Many physicians refer their patients to seek the physical treatment for the cure of their ailments; i.e. exercise to control diabetes, cardio exercise, massage, Pilates, etc. These physical training can help them to recover organically. One thing that creates a huge pace between both of the industries is that, health care professionals can receive payment from third-party payers or secondary payers according to the policies defined by the Government of the United States of America. But there are no rules defined for the fitness industry regarding collection management laid out by the Government or any other health care administrative industry. If the fitness industry complies with the health care industry then they have to involve medical billing and coding procedures to receive claim reimbursements. Their services are mentioned in the doctor’s prescription as the physical therapy for the patient’s treatment. So when medical coders keep the record of physician’s suggestion then the fitness center services are also considered. There are specific CPT codes that are defined for fitness therapy services. They are used for the claim submission process to pay on their services. These CPT Codes create a profound association of the fitness center with the health care industry.
According to the American Medical Association, the codes for the health care services of the fitness industry are copyright of AMA. For Example;
- This code includes the complete information of the therapeutic exercise, it helps the trainees to develop muscle strength, range of motion, and flexibility. Health care practitioners can suggest this fitness therapy for rotator cuff therapy or general use of aerobic machines. This type of training may last up to a one or two-week period.
- This medical code comprises the information of neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, & proprioception. This code is significantly used by Physical Therapists and Massage Therapists for patients with neuromuscular deficits that require movement along with physical manipulation of body parts (along with pressure point work, etc.). This code would not be utilized for therapeutic exercise procedures, but it is used for particular movement programs i.e. shoulder or hip movement post-stroke, or shoulder movements post breast cancer surgery.
Since claim reimbursement is difficult to obtain for most licensed health care practitioners. It certainly won’t be accessible to anyone in the exercise community simply by becoming licensed or accredited. The system is in a revolution scenario. Most of the methods for obtaining reimbursement or contracting dollars would be produced from outcomes-based programming. Many companies are transitioning into this realm by their executive summaries relating to data analytics, outcomes, and ROI. Health and fitness professionals should perform their best to go through recent surveys and studies about medical billing and coding services for the fitness industry. It has set the transition stage relating to the opportunities to work with health care faculties including; clinical population and sets developing relationships with third-party payers through a contract mechanism that will satisfy the requirements of both groups.
CPT codes are the language of health care procedures, and they were composed of physicians. However, this language can help health and wellness practitioners to negotiate contracts that will help pay for memberships, personal or group training, nutrition, and mind/body health programs through the health club industry. After few years, I think that the interruption in the health care industry is big enough that smart health care companies and training programs will be able to propose comprehensive wellness services that will be reimbursed by the health insurance companies. This seems like the next logical step in the revolution of the industry.