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A Report on the Use of Alternative Medicine

US News and World Report-March 9, 2015

About a third of U.S. adults use some form of alternative medicine, and most of them likely pay for it out of their own pocket. Alternative methods -- from supplements to acupuncture -- are used in preventive care as well as the treatment of chronic and acute conditions, but they often aren't covered by health insurance.

There isn't one reason why people choose alternative approaches over traditional medicine. One study published in Social Science & Medicine found that patients who choose a homeopath over a general practitioner are likely to do so because of "disenchantment with, and bad experiences of, traditional medical practitioners." Another in the Journal of the Medical Association suggested that people were motivated more by personal values, beliefs and philosophical attitudes about health.

Regardless of these findings, one thing is clear: Americans aren't flocking to alternative medicine to save money.

The Cost of Alternative Medicine

Americans spent more than $33.9 billion out of pocket on alternative and complementary medicine in 2007, the latest year for which comprehensive federal data are available. That amount includes visits to providers such as chiropractors and massage therapists, as well as products like supplements. While alternative medicine accounts for only about 1.5 percent of total health care spending in the U.S., it comprises 11.2 percent of total out-of-pocket health care spending, according to the 2007 National Health Interview Survey.

There's a perception is that alternative medicine is growing in popularity, with numerous websites dedicated to "natural health" and home remedies. But the research disputes this. According to an analysis of the Medical Expenditure Panel Survey from 2002 to 2008, the use of alternative medicine and spending on these services plateaued -- something blamed in part on the higher proportion of out-of-pocket costs.

Alternative Medicine and Insurance Coverage

When considering reimbursement, the Affordable Care Act mandates that insurers not discriminate against licensed health care providers, including those who practice alternative medicine, such as naturopaths, massage therapists and acupuncturists. But that isn't the same as requiring coverage.

Health insurers can limit coverage they deem experimental or not medically necessary, and they often do. Aetna, for example, says it considers alternative interventions medically necessary only "if they are supported by adequate evidence of safety and effectiveness in the peer-reviewed published medical literature."

So while such things as acupuncture, biofeedback, chiropractic care and electronic stimulation may be covered under their policies, music therapy, aromatherapy, therapeutic touch massage and a long list of other interventions are not.

Even when services are covered by an insurance plan, the insurer may require a statement of medical necessity or prescription from a primary care doctor. The coverage may also provided limited visits or cover only some of the services the provider offers.

Knowing Your Coverage Details

Health insurance coverage for alternative medicine is a mixed bag, varying from policy to policy. Your best bet is to make some phone calls and ask the right questions before making an appointment with a practitioner.

1. Call your insurance company. Ask your insurer the following questions:

-- Am I covered for this treatment?
-- Do I need a referral or prescription from my general practitioner?
-- Will I have to meet a deductible or pay a copay?
-- Am I limited to a certain number of visits?
-- What are some local providers in my policy network?

Make sure you write down who you talk to and what they say, should any coverage issues arise down the line.

2. Contact local providers. Next, call treatment providers, making sure to discuss the insurance plans they accept and their rates. Some alternative therapies, like chiropractic care, tend to cost more for initial visits than they do for follow-up appointments. Get a good estimate of how many visits you'll need to reach recovery or a point where returning won't be necessary.

3. Find out about additional costs. Ask your insurance representative and providers whether there are any additional costs you should know about. If, for example, your provider recommends that you add supplements or if your insurance company covers one treatment but not another, unexpected limitations and add-ons could come with a hefty price tag.

4. No coverage? Negotiate. If your health insurance doesn't cover the services you want, see if the treatment provider is willing to negotiate. Practitioners may be willing to put you on a payment plan or offer discounts to cash-paying customers.

Like most Americans who opt for alternative health care, you'll be paying out of pocket for at least some of your costs. Knowing just how much you'll be charged can help you budget for them ahead of time.

Ask The Expert: Charging for Missed Appointments

Question: I have had recent rash of patients missing appointments and I am hoping there is code to bill for these missed appointments?

Answer: Unfortunately there is no CPT code for “missed appointment.” It is not a billable or reimbursable service (or non-service, as it were) from any insurance carrier. However, an office is not precluded from billing a patient for a missed appointment. In fact, charges for missed appointments are very common among all health care professionals. Dentists, in particular, typically have strict policies on missed appointments and will charge patients when they miss or at least do not notify or reschedule within 24 hours of the appointment. Policies like this are more common than uncommon. The fear of the charge generally will influence a patient to not miss the appointment or, at the very least, contact the office timely to avoid being charged. The latter is in reality what most offices would prefer as they have the ability to schedule another patient for that time.

If you wish to start implementing a missed appointment fee there are few things that should be done to avoid confusion and misunderstanding. Patients must be informed at the time they schedule the appointment that there is a specific policy about missed appointments. It would be best for it to be posted in a conspicuous place, available to read at the time, or, at minimum, given verbally. This should be part of office protocol and followed in the same manner with each patient so the office can ensure that the patient was clearly informed and cannot later state they were not “aware.” Note the burden of proof that the patient was made aware is on the creditor (doctor). This would include costs and what constitutes a missed appointment, such as less than 24 hours’ notice.

