Introduction to Collegiate Revenue and Reimbursement

1
Introduction to Collegiate Revenue and
Reimbursement

• Dont Consider that the Glass is Half Full or
  Half Empty,
• Sometimes there has to be another Glass

2
Are you billing for services provided in the
Athletic Training Room?

• No 118 (68)
• No, But Considering It 35 (20)
• Division I-A
• Division I-AA/AAA
• Division II
• Division III
• NAIA

• Yes 21 (12)
• Division I-A
• Division I-AA/AAA
• Division II
• Division III
• NAIA

3
If Not then Why Not

• Philosophy 45 (38)
• Administrative Support 13 (11)
• No Need 2 (2)
• Clerical Support / Additional Paperwork 11 (9)
• Understanding 18 (15)
• Student Athlete Insurance 1 (1)
• Revenue Distribution 2 (2)
• Licensure 17 (14)
• Other 9 (8)

4
If Not But Considering Biggest Obstacle

• Athletic Training Staff 3
• Self 4
• Team Physician 3
• Athletic Department Administration 7
• University Administration 10
• Legal 1

5
If Not But Considering Biggest Supporter

• Athletic Training Staff 22
• Self 7
• University Administration 1
• Athletic Department Administration 2
• Team Physician 3

6
If Not But Considering

• Provider
• ATC 26
• PT 2
• Physician 6
• Expectations Regarding Revenue 60,735

7
Those that are Billing for Services

• Years 4.75 (Two Weeks 17 Years)
• Services
• Braces
• Physical Medicine
• Physician Visits
• Average Revenue 98,000 (165,000)
• Range in Revenue 7,500 - 375,000
• Provider (Reimbursement Model)
• ATC 4
• PT 4
• Physician 9
• Not Disclosed 4

8
Types of Business Models

• Outpatient ATC
• Internal External
• Non-Athlete
• Outpatient PT
• Internal External
• Non-Athlete
• Physician Extender
• Internal External
• Facility Rental
• Ancillary Services

9
Questions to Consider

• What are your biggest questions?

10
Philosophically should we bill student-athletes
for services we have traditionally provided for
free?

• Service Driven vs. Profit Driven

11
What percent of your student-athletes have a
primary insurance?

• 25
• 50
• 75
• 90
• 100

12
What services are we going to bill?

• Every treatment session?
• Post-surgical cases?
• Time Loss?
• Every time the athlete walks through the door?
• Casting
• Aquatic Therapy
• Braces / Orthotics
• Wound Care
• Physician Services
• Others?

13
What is our patient population?

• Student Athletes
• Athletic Department Staff
• University Personnel
• Student Body
• General Public
• Staff or Facility Driven

14
Will billing for services impact our secondary /
excess insurance?

• Yes, and it actually could decrease your
  secondary premium.
• Yes, depending on how co-pays and deductibles are
  handled.
• Yes, percentage of student athletes without
  insurance.

15
How are we going to address co-pays, deductibles
and remaining balances?

• Student-Athlete Pay?
• If not then who?
• Can we Write Off co-pays?
• Account for it someway!

16
How much can we expect to generate?
d
17
How much are we going to spend to start the
process?

• Clerical
• Software
• Fees
• Personnel
• Physical Therapist
• Physician
• Additional Athletic Trainers
• Other?

18
Who is going to do the billing and collection?

• Current Athletic Training Staff
• New Athletic Training Staff
• Clerical / Insurance Coordinator
• Billing Service

19
When doest the billing process stop?

• Return to Play
• Return to Function
• Insurance Dependent

20
Are we going to be included on an insurance
companies list of providers?

• Do you want to be included?
• Do we have to be included?

21
Do we need to be Approved Providers?

• In All Cases?
• Advantages vs. Disadvantages
• What do other do?

22
Who is the Provider?

• Athletic Trainer
• Physical Therapist
• Physician
• Advantages and Disadvantages

23
Where does the money go?

• Formally
• Informally
• Revenue Distribution
• Service Driven vs. Profit Driven

24
If we begin billing for services are we going to
be a covered entity under HIPAA?

• Thoughts?
• Stay Tuned?

25
How long will it take to become an Approved
Provider

• Two Months
• Three Months
• Six Months
• Never
• What determines if we get approved?
• Can we shorten / find a loop hole in the process?

26
Who decides about implementing this process?

• University President
• Board of Regents
• Athletic Director
• Dean of Student Affairs
• Head Athletic Trainer
• Team Physician
• Health Services Director
• Legal Counsel
• Dean of Medical School

27
Where is this program Housed

• Internal
• Athletic Department
• Health Services
• Physical Therapy Department
• Medical School
• External
• Physician Group
• Private Group
• Advantages and Disadvantages

28
Are we at more Risk if we are billing for
services?
29
Do we have to document better now that we are
billing for services?
30
What is a realistic timeline?

• Provider Networks
• Administration
• Understanding

31
More Questions?