Breaking the code

“I’ve got the BIGGEST story in North American Health Freedom, EVER.”

That’s a pretty impressive opening sentence, isn’t it? It certainly grabbed my attention when I received an e-mail last week that began with that comment. The message was forwarded to me by HSI Panelist Jon Barron, but the comment wasn’t Jon’s. It was written by a passionate and vocal supporter of complementary and alternative healthcare named Tim Bolen.

Mr. Bolen’s e-mail goes on to say, “The conventional medicine stranglehold on healthcare has been broken – period.” This comes courtesy of Tommy Thompson, Secretary of the Department of Health and Human Services (HHS), who signed approvals for the use of a new billing code system that will allow doctors to do something they haven’t previously been able to do: submit alternative medical procedures to insurance companies and Medicare.

Without question, this appears to have the potential of a major breakthrough.

WHO, What, When and Why

Tim Bolen explains that, until now, only two code systems have been available to health practitioners: the World Health Organization’s Diagnostic Codes, and the American Medical Association’s Current Procedural Terminology (CPT) Codes. These codes are required for Medicare and health insurance billing.

The WHO Diagnostic Codes, as the name implies, covers diagnosis only. But by controlling the CPT Codes, the AMA has the power to decide which medical procedures will have codes assigned to them. If a procedure doesn’t have a code, a doctor can’t submit the procedure for insurance coverage. And I’m sure you won’t be surprised that the AMA has refused to issue codes for alternative healthcare, thereby denying insurance coverage for alternative procedures.

To set the stage for the new codes, we have to go back a little bit. In 1996 Congress passed the Health Insurance Portability and Accountability Act (HIPPA), designed to simplify and standardize the processing of health insurance claims. The act allows HHS to test modifications of the existing code set standards. Responding to that opportunity, a healthcare consulting company named Alternative Links began developing its own codes, called Advanced Billing Concept Codes (ABC Codes), six years ago.

The ABC Code set is the new system that was given the green light by Secretary Thompson last month.

Two-year test

The list of healthcare organizations that have voiced their support for the ABC Codes reveals the types of medical services that will benefit: the American Association of Oriental Medicine, the World Chiropractic Alliance, the Midwives Alliance of North America, the Acupuncture and Oriental Medicine Alliance, the American Massage Therapy Association, and the American Nurses Association, to name just a few.

If there’s an obvious catch to all of this, it’s that the ABC Codes have been approved as a pilot program that will be tested for two years to examine how well it works. When (and if) the codes will be supported by widespread insurance reimbursement is unknown. Nevertheless, Synthia Molina, the CEO of Alternative Links, believes that this testing will lead to major improvements in several areas of healthcare management, including claims processing, clinical practice management, and health insurance benefit plan design.

The closing window 

But are there any downsides or drawbacks to the new ABCs? That remains to be seen. When I asked HSI Panelist Allan Spreen for his take on the situation, he recognized the obvious benefits to alternative healthcare, but wondered about the impact on insurance costs. Noting that 75 percent of the U.S. public has paid at least one visit to an alternative practitioner, he said, “Someone will have to pay for the positively immense increase in chargeable services that will come out of this.”

Questions about when the ABC Codes might be fully implemented and how they’ll affect the way alternative healthcare claims are assimilated by the insurance industry will have to wait. For now, there’s a more pressing matter. The ABC pilot program requires registration in order to participate, and the deadline for registration is March 16, 2003. Anyone unregistered by that date will not be able to use the codes during the two-year trial period. Healthcare practitioners, and organizations that would like to participate can register at alternativelink.com.

Call your doctor today (or your chiropractor, or your acupuncturist, etc.) and find out if he’s registered in this pilot program. If the answer is yes, you may find yourself involved in a pioneering venture with the potential to revolutionize integrated healthcare in America.


To Your Good Health,

Jenny Thompson
Health Sciences Institute

Source:
“Testing of ABC Codes Approved for Complementary and Alternative Medicine and Nursing” Alternative Link press release, Internetwire.com, 2/3/03