Improving your value as an Athletic Trainer Presented by Amy DeRosa Vice President and Partner, IncreMedical and Medadept Pennsylvania Athletic Trainers Society, Inc. Annual Meeting General Session June 2017
Disclosures I am an owner and operator of IncreMedical and Medadept, we provide healthcare management, software and outsourced revenue cycle management services. I am also in my 2 nd term as Public Director for the Board of Certification Board of Directors. No conflict of interest exists. The opinions expressed in these slides and presentation are the my own and do not reflect the view of IncreMedical, Medadept or the Board of Certification. Participants must use discretion when using information contained in this presentation.
Presentation Goals Describe the ways in which AT services are valued and analyzed by healthcare and other institutions. Recognize ways that you can increase your value in your current setting. Determine appropriate billing codes and number of units based on patient care provided. Articulate the definition of fraud.
Why do I value Athletic Trainers?
My Elevator Message I teach people how to value themselves. When people ask you what you do, what do you tell them? What words do you use? Do you talk about Athletes or Patients? What is YOUR elevator message?
Definitions of Value the regard that something is held to deserve; the importance, worth, or usefulness of something I value your support. a person's principles or standards of behavior; one's judgment of what is important in life Children adopt their parent s rules and values. estimate the monetary worth of (something) My house is valued at. consider (someone or something) to be important or beneficial; have a high opinion of She valued his opinion.
Do you value you? Are you a High Value Person? If I am High Value Person I value myself and and know my worth. I don t rely on anyone else to determine my value.
What are your values? Keeping up with the Joneses Are you placing value on things or qualities? Social Media Is your value a moving target?
How do you see yourself?
How do others in healthcare value AT s? Are a crucial part of any sports team or individual s athletic career [they] keep our athletes healthy and playing their best. Their unique value benefits school administrators, school board members and athletic directors as well as parents, students and community members. Are on-site Injury Prevention specialists. They save companies time, money, engage employees and bring a unique expertise. They also foster a meaningful safety culture. Are the only allied healthcare professional with a primary focus on preventative healthcare. Keep people healthy and performing well.
Other Rehabilitation Professionals They value your skillset, patients and expertise so much they want every single one of their patients to be athletes too! Industrial or Occupational Athlete Senior Athlete Athlete Athlete Soccer Mom now is known as a Car Pool Athlete
Successes and Challenges Why It Works: Teamwork Mutual Respect Skills Matter Learn from each other Decision made by what is best for patient Decision Tree concept
How do administrators recognize the value of providers? Typically differentiate Salary and Benefit Expense for Revenue Producers and non-revenue generating staff. Can Contribute by increased efficiency for revenue generating provider. Productivity targets are typically based on Units, Visits, RVU s, Charges or some combination of those metrics compared to costs and/or hours worked and/or paid.
Fraud Willful and intentional misrepresentation for financial or personal gain at the expense of others Must be intentional Must have financial or personal gain
Ethics in Billing NATA Code of Ethics #3: Members shall maintain and promote high standards in their provision of services. 3.1 Members shall not misrepresent, either directly or indirectly, their skills, training, professional credentials, identity or services.
Fraud Willful and intentional misrepresentation for financial or personal gain at the expense of others Must be intentional Must have financial or personal gain
CPT USAGE Any procedure or service in any section of the CPT Manual may be used to designate the services rendered by any qualified physician or other qualified healthcare professional. It is the AMA s definition that once the mid-point of time has been passed for time-based codes, 8 minutes for most therapy codes, the provider should bill and be paid for the service.
Value Your Profession Future payment for post-acute services will be bundled with all other services provided for a particular patient. April 1, 2016: CMS initiates bundled payments in 67 markets for hip and knee replacements. Reimbursement for TKA and THA will be based on historical and regional spending minus a discount. Physician visits + Medications + Imaging + Rehab + DME + Lab + Anything that might go wrong Post-acute rehab services will become a cost rather than a source of revenue CMS has indicated they will extend bundled payments to other diagnostic groups in future years
Value Your Profession Other payers are already working on their own versions of bundled payments that will likely include more than orthopedic care alone. Bundled payments will be based on historical costs and the value the services bring to the patient and the payer. If historical costs for rehab are artificially low due to inaccurate billing in today s payment model, future payments will be insufficient to sustain current salaries and programs. If we cannot demonstrate the value and true cost of rehab services now, providers will have no choice but to find lower cost alternatives. Less dollars may mean less restrictions.
Correct Billing If you don t fully report CPT codes and billing, you under-value your services. Billing and coding are used by organizations to determine real costs, negotiate payment rates and describe services provided.
Timed Codes vs. Un-Timed Codes Timed Codes Considered to be one-on-one Minutes can be accumulated in a treatment session Time can be divided among more than one patient Un-Timed Codes No time specification Can only be billed once per day
Medicare/FFP Total Time Rule Medicare and other Federally Funded Payers (FFP) add a layer of restriction to their policy that most other payers do not. Total Time Requirement: Medicare/FFP states the total number of minutes of timed procedures rendered determines the total number of units that can be billed for each patient. Medicare/FFP does not prohibit treating more than one patient at a time.
Medicare/FFP Total Time Rule Ex: 8 minutes of Exercise and 8 minutes of Neuro Re-ed = 16 minutes Only bill 1 unit
Medicare/FFP Total Time Rule In a 16 minute time frame, you could bill Medicare 2 units for 2 different patients 8 minutes of exercise with Patient A 8 minutes of exercise with Patient B
Medicare Math - 8 Minute Time Rule 8 22 minutes = 1 unit 23 37 minutes = 2 units 38 52 minutes = 3 units 53 67 minutes = 4 units 68 82 minutes = 5 units 83 97 minutes = 6 units 98 112 minutes = 7 units 113 127 minutes = 8 units
8 Minute Rule When a therapist performs any 15-minute timed service for less than 8 minutes on the same day as he or she performs another 15-minute timed service for less than 8 minutes, and the time spent performing the two services totals at least eight minutes, then providers may bill 1 unit for the service the therapist performed for the most minutes.
