Where Do Licensed Athletic Trainers Fit Into The Clinical Setting In Montana?
Many ATs in Montana are hired through a physical therapy clinic. Some are hired as an "aide." Recently, Montana physical therapists redid their license and the following statements left us wondering where we now fit while in the clinic:
(3) A person who is not licensed as a physical therapist assistant in accordance with this chapter may not assist a physical therapist in the practice of physical therapy.
(a) the use of heat, light, sound, cold, electricity, exercise, reconditioning, or mechanical devices related to the care and conditioning of athletes; an (b) the education and counseling of the public on matters related to athletic training.
(8) "Physical therapy aide" or "aide" means a person who aids in the practice of physical therapy, whose activities require on-the-job training, and who is supervised by a licensed physical therapist or a licensed physical therapist assistant as described in 37-11-105.
So by definition, we are not a physical therapy aide within the clinical setting because we do not require on the job training.
The following describes the limitations of an aide: 2) A physical therapy aide is limited to performing the following patient-supportive tasks under the direct supervision of a physical therapist or physical therapist assistant:
(a) preparing a patient for treatment by a physical therapist or physical therapist assistant;
(b) providing unskilled aid to a patient after treatment by a physical therapist or physical therapist assistant; and
(c) assisting a physical therapist or physical therapist assistant when safety or patient care requires a second person's assistance.
(3) A physical therapy aide may perform the following and similar nonpatient care routine tasks without direct or onsite supervision, by a physical therapist or physical therapist assistant:
(a) housekeeping activities including caring for and stocking equipment and supplies;
(b) transporting patients, records, equipment, and supplies in accordance with established policies and procedures;
(c) assembling and disassembling equipment and accessories;
(d) preparing, maintaining, and cleaning up treatment areas and maintaining supportive areas; and
(e) transcribing, recording, or copying treatment documentation generated by a physical therapist or physical therapist assistant. All documents prepared by a physical therapy aide must be signed by the treating physical therapist or physical therapist assistant.
There are many questions we had about where an athletic trainer fits within the clinical setting and the physical therapists are worried because 4) A physical therapist or physical therapy assistant who fails to directly supervise a physical therapy aide may be subject to disciplinary action by the board.
Section 2. Definitions. As used in [sections 2 through 8], the following definitions apply:
(1) "Athlete" means a person who participates in an athletic activity that involves exercises, sports, or games requiring physical strength, agility, flexibility, range of motion, speed, or stamina and the exercises, sports, or games are of the type conducted in association with an educational institution or a professional, amateur, or recreational sports club or organization.
(2) "Athletic injury" means a physical injury received by an athlete.
(3) "Athletic trainer" means an individual who is licensed to practice athletic training.
(4) "Athletic training" means the practice of prevention, recognition, assessment, management, treatment, disposition, and reconditioning of athletic injuries. The term includes the following:
(a) the use of heat, light, sound, cold, electricity, exercise, reconditioning, or mechanical devices related to the care and conditioning of athletes; and
(b) the education and counseling of the public on matters related to athletic training.
Section 7. Application and administration of topical medications.
(1) A licensed athletic trainer may apply or administer topical medications by:
(a) direct application;
(b) iontophoresis, a process by which topical medications are applied through the use of electricity; or
(c) phonophoresis, a process by which topical medications are applied through the use of ultrasound.
(2) A licensed athletic trainer may apply or administer the following topical medications:
(a) bactericidal agents;
(b) debriding agents;
(c) anesthetic agents;
(d) anti-inflammatory agents;
(e) antispasmodic agents; and
(f) adrenocorticosteroids.
(3) Topical medications applied or administered by a licensed athletic trainer must be prescribed on a specific or standing basis by a licensed medical practitioner authorized to order or prescribe topical medications and must be purchased from a pharmacy certified under 37-7-321. Topical medications dispensed under this section must comply with packaging and labeling guidelines developed by the board of pharmacy under Title 37, chapter 7.
(4) Appropriate recordkeeping is required of a licensed athletic trainer who applies or administers topical medications as authorized in this section.
(3) A person who is not licensed as a physical therapist assistant in accordance with this chapter may not assist a physical therapist in the practice of physical therapy.
- Athletic Trainers do not pretend to be physical therapists
- Athletic Trainers do not claim to perform physical therapy
- Athletic Trainers do not need to be supervised by a physical therapist
- Athletic Trainers do not assist in physical therapy
- Athletic Trainers perform athletic training within the scope of which we are trained and licensed to do
(a) the use of heat, light, sound, cold, electricity, exercise, reconditioning, or mechanical devices related to the care and conditioning of athletes; an (b) the education and counseling of the public on matters related to athletic training.
(8) "Physical therapy aide" or "aide" means a person who aids in the practice of physical therapy, whose activities require on-the-job training, and who is supervised by a licensed physical therapist or a licensed physical therapist assistant as described in 37-11-105.
So by definition, we are not a physical therapy aide within the clinical setting because we do not require on the job training.
The following describes the limitations of an aide: 2) A physical therapy aide is limited to performing the following patient-supportive tasks under the direct supervision of a physical therapist or physical therapist assistant:
(a) preparing a patient for treatment by a physical therapist or physical therapist assistant;
(b) providing unskilled aid to a patient after treatment by a physical therapist or physical therapist assistant; and
(c) assisting a physical therapist or physical therapist assistant when safety or patient care requires a second person's assistance.
(3) A physical therapy aide may perform the following and similar nonpatient care routine tasks without direct or onsite supervision, by a physical therapist or physical therapist assistant:
(a) housekeeping activities including caring for and stocking equipment and supplies;
(b) transporting patients, records, equipment, and supplies in accordance with established policies and procedures;
(c) assembling and disassembling equipment and accessories;
(d) preparing, maintaining, and cleaning up treatment areas and maintaining supportive areas; and
(e) transcribing, recording, or copying treatment documentation generated by a physical therapist or physical therapist assistant. All documents prepared by a physical therapy aide must be signed by the treating physical therapist or physical therapist assistant.
There are many questions we had about where an athletic trainer fits within the clinical setting and the physical therapists are worried because 4) A physical therapist or physical therapy assistant who fails to directly supervise a physical therapy aide may be subject to disciplinary action by the board.
Section 2. Definitions. As used in [sections 2 through 8], the following definitions apply:
(1) "Athlete" means a person who participates in an athletic activity that involves exercises, sports, or games requiring physical strength, agility, flexibility, range of motion, speed, or stamina and the exercises, sports, or games are of the type conducted in association with an educational institution or a professional, amateur, or recreational sports club or organization.
(2) "Athletic injury" means a physical injury received by an athlete.
(3) "Athletic trainer" means an individual who is licensed to practice athletic training.
(4) "Athletic training" means the practice of prevention, recognition, assessment, management, treatment, disposition, and reconditioning of athletic injuries. The term includes the following:
(a) the use of heat, light, sound, cold, electricity, exercise, reconditioning, or mechanical devices related to the care and conditioning of athletes; and
(b) the education and counseling of the public on matters related to athletic training.
Section 7. Application and administration of topical medications.
(1) A licensed athletic trainer may apply or administer topical medications by:
(a) direct application;
(b) iontophoresis, a process by which topical medications are applied through the use of electricity; or
(c) phonophoresis, a process by which topical medications are applied through the use of ultrasound.
(2) A licensed athletic trainer may apply or administer the following topical medications:
(a) bactericidal agents;
(b) debriding agents;
(c) anesthetic agents;
(d) anti-inflammatory agents;
(e) antispasmodic agents; and
(f) adrenocorticosteroids.
(3) Topical medications applied or administered by a licensed athletic trainer must be prescribed on a specific or standing basis by a licensed medical practitioner authorized to order or prescribe topical medications and must be purchased from a pharmacy certified under 37-7-321. Topical medications dispensed under this section must comply with packaging and labeling guidelines developed by the board of pharmacy under Title 37, chapter 7.
(4) Appropriate recordkeeping is required of a licensed athletic trainer who applies or administers topical medications as authorized in this section.
National Provider Identifier (NPI)
"NATA views having an NPI number like having a state license: it's a professional requirement and adds credibility to both the individual and the profession," says Cate Brennan Lisak, director of external affairs. "Once ATs get their NPI number, it will be theirs forever - no matter where they work. There's no downside to having an NPI number." Applying for an NPI number is quick, easy and free.
The National Provider Identifier is the result of the mandate in the 1996 Health Insurance Portability and Accountability Act (HIPPA) that the secretary of HHS establish a standard national provider identifier. Though all healthcare providers will be eligible to receive NPI's, covered healthcare entities will be mandated to use the NPI as the sole provider identifier on all HIPPA electronic transactions. The 10 digit number will be assigned by CMS founded NPI "Enumerator" through the NPPES (National Provider and Plan Enumeration System.
