Question:
1) What are ABC codes?
Answer:
ABC codes represent over 4,500 healthcare products and services. They fill gaps
in older medical code sets such as CPT ® and HCPCS II and the retirement of
state-specific HCPCS III codes.
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Question:
2) How are ABC codes used within the healthcare system?
Answer:
ABCcodes are a shorthand means of documenting healthcare procedures and
treatments. