Q&A with GATA Hall of Famer, Paul Higgs – Successful Reimbursement for Athletic Training Services

Reimbursement and CPT codes are uncharted territory for most Athletic Trainers. But one trailblazer has built a successful system of billing and reimbursement for athletic training services at Valdosta State University.

Reimbursement and CPT codes are uncharted territory for most Athletic Trainers. But depending on your state’s practice acts, you may be able to explore this new stream of revenue for your athletic training services. One trailblazer has already built a new billing system at the School of Health Sciences at Valdosta State University in Georgia.

I sat down with Paul Higgs, Med, LAT, ATC, CSCS the newest member of the Georgia Athletic Trainers’ Association Hall of Fame. For nearly 20 years, Higgs has been billing 3rd party reimbursement for athletic training services. Read our Q&A session to learn his advice for starting this new venture.

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Meet Paul Higgs, Med, LAT, ATC, CSCS

Paul Higgs’ primary role is an instructor in the School of Health Sciences at Valdosta. He is also the Director of the Center for Exercise Medicine and Rehabilitation (CEMR), Athletic Training Clinic at the university. He spends additional time in the CEMR Athletic Training Clinic where he evaluates and treats students, faculty, staff and members from the community.

His clinic looks much like other therapy and athletic training facilities. He has treatment tables, a variety of modalities, an anti-gravity treadmill, isokinetic dynamometer, and other tools used in day-to-day therapy.

Keep reading to see how Higgs manages billing and reimbursement for athletic training services.

Paul, what are some keys to understanding third party billing and whether or not you can do it in your state?

The practice act in each state is very important. Georgia is one of the first states that required licensure for Athletic Trainers and this certainly helped with the process of being able to bill for services. House Bill 93 was passed in 1999. It states

lawful scope of practice of an athletic trainer qualified pursuant to Code Section 43-5-8 shall be deemed to provide that any person covered under such policies or contracts shall be entitled to receive reimbursement for services under such policies or contracts regardless of whether such services are rendered by a duly licensed doctor of medicine or by an athletic trainer qualified pursuant to Code Section 43-5-8.”

Sometimes it takes a call or two to the insurance companies and it may take a little time in the front end. But, with patience and the state laws at hand, they agree.

What do you have to do in order to bill for the athletic training services that you provide?

Billing does not really make the job that much more difficult. We are already documenting what we are doing with each patient and this is key in the reimbursement process. Your notes, when put in to an EMR system, can then be easily transmitted off to an insurance company for billing. And, billing for services does not increase your liability….your license increases your liability.

Do you “market” your services?

Actually, not really. I have a flyer that I send out from time to time to some doctors in the area as well as throughout the state. Our students come from other areas and they spend time back home when school or sports are not in session.

It is helpful for those physicians to know of the services that can be provided here. I have even received a referral from 3.5 hours away as the ortho in that town and I had worked together for 20 years and he knew me and what we could do down here.

Do you ever receive NO payment for services rendered?

Sometimes you will get a “no,” but it is not very common. Insurance companies, if they have not already, can be presented with the laws and practice act of our state. This is not a common problem. And, we still have the ability to do cash pay for when the deductible has yet to be met or if the patient just wants to do it that way. So, whether it be through insurance or cash pay, we are receiving payment for services.

Are there any particular CPT codes that you use more often in billing?

I will normally spend 45 minutes on my initial evaluation and will bill the Athletic Training Evaluation code 97005, or Physical Performance Test 97750. My treatment sessions run for 30-60 minutes and I will most commonly bill Therapeutic Exercise 97110. I would like to do more job-specific evaluation and testing and doing that will allow me to use additional codes.

How long have you been billing insurance companies for your services?

We have been filing claims at VSU for about a year now. At Georgia College, I started by filing claims for an athlete’s braces around 2002. After a physician ordered the brace, it made more sense to buy the brace ourselves, fit the athlete with the brace, and file the claim than to outsource it to a local clinic to do the identical work. We could control the costs and generally recoup the cost of the brace.

That lead to filing claims for non-athlete rehabilitation on a physician’s written order to later, filing claims based on standing or written orders for our athlete rehabilitation. All work was within the scope of the Georgia Athletic Trainers Practice Act and completed under the authority of a referring physician.

What advice would you give to universities or clinics about how to successfully start billing for reimbursement of athletic training services for the first time?

Just start. The resources necessary are space, staffing, and supplies and many of those things may already be available on campus but not centralized into a “center.” In addition to the Athletic Training Clinic, the VSU Center for Exercise Medicine and Rehabilitation also includes a Fitness/Wellness Center staffed by Certified Exercise Physiologists.

They see clients for individualized fitness plans and pay a monthly fee for the supervision, expertise, and resources of that side of the house while providing ongoing monthly revenue that can be poured back into the Fitness/Wellness Center for additional programs and staff.

A facility like CEMR functions to fulfill the academic, fiscal, and community service goals of the University. The start-up costs can be as much as you want, but it can generate revenue over time to recoup those costs. I have even paid for 2 GA positions by billing for services!

Helpful resources from NATA

As Higgs says, if you want to explore the possibility of billing for athletic training services, just start! Read your state practice act first and contact your local state governing body for additional guidance. Here are two helpful resources from the National Athletic Trainers’ Association to help you get started.

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Jeff Johnson, MA, ATC
Clinical Specialist