Reimbursement

March 25, 2013

An interesting topic that has come up is that of athletic training third party reimbursement. This is a topic that I am interested in, as well. Should we seek legislation for third party reimbursement?

You might know that a few years ago the NATA was seeking different forms of legislation to be recognized by Medicare. This was to reverse the CMS decision that athletic trainers could not provide rehabilitation services incident-to. While it is important nationally for athletic trainers to be recognized by CMS for Medicare and Medicaid, it is certainly not the easiest path.

What states have found is that they are willing to recognize and reimburse athletic trainers for the important services that they provide to their customers. Other states have passed legislation requiring insurance companies to not discriminate against ATs if they reimburse the services to other providers.

The challenge is in educating the insurance company decision makers, just like we have needed to educate the legislators who have passed our licensure bills. Many of these decision makers do not know about athletic training and some have never heard of athletic trainers. This does not mean that they will not support reimbursement for ATs, just that they need information and a clear case.

So what is the case for AT reimbursement? Athletic trainers have been providing the services that are reimbursed by other providers for decades. Rehabilitation is not owned by any profession, but is shared by athletic trainers with several professions. Athletic trainers have specific AT evaluation and re-evaluation codes for reimbursement. All of the other codes are non provider-specific. While many ATs practice in professional sports, colleges and universities, and high schools, there are also many who practice in physicians’ offices, hosptials, and rehabilitation clinics. Athletic trainers are not asking for a new category or for insurance companies to begin paying for services that they do not currently reimburse.

This conversation needs to take place with insurance companies. There are ways that states require insurance companies to pay, but that can only happen after there has been a demonstrated effort to gain reimbursement without legislation. Some states have laws, but this is not something that needs to happen in each state necessarily.

For the sake of the profession we should pursue third-party reimbursement. This is not to say that secondary schools should be neglected. We absolutely should continue to work on this. Why only put one iron in the fire? Should we not support the irons that have interest and skills in this area? We should support all of our practice settings and ensure that we are providing the necessary support legislatively when needed.

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