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Introduction to Collegiate Revenue and Reimbursement

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Introduction to Collegiate Revenue and Reimbursement

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    1. Introduction to Collegiate Revenue and Reimbursement Don’t Consider that the Glass is Half Full or Half Empty, Sometimes there has to be another Glass

    2. Are you billing for services provided in the Athletic Training Room? No =118 (68%) No, But Considering It = 35 (20%) Division I-A Division I-AA/AAA Division II Division III NAIA Yes = 21 (12%) Division I-A Division I-AA/AAA Division II Division III NAIA

    3. If Not then Why Not Philosophy = 45 (38%) Administrative Support = 13 (11%) No Need = 2 (2%) Clerical Support / Additional Paperwork 11 (9%) Understanding = 18 (15%) Student Athlete Insurance = 1 (1%) Revenue Distribution = 2 (2%) Licensure = 17 (14%) Other = 9 (8%)

    4. If Not But Considering – Biggest Obstacle Athletic Training Staff = 3 Self = 4 Team Physician = 3 Athletic Department Administration = 7 University Administration = 10 Legal = 1

    5. If Not But Considering – Biggest Supporter Athletic Training Staff = 22 Self = 7 University Administration = 1 Athletic Department Administration = 2 Team Physician = 3

    6. If Not But Considering Provider ATC = 26 PT = 2 Physician = 6 Expectations Regarding Revenue = $60,735

    7. Those that are Billing for Services Years = 4.75 (Two Weeks – 17 Years) Services Braces Physical Medicine Physician Visits Average Revenue = $98,000 ($165,000) Range in Revenue = $7,500 - $375,000 Provider (Reimbursement Model) ATC = 4 PT= 4 Physician = 9 Not Disclosed = 4

    8. Types of Business Models Outpatient ATC Internal & External Non-Athlete Outpatient PT Internal & External Non-Athlete Physician Extender Internal & External Facility Rental Ancillary Services

    9. Questions to Consider What are your biggest questions?

    10. Philosophically should we bill student-athletes for services we have traditionally provided for free? Service Driven vs. Profit Driven

    11. What percent of your student-athletes have a primary insurance? 25% 50% 75% 90% 100%

    12. What services are we going to bill? Every treatment session? Post-surgical cases? Time Loss? Every time the athlete walks through the door? Casting Aquatic Therapy Braces / Orthotics Wound Care Physician Services Others?

    13. What is our patient population? Student Athletes Athletic Department Staff University Personnel Student Body General Public Staff or Facility Driven

    14. Will billing for services impact our secondary / excess insurance? Yes, and it actually could decrease your secondary premium. Yes, depending on how co-pays and deductibles are handled. Yes, percentage of student athletes without insurance.

    15. How are we going to address co-pays, deductibles and remaining balances? Student-Athlete Pay? If not then who? Can we “Write Off” co-pays? Account for it someway!

    16. How much can we expect to generate?

    17. How much are we going to spend to start the process? Clerical Software Fees Personnel Physical Therapist Physician Additional Athletic Trainers Other?

    18. Who is going to do the billing and collection? Current Athletic Training Staff New Athletic Training Staff Clerical / Insurance Coordinator Billing Service

    19. When doest the billing process stop? Return to Play Return to Function Insurance Dependent

    20. Are we going to be included on an insurance companies list of providers? Do you want to be included? Do we have to be included?

    21. Do we need to be “Approved Providers”? In All Cases? Advantages vs. Disadvantages What do other do?

    22. Who is the Provider? Athletic Trainer Physical Therapist Physician Advantages and Disadvantages

    23. Where does the money go? Formally Informally Revenue Distribution Service Driven vs. Profit Driven

    24. If we begin billing for services are we going to be a covered entity under HIPAA? Thoughts? Stay Tuned?

    25. How long will it take to become an “Approved Provider” Two Months Three Months Six Months Never What determines if we get approved? Can we shorten / find a loop hole in the process?

    26. Who decides about implementing this process? University President Board of Regents Athletic Director Dean of Student Affairs Head Athletic Trainer Team Physician Health Services Director Legal Counsel Dean of Medical School

    27. Where is this program “Housed” Internal Athletic Department Health Services Physical Therapy Department Medical School External Physician Group Private Group Advantages and Disadvantages

    28. Are we at more “Risk” if we are billing for services?

    29. Do we have to document better now that we are billing for services?

    30. What is a realistic timeline? Provider Networks Administration Understanding

    31. More Questions?

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