For over 10 years the National Athletic Trainers' Association (NATA) has been on an ambitious mission to incorporate evidence-based medicine (EBM) into both educational and clinical environments in the hope that third-party reimbursement would follow. It is clear that the implementation of EBM has become widespread, evident through the increasing publications and research as well as the increased educational standards. However, we have not made as great of strides into implementing billing and reimbursement as we would like.
Third-party reimbursement is classically defined as reimbursement for services rendered to a person in which an entity other than the receiver of the service is responsible for the payment.
All athletic training state practice acts allow for the athletic trainers to deliver physical medicine and rehabilitation, services which are generally billable through most insurance companies.
The American Hospital Association established Uniform Billing (UB) codes for athletic training in 1999. Athletic trainers also have their own Current Procedural Terminology (CPT) codes in the physical medicine and rehabilitation (PMR) CPT family of codes for evaluation (97005) and re-evaluation (97006). Despite this, there is a very small percentage of Ats who are actually billing successfully and being reimbursed for their services.
Why is this?
Athletic trainers are still in the fight to prove their worth and value as allied health care professionals, and while billing may help to advance that goal, the lack of understanding of the profession also acts as a barrier for reimbursement, creating a somewhat vicious cycle. The CPT code book uses terminology such as "qualified healthcare professional" and "therapist" which some do not automatically associate with athletic trainer, or even try to argue that this terminology excludes athletic trainer, however, his is not the case. In actuality these terms are purposefully generic and not intended to denote any specific practice or specialty field, instead simply defining the professional who is performing the service described by the code.
For example, an athletic trainer, in some states, cannot bill for services such as dry needling, because they wouldn't be "a qualified health care professional" for that service. They are however, more than qualified in providing rehabilitation exercises so in this case they would fit the term "qualified health care professional."
Many athletic trainers are contracted and employed through a specific employer or entity to deliver AT services that are not billed, so the thought of billing and reimbursement potentially affecting their lives is not in the forefront of their minds. Additionally, if you are working in a setting that does not have an established billing system in place, starting the process to bill for services can be lengthy and requires many external stakeholders.
The time and effort to implement billing for services rendered may very well be worth it to help improve the profession. When athletic trainers bill for the right types of services and document them exceptionally, the profession will have much greater success, of securing recognition by payors, who are the main stakeholder in the billing process. This enhanced recognition, not only makes approval for billing smoother, but it can lead to more stable employment and enhanced employment opportunities. Athletic trainers could see improvements in their working conditions, quality of life, and advancement in salary, each of which athletic trainers are ranked among the lowest (relative to peer health care providers).
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