Pre-Participation Exam Reimbursement Program PF

Pre-Participation Exam Reimbursement Program: 

Generating Revenue for Sports Medicine Pre-Participation Exam Reimbursement Program

Program Overview: 

Program Overview Athletic Department Solutions (ADS) has developed a streamlined process to generate revenue to the sports medicine /athletic department for doing nothing different than you’ve done for years. Due to healthcare reform and enhancements in technology, we are able to obtain reimbursement from student athlete individual health insurance companies for physicals performed by your team physicians.

Financials of Program: 

Financials of Program For students with valid health insurance, we are able to collect $200 - $350 per physical (depending on components of physical). Factors: # of PPEs Performed % of Student Athletes with Health Insurance Type of Health Insurance Components of Exam Do the math (Example): 400 Student Athletes of which 300 have valid health insurance 300 x $250 per physical = $75,000 Set-up = $3000 of initial revenue =$72,000 Collection Fee = 25% = $18,000 Net Revenue to School = $54,000

How It Works: 

How It Works

How It Works: 

How It Works 1. ADS loads all student-athletes into a national database. This enables us to verify health insurance coverage, including deductible, co-insurance, etc. 2. ADS provides a master implementation program that registers the school, provider and insurance carriers. 3. School provides ADS with student athlete demographics, insurance information and a copy of the signed and complete physical form. (Note: Doesn’t all have to be at the same time)

How It Works: 

How It Works 4. ADS will verify all primary health insurance and provide report back to school. 5. ADS will bill for physicals for those with valid health insurance. 6. When checks are received, ADS will reconcile accounts and provide checks to school contact for deposit. (Note: checks will be made out to the billing entity, school)

How It Works: 

How It Works At the conclusion of the month, school would be invoiced 25% for only those checks that were received. 8. When primary insurance doesn’t pay, ADS will work to obtain maximum reimbursement with the insurance company, however no bills for non-payment will go to the student-athlete, their parent or the school. It Really Is This Simple!

Common Questions: 

Common Questions

Common Questions: 

Common Questions Do we need to pay our physicians? Completely up to the school and the physician Most do not as the physicians are willing to provide the service IF the monies generated actually go to support sports medicine. Some are providing compensation to the primary care / family medicine as orthos are receiving compensation via surgery and office visits.

Common Questions: 

Common Questions Is there any up front fee? No; the set-up fee of $3000 is only collected after you receive the first $3000 in insurance checks. After that the fee is 25% of collected. Set-up is a one time fee regardless of the number of years participating.

Common Questions: 

Common Questions Do we have increased liability because we are billing? No; the liability exists in the service provided, not the fact that you bill for the service. Will student athletes or parents receive a bill if insurance doesn’t pay? No; they will receive an EOB (Explanation of Benefits) from their insurance but no bill will be generated for unreimbursed services.

Common Questions: 

Common Questions Can we bill for physicals that have already been completed? Yes, but those performed in the last 30 days have the highest reimbursement rate but we can bill up to 12 months. We have both a internist and orthopaedic provide the physical, can we bill for both? Yes, provided that the exams are on two separate forms. Ortho screening by a orthopaedic typically billed at an additional $120.

Common Questions: 

Common Questions What happens if we don’t get any insurance checks, is there a penalty? No, we only collect when you receive insurance checks. No risk to the school and in fact the school would receive a scanner and verification of insurance coverage on all student athletes regardless of reimbursement. When checks do arrive, how can I guarantee that they go into my budget? Up to the school, however utilize your team physician to provide leverage that the monies generated go to sports medicine. Essentially he / she is lending their NPI # to the school for this to work.

Who Is Doing It?: 

Who Is Doing It?

Example #1: 

Example #1 School: Division 1 – FCS (Non-Football) Number of Student Athletes: 221 Number of Physicals Performed: 115 Uninsured: 45% Revenue Generated: $22,451.32

Example #2: 

Example #2 School: Junior College (with Football) Number of Student Athletes: 189 Number of Physicals Performed: 76 Uninsured: 60% Revenue Generated: $12,719.57

How Do I Get Started?: 

How Do I Get Started? Sign the Service Agreement Indicating Option #3 Provide School Tax ID # Provide Physician Names and NPI #s Install FTP Site (ADS IT Staff will Assist) Scan per Student Athlete: Student Athlete Demographic Information Form Copy of Insurance Card / Information Signed and Completed Copy of Physicals

Contact Information: 

Contact Information Patrick Feely Email: pfeely@csmfoundation.org or pfeely@orchr.com Cell Phone: 334-434-0905