Description

Decoding Insurance and Payment in New York State: What Every Outpatient PT Needs to Know

Navigating the payment landscape can be one of the biggest challenges faced by outpatient PT providers within New York State (NYS). Unfortunately, inconsistent knowledge of payment policies can lead to underpayment, denials, and administrative frustration. This webinar provides a practical overview of how payment works for physical therapy services in NYS. We’ll break down the key payer types (commercial insurance, Workers’ Compensation, No-fault, Medicare and Medicaid), explain who regulates them, and clarify important factors to consider when submitting claims to each. By aligning our understanding of payment systems, we can improve clinical efficiency, advocacy, and financial sustainability across the profession.

The course recording and corresponding course evaluation will be included in your event confirmation email.

Course Learning Objectives

Following this presentation / session, participants will be able to:

• Define terms related to insurance policy and payment
• Identify major payor types as well as oversight agencies or regulatory bodies that oversee them
• Describe appropriate avenues of support for individual payer types
• Explain how to find information related to visit limits, utilization management, fee schedules, and coverage rules across different payers
• Explain the role of third-party administrators
• Describe different common payment methodologies (Per diem, FFS, daily cap)

Continuing Education Credit

PT/PTA CEH's: 1.2

CEH's will be earned following the viewing of the presentation and subsequent submission of an evaluation form.

Speaker Details

Marcia Spoto, PT, DC

Professor Emerita, Nazareth University

STAR Physical Therapy – Founder and Owner, 40 years

Consultant: Spine Care Partners, LLC

Chair: APTA New York Public Policy Committee

Marcia in dually licensed as a Physical Therapist and Chiropractor. She has a background as a clinician and owner of a private practice of Physical Therapy in the Rochester, NY region. She is Professor Emerita of Physical Therapy at Nazareth University in Rochester, NY. She served as an adjunct faculty member at the University of Pittsburgh in the Primary Spine Practitioner (PSP) program. She is the chair of the APTA New York public policy committee. She also currently chairs the APTA Orthopaedics payment and value workgroup, and is a member of the recently formed APTA & Section Partnership Payment Consortium. She currently serves as a consultant for Spine Care Partners, LLC.

Jacob I. McPherson, PT, DPT, PhD

Board Certified Clinical Specialist in Neurologic Physical Therapy

Clinical Assistant Professor

University at Buffalo, Department of Rehabilitation Science

Jacob McPherson has been a practicing physical therapist since 2011. He has served multiple terms as a member of APTA NY’s board of directors and as chairperson of their Public Policy Committee. He is a current private practice owner and is active in payment and policy advocacy in New York State and nationally. He earned his PhD from the University at Buffalo where he now serves as a clinical assistant professor. He earned his board certification in neurologic physical therapy in 2014 and remains active in clinical practice.