Page 16 - Mobility Management, March 2018
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Funding Series
CODING &
EFFICACY
THE CURRENT FUNDING SYSTEM SKEWS AGAINST CRT.
IS THERE A BETTER WAY? By Laurie Watanabe
What’s in a name? Not much, if you recall your high school Shakespeare. Names are labels that can be quite arbitrary, without much depth of meaning or signi cance.
But what happens when a name means nothing at all? That
could be the argument against the current way that complex
rehab technology (CRT) is described and grouped in reimburse-
ment policies practiced by health insurance payors. Too often, the
results are inadequate funding due to CRT products that are inaccurately
and randomly de ned and grouped with much more basic products that have very different applications. Ultimately, the consumer pays the price — especially when that consumer has signi cant, permanent disabilities.
HCPCS History
The American healthcare system is immense, with millions of patients to serve and billions of claims to process each year, according to the Centers for Medicare & Medicaid Services (CMS). No one would reasonably argue against the need for an ef cient system to process and pay those claims.
Thus, the “HCPCS” code.
Julie Piriano, PT, ATP/SMS, is VP of Rehab Industry Affairs & Compliance Of cer for Quantum Rehab. “The Healthcare Common Procedure Coding System (HCPCS) was established in 1978 to provide a stan-
dardized means for CMS to describe the speci c items and services provided in the delivery of health care,” Piriano explained. “The development and use of the Level II HCPCS codes, also known as alpha-numeric codes, began in the 1980s, at a time when the number of seating and wheeled mobility products available on the market was extremely limited.
“Coding ‘equivalent products’ is necessary for third-party payors to ensure claims are processed in a consistent manner.
This also allows third-party payors to track utilization trends. According to CMS, there are national HCPCS codes representing approximately 6,000 separate categories of ‘like items’ or services that encompass millions of products from different manufacturers.”
14 MARCH2018|MOBILITYMANAGEMENT MobilityMgmt.com
