Third Party Reimbursement Initiative Matching Grant Program

Background & Intent

In 2014, the National Athletic Trainers’ Association Third Party Reimbursement Pilot Project launched a joint initiative between the NATA and three individual state athletic training associations (Indiana, Ohio and Wisconsin). Aimed at driving consistent recognition of athletic trainers as qualified health care professionals from insurers / third party payors and employers within these states, the project utilized matching funds from the NATA and participating state associations to professionalize advocacy at the state level.

As a result, major advancements achieved during the pilot from October 2014 – September 2017 included:

  • 1,657 more athletic trainers in IN, OH, and WI now have NPI Numbers.
  • 69 more athletic trainers are billing autonomously using Athletic Training Evaluation and Re-Evaluation CPT Codes along with associated Physical Medicine and Rehabilitation Codes in the pilot states.
  • 22 more employers are using athletic trainers as billable providers.
  • 143 more total payors are reimbursing for autonomously delivered Physical Medicine and Rehabilitation services delivered by athletic trainers.

While gains were made by the specific states participating in the pilot, the long term vision of the project has been to utilize the lessons learned within these states to drive forward similar success across the country.  Key findings that supported the creation of NATA Third Party Reimbursement Initiative Matching Grant Program included:

  • Alignment of leadership, membership, advocacy team members, governmental affairs and legal representatives is critical for progress within a state.
  • Governmental affairs and state practice act language can serve as either a catalyst or barrier to effective progress.
  • Once individual state alignment is achieved, coordinated national efforts remain essential to aid in generating success with key regional and national payors.
  • Ongoing professional advocacy efforts will remain necessary to keep up with the continually changing world of health care reimbursement.
  • Financial resources needed to fund professional advocacy and educational efforts specific to reimbursement by state associations are challenging to secure. Financial assistance from the NATA would be a catalyst to secure accountable professional advocacy resources and drive growth of progress for respective state and national efforts.

With the progress generated by the NATA Third Party Reimbursement Pilot project and the key learnings identified, the Third Party Reimbursement Initiative (TPRI) has evolved out of the pilot project as a means to continue to drive forward this effort nationally. The intent of TPRI is to continue to support state level advocacy for athletic trainers with payors and employers, while building and maintaining coordinated efforts nationally.

To support this initiative, NATA is pleased to offer the TPRI Matching Grant Program intended to assist professional advocacy and/or advancing knowledge and education relative to third-party reimbursement at the state level. In turn, states that choose to participate will be expected to share key learnings and data as part of a larger network that will drive progress nationally.

 

Grant Program 

States seeking to professionalize advocacy and/or advance education and knowledge relative to third- party reimbursement may apply for a grant as part of the TPRI. To encourage accountability from both the national and state level, and to share the financial burden, funding is required from both NATA and the state associations that choose to participate. Funding will be provided through a matching grant system in which, if awarded, NATA will match state association funds up to $10,000 per year for efforts dedicated to advancing third party reimbursement within the state. Grants will be awarded on an annual basis with the continuation of grant funding to be determined annually based on the state’s progress toward established goals related to third party reimbursement.

 

Approved use of grant funds within a state include:

  • Reimbursement for the time of an individual dedicated to leading third-party reimbursement advocacy efforts within the state.
  • Support of legal fees necessary to secure efforts and opinions related to advancing third-party reimbursement efforts within the state. This includes efforts related to updating language in a state’s practice act when applicable.
  • Networking and relationship building efforts with third-party payors, employers, entities that secure prior authorization for payment, or other key stakeholders influencing third-party reimbursement efforts within the state.
  • Tools utilized for data collection, marketing and communication with state and national membership.
  • Development of educational content aimed at sharing key learnings with membership within the state and nationally.

