WASHINGTON, DC. January 30, 2003. An important milestone for complementary and alternative medicine (CAM) and nursing has been reached, as the U.S. Department of Health and Human Services has authorized a test of a proposed modification to the coding standards for the nation’s healthcare transactions. This historic action sets the stage for future authorization of Advanced Billing Concept (ABC) codes for products and services delivered by integrative healthcare practitioners.
The approval by HHS marks the culmination of a six-year effort by Alternative Link (The Link) and, more recently, The Foundation for Integrative Healthcare (FIHC) to plug a gap in the Healthcare Common Procedure Coding System (HCPCS), the healthcare industry’s equivalent of bar codes.
“This is a huge step toward measuring and comparing the quality and cost-effectiveness of different approaches to healthcare,” said Melinna Giannini, coding expert and board member of the FIHC. “Codes developed by the Centers for Medicare and Medicaid Services and the American Medical Association have left unanswered questions about integrative healthcare. With this approval, comes real promise that health policymakers will soon be able to draw from a new body of more complete and accurate data. It makes possible a more rational approach to research, management and commerce in healthcare.”
“Testing and standardization of coding for integrative healthcare, made possible by the HHS approval, will help improve healthcare quality and efficiencies by highlighting best practices among all approaches to care, not just among physician-directed and disease-based models of care,” notes Ms. Giannini. The approval creates an exception to the current HIPAA (Health Insurance Portability and Accountability Act) regulations that originally led to the naming of HCPCS as a national standard. Ms. Giannini credits legal and government relations experts—Tony Martinez, Debra Bass and Sam Brunelli—for “bringing the benefits of the ABC codes to the attention of health policymakers and employers impacted by rising healthcare costs.”
The ABC codes, developed in a joint venture between FIHC and The Link, will fill gaps on several levels, says Ms. Giannini, including the AMA’s HCPCS Level I codes (also known as Current Procedural Terminology or CPT codes) and the CMS HCPCS Level II codes. They will also help facilitate comparisons of the economic and health outcomes of conventional, complementary and alternative practices.
The ABC codes are supported by a variety of healthcare organizations such as the American Nurses Association, the American Association of Oriental Medicine, the Acupuncture and Oriental Medicine Alliance, the World Chiropractic Alliance, the Associated Bodywork and Massage Professionals, the American Massage Therapy Association, the Midwives Alliance of North America and other professional associations.
Both Ms. Gianinni and Synthia Molina, CEO of The Link, caution that the approval is for the testing of ABC codes in HIPAA transactions and that no one could state definitively when the codes would be supported by widespread insurance reimbursement. Still, Ms. Molina predicts that the code testing “will lead to major improvements in the national health information infrastructure, as well as health insurance benefit plan design, managed care and provider contracting, utilization management, clinical practice management, claims processing, outcomes research and actuarial analyses.”
The Foundation for Integrative Healthcare (www.fihc.org) delivers insight, competencies and tools needed by all healthcare professions to support rational health, healthcare and health policy decisions.
FIHC focuses on collecting, compiling and disseminating information on the characteristics and outcomes of care to improve public health, industry efficiencies and socioeconomic development.
Alternative Link (www.alternativelink.com) delivers information products and consulting services that help healthcare pioneers lead emerging markets. The company focuses on intelligence-driven infrastructure and analytical solutions that protect and enhance public access to health-promoting and cost-effective healthcare interventions.
Individuals and organizations interested in participating in the testing of ABC codes may apply as demonstration partners at www.alternativelink.com.