Jan 29, 2015
NATA Fights CMS Decision

Despite protests from the National Athletic Trainers’ Association (NATA), the Centers for Medicare and Medicaid Services (CMS) has implemented rules that limit athletic trainers’ ability to be reimbursed by Medicare for their services. The NATA, however, continues its legal battle to have the decision overruled.

The new CMS rules allow only physical therapists, occupational therapists, and speech and language pathologists to receive Medicare reimbursement for service provided incident to a physician’s office visit. Previously there had been no restriction on who could provide “incident to” therapy services. Certified athletic trainers were sometimes used by physicians to provide those services and received reimbursement.

The NATA filed a lawsuit challenging the CMS decision, but a Federal District Court ruled it did not have jurisdiction to decide the case because administrative remedies available to physicians to challenge the rule had not been exhausted. The court, which did not rule on the merits of the case, also declined the NATA’s request for an injunction, citing its lack of jurisdiction.

The NATA maintains that CMS rules are illegal and has filed an appeal with the Fifth Circuit Court of Appeals, located in New Orleans, but Hurricane Katrina has slowed the appeals process. Briefs and motions will be filed in the coming months, with no decisions likely in the near future.

“The NATA continues to maintain that what the CMS has done is illegal and will continue to seek a ruling on the merits of CMS’ actions,” says Paul Genender, the NATA outside legal counsel handling the case. “Until an injunction is granted by the court of appeals or the district court, the new rule is in effect. Athletic trainers should check with their billing coordinators regarding the effects of the new rule on their practices.”

While relatively few athletic trainers are directly affected by the CMS rules, they are still a major concern to the NATA. “This isn’t just about ATCs who are practicing as physician extenders,” Marjorie Albohm, MS, LAT, ATC, Director of Business Development and Orthopaedic Research at OrthoIndy and The Indiana Orthopaedic Hospital, said in the NATA’s Convention Daily News. “This is about every athletic trainer, because the rule incorrectly implies that athletic trainers are not trained to provide rehabilitation services. That will affect every ATC in every practice setting, and if that’s not overturned, it will be used against us as we go forward.”

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