When it comes to the billing and reimbursement for sports trainers under primary care, you need to learn about several things. For this, we have mentioned basic aspects of this billing process so you can make the right decision. So, spare a few minutes and read on to know about the billing and reimbursement process.
Sports trainers play a vital role in clinics, hospitals, and physician offices. As the demand for physician extenders is increasing, trainers help physicians to improve their efficiency and productivity. These trainers play an important role in any medical setting to deliver the highest medical services to the patients. A sports trainer can understand the patient and help them recover safely and quickly.
Research shows that athletic trainers operating in a health care facility as physician extenders can increase 12 patients each day. The sports trainer plays an important role in the primary care setting by reducing the recovery period of non-surgical injuries, lowering re-injury rates through guiding patients, and rehabilitating muscle injuries. Because of these benefits, trainers are considered valuable assets in any primary care. For this reason, many health facilities are hiring sports trainers to facilitate their patients more than before.
However, hiring trainers in your organization means that you need to consider the billing services of sports trainers. The reimbursement and billing method of athletic trainers greatly differs from the standard medical billing services. It has different codes and policies that you need to follow.
When it comes to the billing for sports trainers, you need to understand several aspects of billing in order to use the right coding and method. Here are a few things that you need to learn about billing and reimbursement for sports trainers. Also, you will learn how athletic trainers can increase the revenues of an organization.
Athletic Training as Revenue
In most health care organizations, sports trainers’ services help improve the efficiency, quality, and financial success of the facility. As trainers have to spend hours outside of the primary care to reach schools, sports facilities, and other organizations, they can become the best marketing source or referral for the employer.
It is important to note that sports training is not only a profession, but it is also a business. Several health care organizations allocate budgets for this position as they do with others.
Billing Insurance for Athletic Training
Health organizations can generate revenue by billing third-party vendors and insurers for trainer’s services. However, it greatly depends on the state where you are practicing medicine. If you want a clear idea of whether you have this option, you will need to visit the National Athletic Trainers’ Association. You can learn about every important thing regarding billing insurance.
After that, make sure to verify your state’s regulatory board’s practice act to understand how it defines an athletic trainer and what type of facilities and services you can provide to patients.
Building a Referral Network
Since you already have many patients, you can use them to develop a patient network for your sports trainers. Referring your patients to trainers will help patients build more trust in your services. They will be likely to visit a trainer that they get to know from their physician or doctor. Apart from this, many times, when physicians are not able to provide certain services to their patients, they can refer them to sports trainers.
However, it is also important to understand that a trainer should have the capacity to convince a referral that they are the best option for them. The more credible and skilled your trainers will be, the more revenue your organization can generate from them.
Billing for Reimbursement
When it comes to billing services, it is the most challenging task after hiring a trainer. Learning how to code and bill for services is a job in itself. You need to use the codes based on your trainer’s services. Knowing about the appropriate codes is key to reimbursement with less risk of getting your claims denied.
Not to mention, you need a separate staff who knows all about the sport trainer coding. You also need to hire professionals who can track changes in the policies and laws of billing and reimbursements for sports trainers. This is when you need help from billing experts, like Lokesh James Medical Billing Expert, who know which code is right for certain services and how to use them. With the help of professionals, there is no chance of rejected claims and less reimbursement. So, if you don’t have a team, then it’s better to outsource this job.
For billing and reimbursement of sports training services, you need to consider the following things. These are some processes and methods that you need to go through while claiming reimbursement.
Billing with CPT Codes
You need to use CPT coding system for the reimbursement of sports trainer’s services. The CPT coding system dictates surgical, medical, and diagnostic services used by physicians and other health providers. Plus, it helps to increase efficiency and accuracy and streamline reporting of the billing services.
For athletic training evaluation, you have four CPT codes: 97172, 97171, 97170, and 97169. These codes define the complexity of the services that trainers give to patients. Additionally, the level of the sports training services performed depends on the severity of the patient’s health problems and clinical decision-making. Before giving services to the patients, the trainer also needs to consult, coordinate, and collaborate with physicians and other health care providers.
Reorganization and Acceptance of ATs
Another thing you need to do is to check your state COPA Chair to verify whether the insurance providers in your state recognize Athletic training. Also, check if they provide regular reimbursement services for trainers. Moreover, if your state AT Practice Act doesn’t prevent sports trainers from receiving reimbursement or billing for services, then you can legally bill by following your state laws.
You also need to know that the employer should be informed and approve trainer billing for services. Once you use the right codes and laws, and fill all the required forms, the insurer has to respond. The insurer will give an Explanation of Benefits (EOB) that either denies payment or pays the claim. In addition, the EOB will define why your payments get denied.
You also need to know that if the insurer denies it because they don’t recognize sports trainers as a qualified health care professional, then you can use a different approach. The employer will need to opt for the process to officially appeal for the insurer’s decision. At this point, they can educate insurance organizations about the athletic trainer’s licensure, skill, education, etc. The trainer also needs to demonstrate their value and worth.
Third-Party Reimbursement and Billing Activities
You need to check whether third-party reimbursement and billing activities are available in your state. In this case, you need to do the following things:
- Contact your state COPA or Committee on Practice Advancement chair
- Contact your state association president
- Check your state association website
Coverage to Athletic Trainer
The athletic trainers also need coverage under a professional liability insurance policy. You need to provide insurance coverage to your trainer. This will help you in the billing services of the sports trainers. The insurance should also cover the services that the trainer provides to the patients.
This is important to deal with several problems in the bill, and it is also vital to build patients’ trust in your trainer.
The process of billing and reimbursement of sports trainers is complex. If you have a separate team that works for the billing services, only then can you manage this task. However, if you don’t have one, it’s better to take help from experts so that you get the payment for your services. In this case, you can take help from billing professionals, like Lokesh James Medical Billing Expert, who can help you in the reimbursement process. We know all the coding and policies that are necessary for the billing services. So, you can leave this challenging task on us and continue giving your medical services to patients.