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Readers’ Corner: AMA Monopoly, Doctors Threatened With Jail

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This week we address questions about the AMA’s monopoly in billing codes, discuss doctors being threatened with jail—and get Trent Lott into the right political party!

AMA Monopoly on Billing Codes

Tom (a physician) writes:

OK, so you want me to not accept Medicare and any insurance to win the point that we need to move towards the ABC billing? While this proposition makes sense to my rebel side, who will pay my bills in the mean time?

This is a misunderstanding. We don’t recommend that you do or do not accept Medicare or insurance. We did, however, note in our article from two weeks ago, on prosecutors threatening physicians with jail sentences, that obscure provisions buried in legislation passed over the last fifteen years make it riskier for integrative doctors to do so.
For more on this, see our response to fellow physician Richard below.
Nancy (another physician) writes:

If the ABC codes are different from the CPT codes and include integrative medicine treatments and evaluations, but the CPT does not, how can the ABC codes be converted to CPT codes without risking inaccurate or fraudulent CPT coding, putting the M.D. integrative medical practitioner (like me) at risk?

When the ABC medical billing code information is translated into the American Medical Association’s CPT Code, this is “supplementary information”. Both the ABC and the CPT information is available. So there is nothing misleading or fraudulent about the translation.
William (another physician) writes:

I will post this on my Twitter page, Facebook and send this to my patients. Thanks for letting me know. I will be adding things like this to my site as well as other things.


Doctors Being Threatened With Jail

Richard (also a physician) writes:

I read with interest your frightening report [on jail time for doctors]. However, you did not outline a solution that can be implemented into Federal and State Legislation. If you have solutions to this crisis, please outline it immediately and publish it on your website, so we can submit comments and express concern to our congressional leaders. It’s an emergency! If we don’t have a healthcare system, you might as well cancel your website.

Thanks for the chance to clarify the approach we were advocating in that article. We see it as a four-step process:

  • An immediate first step is to repeal the language that makes any “unnecessary treatment” billed to the government a matter of fraud. This is much too vague and is interpreted to include integrative treatments as well as truly unnecessary ones.
  • The next step is to repeal the provision that allows insurance companies as well as the government to decide if a treatment is “unnecessary” in the criminal sense of fraud.
  • A third step is to make a clearer distinction in the law between billing error and fraud, since even Medicare staff can’t make sense of the rules.
  • A fourth step would be to exempt doctor protests over government price controls from anti-trust.

If these steps sound like band-aids, they are. What we really need is genuine healthcare reform, but that is too big a subject for here.
Tom (a nurse) writes:

As a RN who cannot bill Medicare, there are many other threats to nurses from HIPAA, including jail time, fines, and a ruined life. This is just one of the many reasons not to go into health care in the first place and I’m working diligently to get out of it altogether.

We should have covered nurses in the article as well. Thanks so much for letting us know.


Robert writes:

RE: “Trent Lott (D–MS) ”: Retired Senator Trent Lott is probably surprised that he was a Democrat. He always claimed to be a Republican.

Whoops! Sen. Lott was the leader of the Republicans in the Senate.

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