The NPI is a numeric 10 digit identifier, consisting of 9 numbers plus a check-digit in the 10th position. It is accommodated in all standard transactions and contains no embedded information about the healthcare provider that it identifies.
IN SUMMARY an NPI identifies a healthcare provider to the insurance companies. Any provider wishing to bill insurance needs it. It is FREE and actually isn't hard at all. I followed the instructions below (and as an attached file) and it took under 10 minutes with an NPI number emailed to me directly after. Mission Accomplished.
To Apply go to: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
When filling out your application use:
Provider Type 22 (Respiratory, Rehabilitative & Restorative Service Providers)
Taxonomy Code 2255A2300X (Specialist/Technologist-Athletic Trainer)
To view the CMS Background and Application Process Information for Healthcare Providers Viewlet
http://www.cms.hhs.gov/apps/npi/npiviewlet.asp
There is a link to help on the NPPES website and toll free helpline 1-800-465-3203
The National Provider Identifier is the result of the mandate in the 1996 Health Insurance Portability and Accountability Act (HIPPA) that the secretary of HHS establish a standard national provider identifier. Though all healthcare providers will be eligible to receive NPI's, covered healthcare entities will be mandated to use the NPI as the sole provider identifier on all HIPPA electronic transactions. The 10 digit number will be assigned by CMS founded NPI "Enumerator" through the NPPES (National Provider and Plan Enumeration System.
The NPI is a numeric 10 digit identifier, consisting of 9 numbers plus a check-digit in the 10th position. It is accommodated in all standard transactions and contains no embedded information about the healthcare provider that it identifies.
IN SUMMARY an NPI identifies a healthcare provider to the insurance companies. Any provider wishing to bill insurance needs it. It is FREE and actually isn't hard at all. I followed the instructions below (and as an attached file) and it took under 10 minutes with an NPI number emailed to me directly after. Mission Accomplished.
To Apply go to: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
When filling out your application use:
Provider Type 22 (Respiratory, Rehabilitative & Restorative Service Providers)
Taxonomy Code 2255A2300X (Specialist/Technologist-Athletic Trainer)
To view the CMS Background and Application Process Information for Healthcare Providers Viewlet
http://www.cms.hhs.gov/apps/npi/npiviewlet.asp
There is a link to help on the NPPES website and toll free helpline 1-800-465-3203
Current Procedural Terminology (CPT)
There are few things more confusing than billing insurance. Be prepared to be confused.
The American Medical Association (AMA) has developed current procedural terminology(CPT) codes to describe treatments rendered. These codes are owned and copyrightedby the AMA. The CPT book is updated annually, and the new CPT codes usually become effective January 1 of the year following the book’s publication.
CPT codes, which are five-digit numbers assigned a specific service, enumerate and standardize medical and surgical procedures and are widely required by governmental and private insurance programs for claims processing and reimbursement. In addition, these codes are used to develop guidelines for medical review, pre- and post-payment review, and utilization review. They are meant to be a uniform language that translates clinical services into claims processing. Each code describes a service that an insurance payer can then process into a payment.
Public and private payers have the option of assigning values to each CPT code, although even if a CPT code exists for a service, the payers do not have to pay for that service. Many payers take their cues from Medicare on whether to pay for a code and what the value of that code is. Verifying what therapy services an insurance plan will reimburse for and what services are not covered is vital to proper reimbursement. Therapy evaluations, aquatic therapy, group therapeutic procedures, and cognitive therapy are a few examples of services not covered by all payers under a therapy plan of care.
There are two types of CPT codes: Timed vs. Untimed
• Time-based CPT codes—These codes require that the provider spend direct one-onone time with the patient. Contact time ranges from 15–120 minutes in length
depending on the CPT code. Providers can bill multiple units of time-based codes by the same discipline to the same beneficiary on the same date of service.
• Procedure/Service-based CPT codes—Because procedure-based CPT codes are untimed, providers can only bill one unit of a procedure-based CPT code per discipline per beneficiary per session, regardless of the amount of time spent providing that specific procedure or modality and regardless of how many areas of the body are treated. These codes do not require direct one-on-one time, but the amount of time a therapist spends performing the procedure is irrelevant because only one unit can be billed per session.
