American Therapy Administrators’ (ATA) comprehensive therapy benefit management offers many competitive advantages to our clients. We combine an innovative business model designed to reduce benefit costs with scalable, streamlined network management and our extensive industry expertise. Cost containment, regulatory compliance, and potential fraud detection are all part of our program. As a result, our clients benefit from a lower cost solution that features a robust network and requires very little staff time and effort.
Our model aligns provider and patient expectations with our clients’ program, so they’re no longer placed in the adversarial role of restricting benefits for physical therapy (PT), speech therapy (ST), occupational therapy (OT) or chiropractic care. ATA is known for delivering a “quiet” program that produces fewer patient complaints, long-term network stability, and documented quality improvements through innovative quality programs.
ATA achieves cost containment for clients by significantly reducing the overutilization currently pervasive with traditional reimbursement models for therapy. Our unique approach puts decisions on level of care needed for a patient in the hands of the provider while at the same time controlling the cost of care. This approach minimizes the number of adverse medical decisions. With less need to perform utilization management, pre-certification or appeals, the healthplan medical management team's time and effort is freed for other organizational priorities.
We have found underutilization rarely becomes a challenge. Rather, our model places therapy benefit management in a framework that assures quality outcomes and high levels of satisfaction in patients and referring physicians.
Fraud, Waste & Abuse Detection
With ATA’s per-episode model, the potential for waste and abuse of therapy benefits is greatly reduced. However, when suspected fraud does occur, ATA has innovative claims processing tools that flag these potential issues for review.
In addition, we encourage everyone involved with healthcare – payers, providers, patients and our clients – to report matters they suspect may involve fraud or abuse to our Fraud and Abuse Department. All information reported is kept strictly confidential.
We are regarded by industry experts as the “safe choice” when it comes to compliance with new regulatory and client business requirements. Our 17 year track record shows we have consistently completed new regulatory requirements well in advance of their effective dates.
ATA’s compliance team is extremely familiar with individual state regulations related to therapy benefit management, and monitors this information regularly. In addition, we are contracted with a legal and compliance law firm that assists us with ensuring that we have up-to-date knowledge and are in compliance with state laws.