Frequently Asked Questions on Revenue
Refer to your state practice act for limitations and specifics.
Refer to your state practice act for limitations and specifics.
Q1. Do certified Athletic Trainers have provider numbers?
A. Yes, Athletic Trainers will use the National Provider Identifier issued by the government. In order to apply for an NPI visit https://NPPES.cms.hhs.gov . There is no cost, and you may need one to practice in this setting.
Q2. What efforts are being made to obtain Medicare recognition and provider numbers for Athletic Trainers?
A. NATA and the Council on Revenue are working diligently to accomplish this. Currently Medicare states that for Athletic Trainers to receive recognition and payment from Medicare a change in the statutes would need to take place. A change in the statutes can only be accomplished through Congressional action. NATA hired a full time Washington D.C. lobbyist in June of 2004. The NATA team’s primary goal is to gain Medicare recognition of athletic trainers as “covered providers.”
Q3. Which commercial insurance companies currently reimburse Athletic Trainers?
A. This varies from state to state and company to company. A company may reimburse in one state and not in another because of state laws/regulations or practice patterns. It may also vary from setting to setting. You should check with your state association or directly with the insurance company for information.
Q4. Whose provider number can be used for billing?
A. See previous question/answer 1. Additionally in some instances an ATC may be able to bill under the physicians number when working as a physician extender. “Incident to” is the term used for this type of billing. Athletic trainers may also bill under a facility’s number.
Q5. Are Athletic Trainers able to bill under the physical therapy evaluation/re-evaluation codes, codes 97001 and 97002?
A. No. Athletic Trainers have been issued their own evaluation/re-evaluation codes by the AMA. Athletic Training evaluation and re-evaluation codes should be used. Athletic training evaluation code is 97005 and the re-evaluation code is 97006.
Q6. Can reimbursement language be written into state athletic training legislation?
A. Yes, the Georgia legislature in 1999 passed athletic training legislation that includes a reimbursement mandate. Other states have passed legislation against practice discrimination. Check with your state committee on revenue or your state government affairs committee representative for the most up to date information regarding your state’s legislation. (The NATA web site has a link to a directory of District and State Representatives for Revenue)
Q7. What CPT codes can Athletic Trainers use to bill third party payers?
A. Athletic Trainers would normally bill using the physical medicine and rehabilitation codes, series 97000, found in the CPT manual. There is a list of frequently used codes by athletic trainers on the Reimbursement Toolsvenue Resources page on the website.
Q8. How are Athletic Trainers different from other allied health care professionals? Why are they unique?
A. Athletic Trainers are experienced physical medicine and rehabilitation health care providers. An athletic trainer’s approaches to treatment and rehabilitation ensure their rapid and safe return to pre-injury level of function; these are a generally higher level than basic activities of daily living (ADLs). Athletic Trainers are also known for their skills in injury prevention. This expertise has a tremendous positive value and may reduce expenditures of health care dollars.
Q9. What type of education is required to become an athletic trainer?
A. Students of athletic training study a wide range of topics including human anatomy, exercise physiology, biomechanics, emergency care, injury/illness prevention, nutrition, psychology, pathology, pharmacology and administration. To obtain certification by the Board of Certification Inc., athletic trainers must pass a national exam after graduation from a bachelor’s or master’s program in athletic training. To maintain the ATC certification athletic trainers must complete 75 continuing education units every three years.
Q10. Are Athletic Trainers regulated in this state?
A. Probably, most states have either a licensure law or a practice act statute in force. You may wish to check your state’s web site or visit http://members.nata.org/gov/state/regulatory-boards/map.cfm. .Currently 47 states have either licensure laws or regulations in place for athletic trainers.
Q11. How much are we able to charge or bill for Athletic Training codes?
A. There are no national fee schedules set for the billing codes Athletic Trainers would use. We suggest you use either UCR (usual customary and reasonable) fee rates based on what physical therapists are charging for their services using similar codes. Currently RBRVS (Resource Based Relative Value Scale, developed and maintained by CMS/Medicare) sets the rates that most insurance/managed care organizations and other payers work from. However RBRVS does not set any rates for our evaluation/re-evaluation codes because Medicare does not reimburse for those codes. You can check RBRVS rates for similar Physical Therapy codes on line and use those figures as a starting point. A link to RBRVS and other Medicare provider fee information can be found at http://www.cms.hhs.gov/apps/pfslookup/step1.asp
Q12. If I bill am I guaranteed payment?
A. No, billing for services even with preauthorization does not guarantee payment.
Q13. How do I know which claim form is required?
A. Ask the carrier you are seeking reimbursement from. Most third party payers will accept and use the CMS 1500 claim form, available on the web and through distribution centers.
Q14. Do I need a prescription to bill for services?
A. In some cases you may, it really depends on your states licensure/practice act and who and how patients are to be referred to you and the insurance carrier.
Q15. What recourse do I have if the third party payer refuses to pay for my services?
A. You have a number of means and ways to try and overrule a denied claim for payment. Most importantly find out specifically why they are denying payment. In some cases the carrier does not recognize that athletic trainers are allied health care professionals. Educating the carrier may rectify that issue. The Reimbursement Manual has a number of techniques you can use to challenge a denial. You can also contact your state or regional Council on Revenue representative for assistance. You also may contact the Patty Ellis at NATA. She is the National Manager for Markets and Revenue. She can be reached via e-mail at firstname.lastname@example.org or by phone at 972-532-8833.
Q16. Can I bill for ATC services?
A. Yes, at this time we do not know of any reason why you should not bill a third party payer except Medicare. Always check your state practice act or licensure law for state specifics and limitations.
Q17. Can I accept cash for ATC services?
A. Yes. If the patient pays in cash they can then submit the bill to their insurance company for reimbursement.
Q18. I work in a Secondary School setting, does reimbursement affect me?
A. Yes, you may have opportunities to be reimbursed for ATC services. For more information see the Secondary School Model at: www.nata.org/revenue-resources/revenue-models What affects one ATC generally affects us all, and many athletic trainers change the setting in which they practice at some point in their professional career.
Q19. I have been told that Athletic Trainers cannot treat patients in a clinical setting. Is this true?
A. Not true in most cases. Refer to the NATA Role Delineation document posted on the NATA web site. Also refer to your state practice and licensure laws.
Q20. I do not wish to pursue reimbursement for my services, do I have to?
A. No, absolutely not.
Q21. Other allied health care professionals are upset that we are seeking reimbursement for services., Why?
A. We believe it is mainly due to unfounded fear. Fear that we will become competitors for jobs in the health care industry and take revenue away from other professionals. It may also be from misinformation and lack of knowledge of the qualifications, skills and abilities of ATs. A lot of our peers in other professions do not know about how the profession has evolved in its training and education.. Others simply may not understand the vital role ATs play in the U.S. health care system. It’s our job to educate them—whether it is insurance companies, physicians, other health care professionals or members of Congress.