Breaking the code

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.

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.

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.