 

Expectations of States Receiving Grant Funding

States receiving grant funding will be responsible for:

  • Collaborating with district and national TPRI team representatives to identify capable individuals or teams responsible for professionally leading TPRI efforts within the state.
  • Ensuring that identified state TPRI leaders are held accountable to maintaining effective communication with overall state association leadership.
  • Assisting identified state TPRI leaders in developing relationships with key external stakeholders including state lobbyists and payor representatives.
  • Maintaining accurate records and reporting throughout the initiative relative to what specific payors are reimbursing and denying claims from athletic trainers within the state, which employers within the state are utilizing athletic trainers to successfully gain reimbursement and how many athletic trainers in the state are functioning in this capacity. This will need to be reported as part of the grant renewal process.
  • Partnering with national and district TPRI leadership to develop and maintain a budget specific to third-party reimbursement efforts. This includes ensuring compliance with reimbursement policies set forth by the NATA and TPRI leadership for the utilization of grant related funds.
  • Completion of an annual report summarizing overall TPRI effort and progress within the respective state.

 

Grant recipients will be expected to serve as collaborative partners with national and regional representatives involved in the TPRI to align efforts and share key learnings. This collaborative effort will include:

  • Regular conference call attendance by identified state TPRI leaders with district and national TPRI team members
  • Timely submission of an annual report outlining objective progress made and overall activity within the state directed toward advancing established TPRI goals.
  • Regular attendance of TPRI state leaders at state, district and national meetings to update association leadership and membership.

 

Application Process

In the initial year, applications for the matching grant will be accepted through April 15, 2018. Applications must be completed in their entirety and signed by the state association president to be considered. Completed applications are to be submitted to gov@nata.org.

A key component of the application process is the inclusion of a current baseline assessment of the state’s status relative to third-party reimbursement efforts. This includes objective documentation of the following metrics:

 

  1. The number of payors that reimburse for Physical Medicine and Rehabilitation Codes delivered autonomously by athletic trainers.

    This is defined as the number of payors that reimburse for athletic trainers that bill for Evaluation and Re-Evaluation CPT Codes (97169 – 97172) and the subsequent associated Physical Medicine and Rehabilitation codes. Revenue Code 951 should be used if needed.

    • Commercial
    • Government
    • Workers Compensation

    *Specific payors that have provided and denied reimbursement must also be identified.
     

  2. The number of employers within the state that are utilizing athletic trainers as billable providers.

    This is defined as the overall number of employers across a state that use athletic trainers to bill for Evaluation and Re-Evaluation CPT Codes (97169 – 97172) and the subsequent associated Physical Medicine and Rehabilitation Codes. Revenue Code 951 should be used if needed.
     

  3. The number of athletic trainers that are working in a capacity where they bill and receive reimbursement for athletic training services.

    This is defined as the overall number of athletic trainers that bill for Evaluation and Re-Evaluation CPT Codes (97169 – 97172) and the subsequent associated Physical Medicine and Rehabilitation codes. Revenue Code 951 should be used if needed.

    Additional requirements as part of the application include demographic information relative to the number of athletic trainers actively practicing within the state, state practice act information, and a review of efforts relative to third-party reimbursement to date.

    Please see the application for additional information and requirements. For more information on the application process, please contact Kyle Scharer at krscharer@gmail.com or (419) 356-6849.

 

Award Notification and Funds Disbursement

Notification of grant award or denial will occur within 30 days of the receipt of a completed application by the TPRI team. Matching grants are awarded in lump sum after approval and after submission of required documentation. Please allow two weeks for processing. Checks are mailed to the individual and address indicated on the applications unless another individual / address is formally identified by the state following selection of individuals / teams who will lead the TPRI efforts for the state. All receipts with documentation must be provided by June 1 of the given year to allow for processing by close of the fiscal year. A sample documentation form is provided with the application.  Documentation should be submitted to gov@nata.org.

 

Grant Application

  1. Download and complete the Third Party Reimbursement Initiative Matching Grant application (pdf).
  2. Send completed application to gov@nata.org by April 15 deadline.