Rehabilitation Services 2817 New Pinery Rd The Wellness Center Suite 1 Portage WI 53901 6087456290 Steve Allison LAT Matt Bekkedal MEd LAT James Shlimovitz LAT Jason Cerkoney LAT ID: 791150
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Divine Savior HealthcareRehabilitation Services
2817 New Pinery RdThe Wellness CenterSuite 1Portage, WI 53901608-745-6290 Steve Allison, LAT Matt Bekkedal, M.Ed., LAT James Shlimovitz, LAT Jason Cerkoney, LAT Andrew Acker, LAT Delaney Dowden, LAT Jessica Schmitz, LAT
Slide2NATA
Third Party Reimbursement InitiativeSteve Allison, LAT, ATC, CEAS NATA TPRI Implementation LeadSupervisor of Rehabilitation Services District 4 Regional CoordinatorDivine Savior HealthcarePortage, WI
Slide3Reimbursement Implementation Resources
Learning Objectives: 1. Understanding the role of NATA TPRI Implementation Lead. 2. Learning about the resources available and how to locate them. 3. Gaining a broad understanding of autonomous treatment and billing in an outpatient rehabilitation setting. 4. Gain an understanding of current issues related to TPRI.
Slide4Allison Consulting, LLCConsultant with OrthoVise, LLC.
Compensated through NATA Third Party Reimbursement Initiative as Implementation Lead.Regional Coordinator for District 4.Conflicts of Interest
Slide5Personal life
Slide6Divine Savior Healthcare - WELLNESS CENTER 2016
Rehabilitation Services: Outpatient SettingPhysical therapy, Occupational therapy, Athletic Training.Outpatient: 23 PT’s, 7 PTA’s, 9 OT’s, 6 COTA’s, 7 AT’s.Occ. Health and Podiatry Services.Orthopedics.Speech/Language Pathology/Audiology.LaVita “Medically Integrated” Fitness Center.Portage, WI (Population: 10,183)
Divine Savior Healthcare
Rehabilitation Services
Slide7Athletic Trainer in Wisconsin for 28 years
Graduate of UW-Stevens Point.Attended Kansas University.A runner by background - fostered my interest in Athletic Training.Spent ALL of my career in the outpatient rehabilitation clinic setting.Work in an administrative role as supervisor of rehabilitation services at DSH.Consulting role with NATA Third Party Reimbursement Initiative.Professional Life
Slide8Third Party Reimbursement is an exciting and important (pivotal) direction for the profession of Athletic Training.
Creates a Business Model Shift within Healthcare Institutions to utilize AT’s as a DIRECT REVENUE clinician.With TPRI – challenges/barriers that present themselves:Support/buy in from your EmployerPractice Act ConsiderationsPayor RecognitionBilling and CodingDocumentationMentorship and CompetenciesTreatment Progression Considerations in the OP Clinical Setting
Third Party Reimbursement
Implementation Resources
Slide9Third Party Reimbursement
Implementation Resources
NATA Third-Party Reimbursement Initiative
Implementation Strategies for Athletic Training Reimbursement in the Outpatient Rehabilitation Clinic Setting
A Checklist and Roadmap for Success
Will be made available on the NATA Website
Slide10NATA Third Party Reimbursement Initiative
Implementation of Autonomous Athletic Training Rehabilitation ServicesFrequently Asked QuestionsMany questions have and continue to surface related to the mechanics of the implementation process. A FAQ document was created to address the more common questions/barriers that athletic trainers and/or health systems are often challenged with when moving towards autonomous athletic training rehabilitation services. Will be made available on the NATA Website
Third Party Reimbursement
Implementation Resources
Slide11AT Mentor Preceptor Checklist
AT Mentor Competency TrainingDealing with Reimbursement DenialsSample Letter to Self-Insured Entities. -Requesting Athletic Training Evaluation CPT Code RecognitionWill be made available on the NATA Website
Third Party Reimbursement
Implementation Resources
Slide12Documentation to get paid – NATA 2020 Symposium.
Identify/discuss documentation – what is the payor looking for, what is the provider looking for…??Create a guidelines to documentation 2020.Third Party ReimbursementImplementation Resources
Slide13Current Trends to Monitor:
CMS initially looking to decrease payment by 15% to PTA/COTA.CMS planning to cut 8% of reimbursement to physical therapy in 2021.CMS requiring discipline modifiers w/ CPT codes:GP – Physical therapyGO – Occupational therapyEx: CPT Strength/ROM/Flex 97110GPAT does not have a modifier: 97110NOTE: These are NOT referred to as G-Codes.
Third Party Reimbursement
Implementation Resources
Slide14Medicare G-Codes –
Discontinued 1/1/2019.Third Party Reimbursement Initiative
G-codes are quality data codes that rehab therapy providers—including eligible physical therapists, occupational therapists, and speech-language pathologists—include on their Medicare claim forms to fulfill requirements for
Physician Quality Reporting System
(PQRS) and
Functional Limitation Reporting
(FLR). Although, the G-codes for PQRS and FLR are different and distinct, CMS uses both sets of codes to track information about Medicare beneficiaries’ function and condition.
Slide15Evaluation Codes are Discipline Specific:
Physical Therapy: 97161 Low Complexity97162 Mod Complexity97163 High ComplexityAthletic Training:97169 Low Complexity97170 Mod Complexity97171 High Complexity
Third Party Reimbursement
Implementation Resources
Slide16How do payors know an AT is providing the service:
In Hospital/Clinic Setting: 0951 Revenue CodeRecently some payors who recognize the AT Evaluation codes are NOT recognizing the 0951 Rev. Code and claims are being denied.Third Party ReimbursementImplementation Resources
Slide17Concerns to Monitor:
CMS Required Discipline Modifiers: GP/GO/GNCurrently CMS doesn’t recognize Athletic Training – No AT discipline modifier.Some commercial payors are requiring this discipline modifier – AT doesn’t have one – makes for an easy NO.Washing the 0951 Revenue Code through Medicare Filters will scrub this as a non-reimbursable Revenue Code. Some commercial payors using this as an easy NO.Third Party ReimbursementImplementation Resources
Slide18A lot of factors in play as we move forward with NATA Reimbursement Initiative.
Continue to move forward with Commercial payors – local and national.Look to gain federal recognition through non-Medicare federal payors…back door to CMS.Demonstrate AT will not be an increase in costs direct cost to a payor.Third Party ReimbursementImplementation Resources
Slide19Implementation Lead with
OrthoVise, LLC Work diligently with the NATA Third Party Reimbursement Initiative to:Assist States/Healthcare systems with successful implementation of AT rehabilitation services.Answer questions regarding Implementation:Healthcare systems.Rehab directors. Individual AT’s. Present/Promote the VALUE of the Athletic Trainer.
Increase number of
payors
recognizing and reimbursing for AT services.
NATA Third Party Reimbursement Initiative
Slide20Questions/Comments
Third Party ReimbursementImplementation Resources
Slide21Thank you
Steve AllisonIndependent ConsultantOrthoVise, LLCNATA TPRIsallisontc@gmail.com
Third Party Reimbursement
Implementation Resources
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