Remember, it is not so much that the doctor wants the fee (note the fees for missed appointment are minimal $20-25 typically, and not at the full price of the services that would have been provided) but simply wants the patient to respect the professional status of the services and the office.

Many offices are elastic in implementing the policy and may even forgive payment for those patients who have a valid excuse or other issues that were precedent. A patient whom has had the fee forgiven may likely be more respectful after a favor has been afforded and feel a greater sense of obligation to the office in the future. Though it could go the other way, it is best to remember why the policy is there: not to collect a fee but to ensure compliance. If a patient does not comply, at least we know to not schedule them and exacerbate it further.

The October 1, 2015 ICD-10 Code Change

The question everyone is asking is will ICD-10 happen this year or will it be delayed as it was in 2013 and 2014? We have sought out the nation’s top experts to give us their forecast, and have summarized the findings.

All agree that the implementation and use of ICD10 is now appearing more imminent as the opposition to its adoption has gotten smaller. In 2013 there was almost no group who endorsed its use and it was delayed. In 2014 while it did gain momentum there still a fair amount of very vocal and strong opposition and it was delayed to 2015.

Last year’s delay was buried in a national budget bill. However, this year that same budget bill has already passed and it was presented without any language to delay the ICD10 start in October.
The “ICD10Monitor” a publication which follows closely all related information on ICD9 and ICD 10 reported the following:

Despite a significant lobbying effort mounted by a small but very vocal minority within the healthcare industry, the implementation of ICD-10 is expected to proceed without further delay.
The failed push marked a third attempt to delay the Oct. 1, 2015 ICD-10 implementation deadline well into 2017. Members of Congress rejected the request to include language that would again delay ICD-10 in the spending bill that was passed by Congress on Dec. 11 and ratify by the Senate on Dec. 13.

“Congress issued a strong message and sent the ‘delay ICD-10’ crowd back to the bench,” said Chris Powell, CEO of Precyse, a provider of health information management solutions and staunch advocate for ICD-10.

There are also many more signs indicating the moving forward of ICD10. Medicare has done extensive beta testing with ICD10 with several hospitals and doctors of all specialties and they indicated that the system was functioning as expected. Medicare has also begun publishing (which was not done last year) their allowed ICD10 codes sets per their National and Local Coverage Determinations.
Other major carriers (United Health Care, Blue Cross, Blue Shield, etc.) have also done testing and have set specific training and timelines for themselves and their providers to adhere to the coming transition.

Perhaps the most compelling argument for ICD-10 is reflected in the reason medical specialty societies pushed for the new coding standard in the first place. While ICD-9 is focused on reimbursement, ICD-10 is a more precise system for assessing quality of care and tracking diagnoses for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

The limitations of the outdated ICD-9 coding system have the very real effect of getting in the way of providing the best and most cost-effective patient care. ICD-9 is extremely limited in its ability to capture even basic patient information, such as classifying laterality and coding for severity of illnesses, which can result in payment errors and delays in payment processing.
We will continue to monitor the progress and will forward information as it is received, but by all indications it appears ICD-10 is “To Be”.
Interested in taking a peek at what the conversion of your favorite code will look like, plug it in to our code converter to find out

Medicare PQRS Reporting for 2015

Medicare reporting for 2015 now only requires 2 measures, pain and functional assessment. The blood pressure measure was eliminated for 2015. To successfully report providers must report these measures on at least 50% of eligible visits. Those providers who do not successfully report these measures will have a 2% reduction of the Medicare fee in 2017.

2015 Medicare Fees and Deductible

Deductible for 2015 remains $147. Note deductible is for all covered services meaning in a chiropractic office this is limited to spinal manipulation but also includes essentially any and all services done in a medical setting. Therefore deductible is met with any covered service by any provider.

Fees for 2015 are scheduled to increase but are not posted and have been delayed to publish on or about January 20, 2012. However there will be potential reductions for non-use of electronic health records (1%) and PQRS (0.5%) respectively. If you did not do an attestation of a certified E H R by October 2014 there will be a 1% decrease in your 2015 fees. This amount increases 1% each year but caps in 2020 at 5%. This reduction equates to about $0.30 to $0.60 for 2015. Additionally there is a 0.5% reduction in Medicare rates for offices that did not report PQRS measures in 2013 then the reduction applies. If you did PQRS measures in 2014 those will count towards 2016. If you did do PQRS measures you will also receive a bonus payment from Medicare for 0.5%

Visit the Medicare Portal of this Digital Directory for your state specific allowances.

Be Aware of Virtual Credit Card Fees

Many providers accept credit cards as a form of payment, but need to be aware of the associated fees when accepting virtual credit card payments from insurers for reimbursement purposes. Virtual credit cards are unique card numbers generated for a specific one-time transaction and linked to real accounts with card issuers. Clinics need to be aware that these transactions carry significant fees compared to traditional forms of payment--up to five percent of the transaction amount--and may include additional fees to offset fraud risk when card numbers are entered manually, which in effect reduces reimbursement to the clinic. It also effectively transfers the cost of the transaction from the payer to the clinic.