Why EVERY US Health Practitioner Needs to Use ABC Codes RIGHT NOW...

Opinion by Consumer Advocate  Tim Bolen 

Tuesday, February 27th, 2007

Every practitioner in the United States knows that the current US Department of Health & Human Services (DHHS) billing code system doesn't work.  A whole industry has sprung up around the simple fact that it doesn't work, trying desperately to keep practitioners out of trouble when they attempt to wend their way through the billing miasma.

And, a miasma it is.

Worse, is that the system, cumbersome and confusing, has been contracted out, region by region, to insurance companies - and not necessarily "health" insurance companies, for management.  In Los Angeles, for instance, several years ago, when a billing person in a practitioner's office called "Medicare" on the telephone to get assistance, the phone was answered by an employee of a Title Insurance Company.

US Medicare has NO FEDERAL EMPLOYEES. None.  It is all contracted out.

Yes, I said Title Insurance . Title insurance is protection against loss arising from problems connected to the title to your real estate property (like your home).  

Scary?  Yes, that is.  And even scarier is that those Medicare contractors' employees and even the practitioner’s billing staff are offered cash incentives to rat on their employers when they can identify  "fraudulent claims."  Practitioners walk a difficult line, trying to bill Medicare, Medicaid, or health insurance using the DHHS system developed by and for physicians.  Accusations of fraud are flung easily – since the government rewords whistle-blowers and collects a whooping $10,000 per claim in penalties against those who bill incorrectly - including the Medicare and Medicaid contractors.  No wonder insurance companies are reluctant to cover alternative medicine practitioners. There's good money, for anyone to snitch on a practitioner who uses the wrong codes or on an insurance company who processes an incorrectly coded claim.

I'm not surprised when I hear that health practitioners drop out of the system in waves.  They just don't need the hassle.  Take a system that is "sketchy" at best, designed by bureaucratic dolts in an agency that has little, or no, concept of its role - DHHS - and severely penalize those who have to use it - and you have a formula for disaster.

More, once the system is used, at all, the data gathered from the use of that system becomes the basis for health (removed text)  policy decisions in the US.  For policy makers like elected officials, insurance companies, government agencies, think tanks, you-name-it, make decisions based on the crappy codes provided by DHHS.  The result is stupid, incompetent and limited use of available health care.

Are you alarmed yet?  You should be.  I've just told you the real reason why the system itself is the number one killer of Americans.  And, the number two, and the number three. The system only codes and measures expensive medical treatments while repressing data from the vast majority of practitioners who are not conventional doctors.

In short, without change in the billing code system RIGHT NOW we have no chance of revising or changing our failed system.

Right at this moment there is a revolution going on in US Health Care.  The American economy simply cannot withstand the manipulations of US Health Care's current masters.  This is the year it will happen - and the seeds will be sown for the future.  The rebuilding begins now.  Hence, the title for this article...

So, Why does EVERY Health Practitioner Need to Use ABC Codes RIGHT NOW?...

Four reasons:

(1)  All health care transactions are in the process of going "electronic" as fast as people learn to use computers.  All transactions with the Federal government (Medicare, Medicaid, etc), right this minute, must be billed electronically. Electronic transactions are easier to handle, and get paid much faster.

(2)  Practitioners need billing codes that ACTUALLY DESCRIBE what they do, so that they don't accidentally commit fraud and have to endlessly explain what they do, on paper, or electronically, trying to get paid for their services using codes that "sort of, kind of" come close to the services they provide.  Especially since making a "mistake" in billing codes could end up described as a felony by an eager employee in the practitioner’s office or the insurance contractors office who are looking for some easy money. 

The problem with the current system is that, because of US Department of Health & Human Services (DHHS) mismanagement, there are only codes (CPT Codes) for conventional Medical Doctors – representing about  14% of the health practitioner base available to solve our nation’s pressing need for more care at less cost.  AND, even conventional doctors have a hard time picking the right codes because DHHS dictates what these doctors can and can’t do if they are going to get paid. 

There are, virtually, no "approved" billing codes available for the other 86% of, lawfully operating health practitioners.  For more information on this problem - read my earlier article "Why is the US Health Care System Failing? - Incompetent Management at DHHS...".

ABC Codes were designed for twenty four health practitioner types who lack billing codes – and for medical doctors who practice alternative medicine.  And they can be used RIGHT NOW, even though the dolts, and dimwits, at DHHS have not yet approved the system.

(3)  The people who designed ABC Codes, ABC Coding Solutions (formerly Alternative Link), knew what they were doing, and spent eleven years and millions of dollars, researching and designing a system that works.  They, unlike DHHS management, actually went out into the real healthcare world and asked questions. They actually looked up existing State and Federal laws to determine EXACTLY what the "Scope of Practice" was in each state for each of the twenty-four (24) lawfully operating health practitioner types. Then they went to subject matter experts for each health profession and asked THEM which ABC codes described treatments offered by their colleagues.

