Medical Billing Codes—Will Nurses and Alternative Medicine Ever Get a Foot in the Door?

November 13, 2012
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medical-billing-codesNot if crony interests can stop it. But there are the highly respected ABC codes, which integrative practitioners can start using immediately.

Two years ago we told you about how the world of medicine is run by billing codes—every hospital, doctor, and practitioner who accepts insurance or Medicare uses billing codes both for a record and for any reimbursement. Billing codes can also be used by researchers to track the effectiveness of various treatments.

Would you be surprised to learn that the standard billing codes, set up by the American Medical Association, don’t include complementary or alternative medical (CAM) therapies? ABC Coding Solutions is one of the few billing code providers that offer codes for a full range of integrative practitioners and therapies as well as nursing and other services.

In 1983, the government agreed to make the AMA’s codes the only ones allowed for Medicare billing, which means that alternative and integrative medical practitioners are completely squeezed out. Moreover, without the proper codes, it is harder to collect good data on the benefits of CAM—which may be the very reason that government and the AMA don’t want any alternative codes.

This is just another example of crony capitalism at work. For more on the AMA’s cozy working relationship with the government, see this article.

The Department of Health and Human Services (HHS) granted an exception to test ABC Codes in electronic healthcare transactions in 2003. Alaska Medicaid used ABC codes under this exception between 2004 and 2009 to process over 2 million claims and payment transactions in a behavioral health program. Alaska documented a cost savings of over 50% in using ABC codes rather than the AMA’s codes required for filing claims!

HHS then asked the Centers for Medicare and Medicaid Services (CMS) to review ABC’s cost–benefit analysis quantifying these savings. CMS reported back that there was “no compelling data to have ABC codes added to the [standard] codes required for filing healthcare claims.” The CMS report was full of blatant errors, which ABC attempted to get them to correct, but HHS paid no attention.

After this experience, ABC decided to abandon working with the government, after already spending $700,000 on lobbying. For now ABC Coding Solutions is working directly with practitioners to use the ABC billing codes in filing electronic claims with private insurers. “We found that nurses, counselors, chiropractors, and many other integrative health professionals are frequently not reimbursed by insurance companies. Without ABC codes, these professions are often reimbursed at the wrong rate and their payments are delayed,” explained Melinna Giannini, CEO of ABC Coding Solutions. This helps close the gap and allow some 2 million more healthcare professionals to get paid, by allowing practitioners to supplement conventional medical codes as they file electronic healthcare claims.

Medicare is not likely to provide coverage for CAM services any time soon. Not even nurse practitioners and other advanced-practice nursing services are covered under Medicare. There is language in PPACA, the Patient Protection and Affordable Care Act, that would expand coverage to providers who are not MDs or DOs so long as those practitioners are acting within their scope of practice to provide benefits allowed by the insurance organization. However, Medicare disallows many services that are not managed by MDs, who don’t want competition from nurses, much less from integrative medicine.

On the one hand, the government realizes that there are major cost savings to be had by allowing highly trained nurses to do more. On the other hand, the government and the American Medical Association are in a crony relationship. How this will shake out over time remains to be seen.

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8 Responses to “Medical Billing Codes—Will Nurses and Alternative Medicine Ever Get a Foot in the Door?”

  1. It is sad that alternative medicine is being pushed aside and not given the recognition it deserves. We are talking about methods and herbs that have been used to centuries before “conventional medicine” existed. I guess conventional healthcare providers and drug companies feel threatened.

       1 likes

  2. sean ahner says:

    Billing codes are acodes related to drugs, hospital revenue codes, dental codes, and codes unique to Medicare and medical billing codes are used to classify a patient’s treatment, diagnosis, and related medical supplies.

       1 likes

  3. Louise Esther Rothstein says:

    I have multiple chemical sensitivities.
    48 million other Americans have them-and this is not insured on:
    We either get inappropriate “care” or we pay out of pocket until we have nothing left.

    Most of us know what does help us.

    That is where our medical money should go.

    It does not go there now.

    And we do go for broke:
    The insurance won’t pay.

    The Chemical Sensitivity Foundation can confirm this.

    And they are online now.

    Please check this out.

    Now.

    For this cannot be right.

       5 likes

  4. Patricia Stuut says:

    Another example of corporate socialism – taking the government role of a formerly free, democratic people to further control over money in their pockets to the detriment of liberty and equality (not to mention HEALTH) of the citizens of the former United States of America (that exists no more) for the unholy gain of the corporate class of power brokers.

       6 likes

    • Lauren says:

      Sadly, Obamacare could have been repealed if voters would have voted for my former governor, Gov. Mitt Romney and other REPUBLICANS. Face it — there has never been a time in history where a presidential administration is more DIVISIVE and HOSTILE to the minority party, the Republicans. The Republicans aren’t perfect, but I am in line with their beliefs far more than the Democratic party, of which I used to support until 10 years ago, until I finally woke up and realized the far leftist, MARXISTS hellbent on destroying the USA from within were taking over. Way to go all you Obama and Democrat voters. If you thought the first term of Obama was bad, just wait until the second term. God help us! goinderwllvwwwllvwnrRSeoprtosecibuto the tt, –es would ever

         5 likes

      • Nancy says:

        Repeal of The Affordable Care Act would set us back decades. At least now, there is a “starting” point in health care administration and expect many changes as time goes on. Hopefully, the time will come when other types of health care workers; nurses, MA, PA’s, etc. will be able to see and treat patients and get reimbursed.

        I formerly worked in Health Care Administration BEFORE all of the code change, etc. I performed pre- and post-payment review of Medicaid claims for the state of MI.

        IMO, these are the two things need to change ASAP for health costs to be contained:
        1. The hospital business model of rewarding and soliciting physicians’ whose practices bring in the most patients. Until that happens, hospital costs will continue to rise.
        2. STOP ALLOWING THE ADVERTISING. I remember how it was before doctors, hospitals, lawyers were allowed to advertise.

           1 likes

        • Sue H. says:

          Nancy, the type of “health care” we are spending all our money on is doing more harm than good!!! The paradigm is killing 100,000 or more people a year. To have that as a “starting point” is unhealthy. It needs to be dismantled and come at from a different angle. What if providers were paid for getting their patients well instead of the “disease maintenance” they are being paid for now. Doctors practice medicine; they have no place in the health care market. There are many practitioners who are way more qualified than doctors to get people healthy. We need to give medicine it’s proper plae in the health care system–one very small part with an important but very minimal role..

             0 likes

  5. Timothy H Carr says:

    Change billing codes now!

       5 likes

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