8 Minute Rule Ex: 5 minutes of Exercise and 7 minutes of Neuro Re-ed = 12 minutes Bill 1 unit of Neuro Re-ed
Correct Billing Medicare recognizes that under-billing is just as incorrect as over-billing The key is correct billing using the correct codes Rick Gawenda Past President of the APTA Section on Health Policy and Administration
Unit Assignment All Other Payers* Bill 1 unit for each treatment rendered from 8 to 15 minutes if using distinct timed codes on the same day of care. Ex: 8 minutes of 97110(TE) and 8 minutes of 97140(MT) can be billed as 1 unit of each. The key is documenting to support the care provided ONLY MEDICARE, MEDICARE REPLACEMENT and MEDICARE AS A SECONDARY HAVE A TOTAL TIME LIMIT RESTRICTION ON THE UNITS YOU CAN BILL *Provider manuals, updates and contracts MUST be consulted.
Unit Assignment All Other Payers In a 45 minute treatment session, you could potentially bill non-medicare patients 4 codes/units: 10 minutes of Therapeutic Exercise - strengthening 10 minutes of Manual Therapy soft tissue mob 10 minutes of Functional Activity posture training 15 minutes of Neuro Re-ed proprioceptive training
Correct Coding Bill using the code that most accurately describes the treatment given The PURPOSE of the intervention determines the code to be used STEP UP 97110(TE) to promote strengthening and knee control 97112(NR) to teach proper alignment(decrease femoral ADD/MR) 97530(TA) to promote independence and safety for stair ambulation
Correct Coding Always keep in mind why you are doing what you are doing with a patient Let your treatment rationale guide your billing
Correct Coding 97112 & 97110 Therapeutic Exercise (97110) is consistently overbilled for treatment that is Neuro Re-education (97112) To support a 97112(NR) charge, the evaluation or assessment needs to substantiate the need for neuromuscular re-education (Balance test, observation of abnormal muscle movement patterns, etc.)
Correct Coding 97535 & 97530 Therapeutic activity (97530) and Self-care/Home management (97535) are frequently confused.
Correct Coding 97530 Therapeutic Activity (97530) Lifting - Carrying Reaching - Coordination Pushing - Daily activities Pulling - Mobility Examples of use for athletic patients Teaching mechanics of sport that minimize chance of re-injury(throwing motion, swim stroke, etc.) Jumping activities Plyometrics related to sport
Correct Coding - 97535 Self-care/Home Management (97535) May include elements of pushing, pulling, carrying, reaching, etc. in a broader activity Bathing Dressing Cooking Cleaning
Correct Coding Education Component Bill for patient education using the code that applies to the education provided Home exercise: Therapeutic Exercise 97110 Safety skills: Self-care/Home Management 97535 Body mechanics/lifting: Therapeutic Activity 97530 Postural alignment: Neuromuscular Re-ed 97112 Education on condition: Therapeutic Activity 97530
New Evaluation Codes for 2017 Why the Change? The current evaluation codes do not take into consideration the severity, complexity or clinical decision making involved in evaluating different patients presenting with different problems. 3 Levels of Evaluation Codes that designate a Low, Moderate and High Complexity Evaluation & Re-evaluation Codes PT 97161 (Low), 97162 (Moderate), 97163 (High) and 97164 (Re- Eval) OT 97165 (Low), 97166 (Moderate), 97167 (High) and 97168 (Re- Eval) AT 97169 (Low), 97170 (Moderate), 97171 (High) and 97172 (Re- Eval)
New Evaluation Codes for 2017 For now, CMS will be reimbursing all of the new codes at the same rate as the current evaluation codes. CMS desires to maintain a neutral budget and want to avoid over-coding or under-coding. The AMA encouraged a "breaking in period" to give therapists a chance to become accustomed to using the new codes. Other payers may or may not follow suit.
New Evaluation Codes Criteria Breakdown Effective January 1, 2017 - - - -
Resources CMS Homepage: www.cms.hhs.gov http://www.cms.hhs.gov/therapyservices/ http://www.cms.hhs.gov/transmittals/ Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual.
Resources CPT Assistant: April 2003, February 2004, December 2005, February 2007, May 2008, May 2009 CPT Assistant Insider s Guide: 2010, 2012 AMA CPT Manual Professional Edition 2014, 2015, 2016 AAPC Timely Tidbits, 2013 Rick Gawenda Seminars NARA Fall 2016 Conference Materials
Future of Healthcare- Rehab Continuum Focus is on prevention and reducing re-admissions. Starting rehab sooner has reduced total cost of care while increasing dollars spent in rehab. Informal study: At Emory Physical Therapy, out of 3000 new patients, around 800 indicated that their current injury was due to a previous untreated or undertreated problem. Most were college age or previous. There are enough patients to go around.
Future of Healthcare- ACO s Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to patients. The goal of coordinated care is to ensure that patients get the right care at the right time by the right provider, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves.
Future of Healthcare- ACO s Current Accountable Care Organizations: Finding non-traditional options for rehab services. Student physicals include a rehab component. Need someone managing continuity of care. Need more, not less rehab providers. Athletic Trainers need to be willing, certainly are able, to fully participate in multiple rehab settings. As an employer, we need every professional working to the top of their license.
How can you improve your value as an Athletic Trainer? Believe that you have it. I do.
Thank You! Keep in touch. aderosa@incremedical.com @aimerd