And those twenty four classifications answered in explicit detail.  In other words, the ABC Codes system, unlike the DHHS offering, actually was designed to work, and they properly express REAL health care offerings in America.  At the moment there are 4,500 ABC Codes.  And, they're beautiful.

(4)  Can you use ABC codes now?  Yes, and for less than $50 per month per practitioner, with no limit to the number of patients it will carry, practitioners can go on-line and create truthful claims using a tool created by ABC Coding Solutions called "eClaim.biz" .  Data from all practitioners is stored from this tool in a huge HIPAA compliant secure data center, and the statistics (but not the client data) are available instantly to move all practitioners’ care into the mainstream.

(5)  Once ABC Codes are in general use for documenting what is really going on, decision makers will have access to data inside "eClaim.biz" and can compare all healthcare services to the cost of conventional medicine.  Those professions can use those statistics to claim their rightful place in the US health care paradigm.

Want to SEE what I'm talking about?  

At the end of this article I'll give you a tour of ABC Codes - and I'll make it possible for you to see how the system can affect YOU personally, whether you are a practitioner or a consumer.

First, a history -   Melinna Giannini, the President and CEO of ABC Codes, before starting this company, for years designed health plans for industries that wanted to run their own plans, and manage them themselves.  She was no stranger to the problems of health care management issues.  Then one day her health started to decline, and it became hard to keep up with the daily load managing the intense kind of demands put on someone in her line of work.

So, she grabbed her health insurance card and went to see her doctor - and there it began.  $15,000 later, the amount paid by her insurance company to providers for tests, tests, and more tests, and treatments and more treatments, she was absolutely no better than the first day she went to see somebody.  Sound familiar?

Then she went to see a so-called "Alternative Medicine" practitioner, spent an un-reimbursed $500 of her own money - and got her life back.  Sound familiar?  Of course it does.  It's happening every day in America.  About half, now, of the total dollar spent on health care in the US, right now, is out-of-pocket - people seeking, and easily finding, "alternatives" to the crap known as mainstream "non-critical" medical care.

Everybody knows, for instance, in the US, for cancer and heart disease, the conventional treatment is worse than the disease.

Reality now - "ABC Codes" is a three part system.  Originally, Alternative Link was set up to design new codes and get them through the DHHS approval system.  Then it's function was changed to focus simply on the use of the ABC codes, and they changed the company name to "ABC Coding Solutions."  The original idea was that when ABC codes became accepted, the company would make money on the use of the codes, just like the AMA does with CPT codes.  But when Secretary Tommy Thompson left DHHS, before ABC Codes were approved, and DHHS management spit on the three years worth of data submitted, they took another tack.

What was that tack?  Simple - shove DHHS aside and offer the use of the codes directly to the practitioners who needed them as they were filing claims as a means to reduce fraud, save time and quickly justify their fees.

How did they do that, and how could that possibly work?  ABC Coding Solutions set up a subsidiary company called "eClaim.biz" and, after eight months of beta-testing, launched their new product about six weeks ago.  It works quite well.

What is "eClaim.biz,"  and what is it designed to do?  As the web page for "eClaim.biz" says:

"eClaim.biz is the only web-hosted application that supports paper and electronic billing claim filing within the legal scope of practice for multiple practitioner types in all 50 states and the District of Columbia."

This inexpensive program has code look-ups for all codes sets needed to file professional claims that save even more time trying to find the right code (you don't have to buy a shelf full of code books).  ABC codes are mapped to the closest DHHS codes and help truthfully document what was done to treat the patient while the practitioner only views those codes that he, or she, is allowed to use in the State where the patient was seen.

Those that have used the program report huge increases in the number of claims the insurer or payor will reimburse.

Even if the insurance company does not pay for the services, practitioners are turning their patients into advocates for fair reimbursement policy.  And the patient gets a very professional bill for the services provided.  It is probably that in most cases this bill would suffice for the new Health Savings Account (HSA) deductions - more research is being done on this connection.

If you are one of the following practitioner types listed just below, than this system was designed for you, with input from your profession. Better, if there aren't enough codes for what you do - they'll, with your help, make them.

I suggest you go to the "eClaim.biz,"  website and get acquainted, right now.

Why "right now?"  A lot of reasons.  But the best one I can think of is that the US Congress is revising health care this year and they need usable statistics to show why YOUR health care practice needs to be paid for by Medicare, Medicaid, or health insurance.  The next best reason is that this product will bring your billing practices into the new era.

Stay tuned...

Tim Bolen - Consumer Advocate