

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Course Completion Requirements

After you listen to the live audio conference and review the handouts, you will return to the My Courses page on the Learning Center to take the online posttest and print your CEU certificate. You must complete the online posttest with at least 70% accuracy in order to claim CEU credit.

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Technical Requirements
Computer System Requirements.
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$169.00 $99.00