There are no specific CPT codes for PT, OT, or AT services that can only be used by the PT, OT, or AT. Physicians and non-physician practitioners may provide therapy services where state and local laws allow them to. As long as the PT, OT, or AT provider is qualified to provide the service, he or she can bill for the service as well. The qualification can be met through education, licensure, continuing education, special certifications, etc., and must be allowed by the applicable state practice act and state laws. Refer to the specific payer for information on qualified provider criteria. An insurance payer has the last word on whether it will reimburse for a service, and whether the PT, OT, or AT is qualified to provide the service.
Athletic Trainers normally bill using the physical medicine and rehabilitation codes, series 97000. Click HERE for a complete list of codes used by athletic trainers provided by the NATA, the following are some of the most commonly used codes for our practice:
EVALUATION
97005 - Athletic Training evaluation
97006 - Athletic Training re-evaluation
MODALITIES
97014 - Electrical stimulation (unattended)
97035 - Ultrasound, each 15 minutes
THERAPEUTIC PROCEDURES
97110 - Therapeutic procedure, each 15 minutes, therapeutic exercise for ROM, strengthening, endurance
97140 - Manual Therapy Techniques, each 15 minutes, massage, mobs, manual traction
What codes insurance companies will allow and pay for vary based upon plan. Rarely does any plan pay for a re-eval, even if it is PT. If you work in a clinic, make sure you have your billing department explain to you which codes may work best for you.
The American Medical Association (AMA) has developed current procedural terminology(CPT) codes to describe treatments rendered. These codes are owned and copyrightedby the AMA. The CPT book is updated annually, and the new CPT codes usually become effective January 1 of the year following the book’s publication.
CPT codes, which are five-digit numbers assigned a specific service, enumerate and standardize medical and surgical procedures and are widely required by governmental and private insurance programs for claims processing and reimbursement. In addition, these codes are used to develop guidelines for medical review, pre- and post-payment review, and utilization review. They are meant to be a uniform language that translates clinical services into claims processing. Each code describes a service that an insurance payer can then process into a payment.
Public and private payers have the option of assigning values to each CPT code, although even if a CPT code exists for a service, the payers do not have to pay for that service. Many payers take their cues from Medicare on whether to pay for a code and what the value of that code is. Verifying what therapy services an insurance plan will reimburse for and what services are not covered is vital to proper reimbursement. Therapy evaluations, aquatic therapy, group therapeutic procedures, and cognitive therapy are a few examples of services not covered by all payers under a therapy plan of care.
There are two types of CPT codes: Timed vs. Untimed
• Time-based CPT codes—These codes require that the provider spend direct one-onone time with the patient. Contact time ranges from 15–120 minutes in length
depending on the CPT code. Providers can bill multiple units of time-based codes by the same discipline to the same beneficiary on the same date of service.
• Procedure/Service-based CPT codes—Because procedure-based CPT codes are untimed, providers can only bill one unit of a procedure-based CPT code per discipline per beneficiary per session, regardless of the amount of time spent providing that specific procedure or modality and regardless of how many areas of the body are treated. These codes do not require direct one-on-one time, but the amount of time a therapist spends performing the procedure is irrelevant because only one unit can be billed per session.
There are no specific CPT codes for PT, OT, or AT services that can only be used by the PT, OT, or AT. Physicians and non-physician practitioners may provide therapy services where state and local laws allow them to. As long as the PT, OT, or AT provider is qualified to provide the service, he or she can bill for the service as well. The qualification can be met through education, licensure, continuing education, special certifications, etc., and must be allowed by the applicable state practice act and state laws. Refer to the specific payer for information on qualified provider criteria. An insurance payer has the last word on whether it will reimburse for a service, and whether the PT, OT, or AT is qualified to provide the service.
Athletic Trainers normally bill using the physical medicine and rehabilitation codes, series 97000. Click HERE for a complete list of codes used by athletic trainers provided by the NATA, the following are some of the most commonly used codes for our practice:
EVALUATION
97005 - Athletic Training evaluation
97006 - Athletic Training re-evaluation
MODALITIES
97014 - Electrical stimulation (unattended)
97035 - Ultrasound, each 15 minutes
THERAPEUTIC PROCEDURES
97110 - Therapeutic procedure, each 15 minutes, therapeutic exercise for ROM, strengthening, endurance
97140 - Manual Therapy Techniques, each 15 minutes, massage, mobs, manual traction
What codes insurance companies will allow and pay for vary based upon plan. Rarely does any plan pay for a re-eval, even if it is PT. If you work in a clinic, make sure you have your billing department explain to you which codes may work best for you.