BREAKING THE HEALTH CARE CODES
PART 2 of 2
Carolyn Dean, MD, ND and
Since 1996, ABC Coding Solutions has developed codes tied to legal research that reflect the practices of more than 3 million licensed and underserved healthcare practitioners. Melinna Giannini says that when used together with CPT and government codes, ABC codes support a complete, accurate and precise documentation of patient encounters and a common language for comparing the economic and health outcomes of competing approaches to care. ABC codes are not trying to replace CPT and government codes; rather they fill critical gaps and offer electronic means of documenting care from a full range of practitioners. And, the ability of ABC Coding Solutions to automate the determination of whether a code is legal or not saves billions in administrative costs.
In fact, ABC Coding Solutions advocates ABC codes as a missing and essential building block of health information technology that the company estimates will save more than $51 billion per year in U.S. healthcare costs. One way these savings are generated is by making codes available directly to professionals other than allopathic doctors. For example, in Alaska, the state’s Medicaid Behavioral Health Department uses the ABC codes to replace the state codes that were retired. In a successful pilot study, Alaska Medicaid used ABC codes to process more than 500,000 health claim and payment transactions in one year. A Medicare Advantage plan has paid claims on ABC codes for over five years. Both programs continue to use ABC codes.
With ABC codes, everybody shares in the benefits. An estimated 36.9% of the cost savings from ABC codes go to commercial health plans, 29.3% to federal programs, and another 13.2% to state and local programs. Additional savings benefit employers, health practitioners, patients and others.
Having ABC codes will not change medicine overnight—nothing will—but having codes to fill in the gaps, I think, is a big step in the right direction. No doubt, it’s a process. We have the experience of the Alaska Behavioral Health Program, which adopted a mere dozen ABC codes and within the first year saved their department $2 million. Unlike businesses that have to invest millions and wait many years to see a return, ABC codes can be implemented and begin saving money immediately.
At the outset, the ABC codes can provide incredible data on the effectiveness of different modalities. From a handful of studies, we know that chiropractic care is superior to allopathic drugs and surgery for treating low back pain. But the insurance industry lacks actuarial data on treatment protocols and cost so there is no data to prove that chiropractic care is cost-effective compared to drugs and surgery. Having this data will be phenomenal for the chiropractic profession as will similar data be for midwives and naturopaths who treat flu with remedies that work, or integrative medicine docs who practice chelation therapy, or give IV magnesium and hyperbaric oxygen for stroke. We say, level the playing field and find out what works and let the data help people choose the care they want!
Consumer Directed Health Care (CDHC)
ABC Coding Solutions is collecting data from practitioners who are receiving direct reimbursements based on ABC codes. It appears that health payers are less likely to deny consumers than practitioners. So, consumers can become involved with changing the coding system of health care –making your integrative medicine doctor, chiropractor, masseuse, etc., aware that they can use ABC codes to document your visit or procedure—and this in turn will help you file a claim.
You may have heard of CDHCs or Health Savings Accounts (HSAs). They are an attempt to “solve” the problem of rising health care costs. How do they work? They raise consumer awareness about the real costs of health care and help people make better decisions about how to spend their health care dollars. The assumption is that you need to approach health care like buying a car. When it’s your money –not insurance money at stake - you take the time to research the best product at the best price.
However, they are currently set up using the allopathic medical system. Promoters of these plans have not figured out how to meet the demands of millions of people who want safer and cheaper modalities than prescription drugs and surgery. They do not yet know how best to prevent disease. Preventive medicine, in the eyes of a CDHC, is having a routine physical examination, immunization, and a mammogram. It’s not, as Elissa and I would view it, having a nutritional evaluation and going on a healthy detox and nutritional supplement program.
Health Savings Accounts (HSAs) were created by the "Medicare Prescription Drug, Improvement and Modernization Act of 2003," signed into law by President Bush on December 8, 2003. It will merely help individuals to save on certain “qualified” medical and retiree health expenses on a tax-advantaged basis. The key word in the previous sentence is “qualified.” If it’s not coded, you can be guaranteed, it’s not qualified. HSAs do allow for consumer controlled and tax-advantaged payments to a much wider variety of practitioners such as acupuncturists, nurses and therapists. ABC codes will help automate this process and facilitate reimbursement.
On the issue of keeping MDs in the gatekeeper role of allowing or not allowing people to use their HSAs is an extremely important issue impacting Elissa and other citizens in Oklahoma, in particular. It is believed that Oklahomans use natural healers in much higher numbers than in other states. This is because of a statewide referendum in 1920 that barred an allopathic monopoly law. As a result, natural healers practiced without harassment. When people in these practices wanted to set up schools to pass on their knowledge to the next generation, they did so under the vocational school regulatory system.
