>>FREQUENTLY
ASKED QUESTIONS FOR AT IN THE CLINICAL SETTING
1.
As an athletic trainer in a clinical setting, is it illegal for
me to bill for athletic training services?
2.
As an athletic trainer in a clinical setting, I know that legally I can
evaluate and
treat “athletic injuries” in the clinic and bill for them.
What/who is considered an “athlete”?
3. Please
clarify how the athletic trainer can function in the Physical Therapy
Clinic.
4. Please clarify the athletic trainer’s ability to document
in a physical therapy chart when working as “other licensed personnel” in
the physical therapy clinic.
5. Can person who is awaiting their Ohio AT license begin to work in
the clinic while they are awaiting approval?
6. I was told that CPT codes are Physical Therapy Codes and therefore
cannot be used. Can you clarify this for me?
7. I have heard a lot about the physician extender model. Can you provide
me with additional information.
8. When hiring athletic trainers to cover outreach contracts,
our patient load in physical therapy does not always allow us to hire
the AT to work
in the clinic. I try to hire the AT for more then just outreach contracts
to help with turn over. What are some other areas that I can utilize
the ATC’s skills to justify their time outside of the school?
9. What information is available for us to give 3rd Party Payors when
approaching them about reimbursement?
10. Our facility currently bills and is being reimbursed for AT services.
How can I help out the profession?
1.
As an athletic trainer in a clinical setting, is it illegal for me
to bill
for athletic training services?
In the State of Ohio, our scope of service does include rehabilitation
and modalities. As long as you are providing and billing for a service
that falls under the domains of athletic training and our laws governing
the practice of athletic training in Ohio, you are not performing
an illegal service.
We
also suggest they get pre-authorization from the payors whenever
possible for AT services.
On
the other hand, you CANNOT bill under Physical Therapy codes for
athletic training services. You must insure that you utilize
the
CPT codes for athletic training evaluation and re-evaluation.
(97799)
The question is not usually the ability of the AT to bill,
but whether the 3rd Party Payor recognizes athletic training
services
and reimburses
for the services.
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2. As an athletic trainer in a clinical setting, I know that
legally I can evaluate and treat “athletic injuries” in the clinic
and bill for them. What/who is considered an “athlete”?
The Ohio Practice Act states that an “athletic injury” means
any injury sustained by an individual that affects the individual’s
participation or performance in sports, games, recreation, exercise
or other activity that requires physical strength, agility, flexibility,
speed, stamina, or range of motion. This definition was effective 6/30/97.
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3. Please clarify how the athletic trainer can function in the
Physical Therapy Clinic.
Athletic Trainers, when functioning under a physical therapist
act as “other licensed personnel”. The specific role
will depend upon the referral and the specific clinic protocol.
If
the prescription calls for PT services, then the AT can only
act as unlicensed personnel per PT laws when helping treat
the patient. If the script calls for AT services, then bill for them
and if a PT helps you with the case, then they are acting as
unlicensed personnel.
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4. Please clarify the athletic trainer’s ability to document
in a physical therapy chart when working as “other licensed personnel” in
the physical therapy clinic.
According to the Ohio AT section of the PT/OT/AT board, clinical
protocol will probably dictate this, with protocol being
more dependent upon
criteria for reimbursement than any other factor.
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5.
Can person who is awaiting their Ohio AT license begin to work in
the
clinic while
they are awaiting approval?
Yes, according to the AT section of the Ohio PT/OT/AT board.
He/she can begin working, but CANNOT be function independently,
or refer
to him/herself as an athletic trainer. He/she is unlicensed
regardless of other credentials such as ATC from NATABOC
or licensure from
another state. That individual cannot refer to himself/herself
as an athletic
trainer, ATC or document this in any way. In the State
of Ohio, there is no grace period from the time an application
is submitted
to the
date an Ohio license is issued.
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6. I was told that CPT codes are Physical Therapy Codes and
therefore cannot be used. Can you clarify this for me?
CPT codes are not physical therapy codes. According to
the American Medical Association, CPT codes can be used
by state
licensed,
state certified or state registered professionals, who
have the described
service in their state determined to be within their scope
of practice. They note that it is up to the individual
state practice
acts to
determine whether a health care provider is qualified to
perform a described
service in any individual state.
In 1996, the AMA’s CPT coding division clarified that
the physical medicine CPT codes are not provider specific,
but may be used by any
provider qualified to provide the service.
In November 1999, the American Hospital Association National
Uniform Billing Committee designated a new category
specifically for athletic
training services.
In July 2000, the AMA’s CPT code editorial panel approved
the addition of athletic training evaluation/re-evaluation
codes.
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7. I have heard a lot about the physician extender model.
Can you provide me with additional information.
Sport medicine is a “team concept” with the AT
playing an important role. Many physicians are choosing to
hire ATC as a part
of their office staff. The ATC provides skills such as triage,
exercise prescription, rehabilitation and patient education.
The ATC returns revenue to the practice. The AT services
in the physician’s
office return a high rate of reimbursement for billed services.
The ATC will need to follow the directive of the physician.
What their responsibilities are may vary, depending
upon training and credentials.
You can gain additional information by visiting the
NATA website at www.NATA.org,
but please remember Ohio AT law when providing
a service
and make sure the service being provided is within
your scope of practice.
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8.
When hiring athletic trainers to cover outreach
contracts,
our patient
load in physical therapy does not always allow us to
hire the AT to work in the clinic. I try to hire the
AT for
more then
just
outreach contracts to help with turn over. What are
some other areas that
I
can utilize the ATC’s skills to justify their
time outside of the school?
Some additional ways facilities/clinics utilize ATC’s
are:
*educational seminars to general public and school
systems
*coverage of community events such as marathons, etc.
*rotate through physician’s offices to aid the physicians in
taking the history, preliminary
assessment and then HEP instruction, casting/bracing, etc. as
well as learn from the
physician
*wellness program supervision following discharge from rehabilitation
*functional training of patients once acute rehabilitation phase
is complete
*sports performance training
***NOTE: if you have any additional ideas, please email them
to Hollie at Hollie_Kozak@HMIS.org
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9. What information is available for us to give 3rd Party Payors
when approaching them about reimbursement?
Before contacting any provider, please check with the chair
of the CIC Committee to see if your prospective payor has already
been contacted and to check their status. Also, make the chair
aware of any insurance contacts you may have personal connections
with to see if they can help us get approval with their company
and/or with others.
The
Ohio CIC Committee is attempting to gather information from Clinical/Industrial
Athletic Trainers around the State
regarding
who is billing, how
they went about getting approval, who is reimbursing and
how much, etc..The
Committee hopes
to use this information to put out packets, or at least have
them on the website for ATC’s to use.
The Committee will also be working on packets for the AT
on how to approach 3rd Party Payors, packets for the 3rd
Party
Payors
and then
packets for
physicians.
The Committee is committed to striving forward regarding
this issue. We want to provide a united, universal approach
to 3rd
Party Payors.
We need
to educate
them and then work with them on reimbursement.
You can currently obtain information from the NATA
website under the “members
only” section. It contains sample letters and FAQ.
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10. Our facility currently bills and is being reimbursed for
AT services. How can I help out the profession?
If you are being reimbursed for AT services and wish to help
the profession grow in this direction, you can contact Hollie
Kozak,
CIC sub-committee
chair at Hollie_Kozak@HMIS.org or call her at 330-480-3010.
The CIC is always looking for individuals to either participate
on the committee. If you prefer not to be an active member
on the committee,
you can still
help by providing us with information.
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