Q. Do certified ATCs have provider numbers?
A. UPIN-Universal Provider Identification Numbers are issued by Medicare at a national level to providers recognized and approved in Medicare statutes. Since we are not recognized by Medicare, ATCs would not be issued a UPIN. Most third party payers will reimburse utilizing the providers tax ID number or social security number.

Q. What efforts are being made to obtain Medicare recognition and provider numbers for ATCs?
A. NATA and the Committee on Reimbursement are assessing opportunities and avenues to accomplish this. Currently Medicare states that for ATCs to receive recognition and payment from Medicare, a change in the statutes would need to take place. A change in the statutes can only be accomplished through Congressional action.

Q. Which commercial insurance companies currently reimburse ATCs?
A. This varies from state to state and company to company. A company may reimburse in one state and not in another because of state laws/regulations or habit of practice. On the NATA web site there is a partial list of companies that have been reported to us as paying for ATCs services. This information will be updated sometime in April, 2003.

Q. Whose provider number can be used for billing?
A. See previous questions/answers. Additionally in some instances an ATC may be able to bill under the physicians number when working as a physician extender.

Q. Are ATCs able to bill under the physical therapy evaluation/re-evaluation codes?
A. No. ATCs have been issued their own evaluation/re-evaluation codes by the AMA, those are the codes that should be used.

Q. Can reimbursement language be written into state athletic training legislation?
A. Yes, the Georgia legislature in 1999 passed athletic training legislation that includes a reimbursement mandate. Other states have passed legislation against practice discrimination. Check with your state committee on reimbursement or your state government affairs committee representative for the most up to date information regarding your state’s legislation. (The NATA web site has a link to a directory of District and State Representatives for Reimbursement)

Q. What CPT codes can ATCs use to bill third party payers?
A. ATCs would normally bill using the physical medicine codes.

Q. How are ATCs different from other allied health care professionals? Why are they unique?
A. ATCs are experienced health care providers to the physically active population and others. Their aggressive approaches to treatment and rehabilitation return individuals to their pre-injury function levels, these are higher generally higher than basic activities of daily living. ATCs are also known for their skills in injury prevention. This expertise can have a tremendous positive value on the reduction of expenditure of health care dollars.

Q. What type of education is required to become an athletic trainer?
A. Students of athletic training study a wide range of topics including human anatomy, exercise physiology, biomechanics, emergency care, injury/illness prevention, nutrition, psychology, pathology, pharmacology and administration. To obtain certification by the National Athletic Trainer’s Association Board of Certification, Athletic Trainers must pass a written, practical and written simulation exam administered by the National Athletic Trainers’ Board Of Certification. They also must maintain the ATC certification by completing continuing education units, annually.

Q. Are ATCs regulated in this state?
A. Athletic Trainers are currently regulated in the State of Connecticut, but not licensed, however, a licensure bill is pending implementation. Please contact Tom McCarthy for information regarding the status of Connecticut athletic training licensure at: McCarthyT@mail.ccsu.edu

Q. How much are we able to charge or bill for Athletic Training codes?
A. There are no national fee schedules set for these codes (ATC specific) we suggest you use either UCR (usual customary and reasonable) fees based on what the Physical Therapists are charging for the similar codes.

Currently RBRVS(Resource Based Relative Value Scale) is setting rates that most insurance/managed care organizations and other payers use, however RBRVS does not set any rates for our Evaluation/re-evaluation codes as they do not reimburse those codes. You can check RBRVS rates for similar Physical Therapy codes on line.

Q. If I bill am I guaranteed payment?
A. No, billing for services even with preauthorization does not guarantee payment.

Q. How do I know which claim form is required?
A. Ask the carrier you are seeking reimbursement from. Most third party payers will accept and use the CMS/HCFA 1500 claim form, available on the web and through distribution centers.

Q. Do I need a prescription to bill for services?
A. In some cases you may, it really depends on your states licensure/practice act and who and how patients can be referred to you.

Q. What recourse do I have if the third party payer refuses to pay for my services?
A. You have a number of means and ways to try and overrule a denied claim for payment. Most importantly find out specifically why they are denying payment. In most case the carrier does not recognize that ATCs are allied health care professionals, educating the carrier may rectify that issue. If you have not attended either Reimbursement Session I or II do so if you have an opportunity, presented are a number of techniques you can use to challenge a denial. You can also contact your state or regional reimbursement representative for assistance. You also may contact the NATA Reimbursement Manager in Dallas.

Q. Can I bill for ATC services?
A. Yes, at this time we do not know of a reason why you should not bill any third party payer except Medicare. However, due to lack of licensure, the ability to be recognized by a third party payer is limited. Please contact the CATA Chair on Reimbursement, Tim Speicher at: speichert@sacredheart.edu for more information.

Q. Can I accept cash for ATC services?
A. Yes, if the patient pays in cash they can then submit the bill to their insurance company for reimbursement.

Q. I work in a Secondary School setting, does reimbursement affect me?
A. Yes, you may have opportunities to be reimbursed for ATC services. For more information regarding reimbursement in the secondary school setting go to the NATA web page and click on the reimbursement area, there is information regarding reimbursement there.

Q. I have been told that ATCs cannot treat patients in a clinical setting. Is this true?
A. Not true in most cases. Refer to the NATA Role Delineation document posted on the NATA web site.

Q. I do not wish to pursue reimbursement for my services, do I have to?
A. No, absolutely not.

Q. Other allied health care professionals are upset that we are seeking reimbursement for services, why?
A. We believe it is mainly due to unfounded fear. Fear that we will become competitors for jobs in the health care industry. It may also be from misinformation and lack of knowledge of an ATCs education and the role we play in the U.S. health care system.

For answers to any questions not found here we suggest you contact Paul Carter the NATA Reimbursement Manager or your state reimbursement representative Tim Speicher, speichert@sacredheart.edu