None of these groups of natural healers were ever forced to create licensing bodies and obtain a license to practice. In recent years, when out-of-state trade groups come into the state in an effort to promote licensure to build their own political empires, the citizens of Oklahoma routinely and vigorously reject such monopoly tactics. The experience Oklahomans have had in supporting true health freedom in this area of regulation has resulted in encouraging very talented practitioners to develop new and novel ways of providing services that would be forbidden under licensing laws.
In Oklahoma, which brags about being the buckle on the Bible belt, there are several well-established religious sects that frown upon consulting with MDs as a tenet of their faith. Members of these religious groups, who may use natural healing arts practitioners as their primary care providers, thus prime candidates for desiring HSAs, would not be able to access the use of the HSAs should they be required to get “permission” from an MD.
The health freedom movement, which is alive and well in almost 40 other states, promotes laws to protect natural healers from forced licensure and is also a sign that ordinary citizens want direct access to these healing arts without a lot of government restrictions.
Based on informal surveys Elissa and I have taken over the years, we think that many of those lumped in with the uninsured population, choose to be uninsured because they don’t use allopathic practitioners but depend only on the natural healing arts. Thus, these people have very little incentive to seek medical insurance.
ABC Coding Solutions is well aware of HSAs and they are encourage practitioners to create super bills where they can list the ABC codes and simply check off what happens in an office visit if their clients want to submit their own bills to their health payer. ABC Coding Solutions can help create customized super bills based on state laws and the state scope of practice for individual practitioners. Presently there are over 800 versions of practitioner guides or sub-sets of the ABC codes for each practitioner in each state. This means a massage therapist in Idaho would have a specific list of ABC codes allowed under Idaho scope of practice laws for that profession. Then, this massage therapist can create a super bill that describes her practice and simply check off the services she used and give this bill to her client to submit for reimbursement.
ABC codes have been in experimental use since 2003 when Tommy Thompson declared they were legal codes. However, ABC codes need to leap over one more hurdle. They need to be named a permanent government standard so that all health payers are prepared to accept ABC coded claims. It may not be, as we have believed, that insurance companies don’t like the natural healing arts and that’s why they won’t cover them. It’s partly because they don’t have the proper codes and tools to process payments.
ABC codes are being considered by the U.S. Department of Health and Human Services as a mandatory standard under the Health Insurance Portability and Accountability Act (HIPAA) and are already considered an optional HIPAA-compliant set of codes. But the government seems to be dragging its feet and it may be time for the voice of the people to be heard.
In December of 2005, the Department of Health and Human Services (HHS) granted an extension for continued use of ABC codes through October of 2006. We have from now until that time to lobby our practitioners and elected officials to have ABC codes made a government standard. Go to www.ABCcodes.com to learn more about the codes that could change medicine. As mentioned above, you and your practitioner can start using ABC codes to bill for your care. I’m not saying that you are guaranteed an automatic claim payment on your first try –but the more claims sent in, the more oil that greases the wheel of this new process.
And here is something to tell your practitioner, ABC Coding Solutions is inviting ABC code registrants to beta test an online claim filling tool, eClaim.biz for one month. This system lets practitioners document care with ABC codes and then process the claim using CPT, HCPCS II and/or ABC codes. The first 250 applicants will participate in this beta test, which will also provide HHS with data about the cost-benefits of using ABC codes in HIPAA transactions. As thanks for providing feedback on eClaim.biz, ABC Coding Solutions is offering 1) a one-month free subscription following the test period, 2) a free annual licensing fee, and 3) an electronic coding manual. [Read]
We don’t need more caregivers in the U.S.; instead we need to rethink coding. Coding is creating an artificial bottleneck for direct consumer access to quality health care. Consumers are demanding choice in the care they are offered and while most people would agree that they want access to allopathic medicine, no one wants to be told that this is their only option. You can help create choice by demanding that ABC codes are available to document the care that consumers are already using. For part one, click 1 below.
here for part-----> 1
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© 2006 Carolyn Dean -
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Dr. Carolyn Dean is a medical doctor, naturopathic doctor, herbalist, acupuncturist, nutritionist, as well as a powerful health activist fighting for health freedom as president of Friends of Freedom International. Dr. Dean is the author of over a dozen health books, the latest of which is "Death By Modern Medicine".
Elissa Meininger is vice president of Friends of Freedom International and co-founder of the Health Freedom Action Network, a grassroots citizens' political action group. She is also a health freedom political analyst and can be heard on the natural health radio show SuperHealth, broadcast weekly on station KEBC (Information Radio 1340) in Oklahoma City.
In December of 2005, the Department of Health and Human Services (HHS) granted an extension for continued use of ABC codes through October of 2006. We have from now until that time to lobby our practitioners and elected officials to have ABC codes made a government standard.