As long as your state practice act does not restrict billing or reimbursement for services rendered, then it is legal to bill. (so long as you follow state practice acts, scope of practice and appropriate coding guidelines.) Therefore, it is critical that ATs only bill for services which are MEDICALLY NECESSARY to et an individual back to ACTIVITIES OF DAILY LIFE (ADLs).
The process for getting credentialed and contracted with a payor is slightly dependent on your setting and employer. For detailed instructions on your setting specifically visit the NATA website's "billing and reimbursement" page. There you will find several pdf guidelines on how to get started and who to contact. For this blog I'm going to focus on giving you a more general idea of steps that everyone would need to take, regardless of setting.
The first step is making sure your employer is informed and approves of you billing for services. You'll need their support and approval to have a chance at implementing billing for services. If your employer is not on board, figure out why and consider what education or information they would need to change their mind. This could be by educating them on athletic trainers value as allied health care professionals, though hopefully they understand this already as your employer. It is more likely that they don't understand the benefits billing provides, so they may be hesitant to go through the process of setting it up. This obstacle can get overcome through return on investment reports and may take some time (usually ROIs are based off of at least 6-12 months of data).
Next, register for a National Provider Identifier (NPI) number. An NPI number is a unique 10-digit identification number issued to health care providers in the US by the Centers for Medicare and Medicaid Services. It helps to add credibility to the individual and the profession. N fact, the primary goal of encouraging athletic trainers to obtain their own NPI numbers is to help the NATA with their reimbursement efforts. It helps to show the large number of actively working Athletic trainers and further emphasizes our value as health care professionals.
When you are set up to bill, it is vital that only essential services are being billed for, documentation is exceptional and the appropriate referrals, ICD-10 and CPT codes are being utilized. Not only does this help in the fight to prove athletic trainers are competent health care providers, but it also helps the process for benefits to be approved by the payor. When you bill an Explanation of Benefits (EOB) will be sent to you that either pays the claim or denies payment, and if denied provides an explanation as to why. If the explanation is due to a lack of recognition of an AT as a qualified health care provider, don't just accept it!! There is a process in place for this instance in order to appeal to the insurer's decision. (visit the NATA's Website for detailed instructions.)
Still need help convincing stakeholders or implementing billing? Try helping out at the state or district level! The NATA created the TPRI Matching Grant Program in order to support the third-party reimbursement initiative nationally. The purpose of this grant is to encourage financial and resource investment that is shared by States, Districts and the NATA, while creating a standardized and coordinated approach to third party reimbursement. The NATA matches up to 50% of state or district association expenses, up to a maximum of $25,000 for districts and $10,000 for states, annually.
Some examples of what these funds can be used for are:
Legal fee support related to efforts to advance third party reimbursement
Tools utilized for data collection, marketing and communication with state/district/national membership
Development of educational content
Reimbursement for the time of an individual to leading TPR advocacy efforts
There are many ways that you can help the efforts to implement third party reimbursement and billing for athletic training services. Whether you want to help at an individual level, by getting an NPI number or billing at your clinical site, or at the state/district level by joining advocacy efforts, the main way to help is to get involved at all.
Resources:
Comentários