Reimbursement

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Third-party reimbursement. The process by which medical vendors receive reimbursement from insurance companies for services they provided to policyholders.The primary mechanism of paying for medical services in the United States.. Importance of Reimbursement for Athletic Trainers. Legitimate accep

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Reimbursement

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1. Reimbursement Kayla Clabaugh

2. Third-party reimbursement The process by which medical vendors receive reimbursement from insurance companies for services they provided to policyholders. The primary mechanism of paying for medical services in the United States.

3. Importance of Reimbursement for Athletic Trainers Legitimate acceptance as a health-care provider In clinical settings, the income generated from provided services is used to pay the salary and benefits of the ATC. In college/high school setting, reimbursement may be necessary to generate income to continue to provide the appropriate level of care.

4. Things to consider Have a plan!!! Build a business model Licenses and Regulations State specific Determining Costs and Setting Budget Education and Training Documentation Pricing How much should you charge? Revenue Potential

5. What can influence revenue potential? Your state Your setting How “ATC friendly” insurance laws and regulations are Type of personal insurance Size of staff # of treatments you give # of procedures you can bill for Rule of thumb estimate: Each ATC could receive $25,000 per year or approximately $475 per athlete.

6. Recommended/Required Tools Computer software Track patients Maintain clinical records A billing system/staff/service A policy and procedures manual HIPAA/FERPA compliance manual The NATA reimbursement manuals Code Manuals HCPCS- healthcare common procedure coding system CPT- current procedural terminology ICD- international classification of diseases Training Documenting files Submitting claims Working with reimbursement/insurance companies

7. What about athletic training students? ATS must be under direct supervision while performing any billable treatment ATS must sign “athletic training student” on all treatment notes, which then must be co-signed by ATC.

8. Medicare Access to Physical Medicine and Rehabilitation Services Improvement Act (H.R. 1864) Improve patient access to quality healthcare, and assurance that the physicians’ practices will receive payment for covered services. Allow physicians to decide which certified healthcare professionals will give proper, cost-effective services. Reduce expenses to Medicare by providing cost-effective services.

9. So what does this have to do with us? Athletic trainers represent the greatest opportunity for cost savings to Medicare. Athletic trainers have demonstrated the ability to accelerate rehab and quickly return patients to activity. “Athletic trainers offer unique skills that allow patients to benefit from their ability to safely accelerate rehabilitation and provide outgoing care under the physician’s supervision.” -Marjorie Albohm, MS, ATC, NATA board member

10. In a high school setting Services: Strength and conditioning programs Injury rehabilitation services Counseling Emergency medical aid Evaluations Referrals **not all services provided will be reimbursable**

11. In a high school setting (cont.) Create a contract Inform parents Who will pay? Primary insurance policy of parent or guardian

12. In a college setting Services: Strength and conditioning programs Injury rehabilitation services Counseling Emergency medical aid Evaluations Referrals **not all services provided will be reimbursable**

13. In a college setting (cont.) Create a contract Inform athletes and parents Who pays? The patient’s primary and secondary managed care company or insurance carrier

14. Here is one example http://www.moata.net/reimburse.doc

15. Lock Haven University Susquehanna Health Sports Medicine Center Haven’t had much luck “on hold” Next Step: Dean

16. References Rankin, J., Ingersoll, C. (2006). Athletic Training Management: Concepts and Applications. McGraw-Hill. New York, NY. Ray, R. (2005). Management Strategies in Athletic Training. Human Kinetics. Champaign, IL. www.nata.org www.oata.org www.moata.net

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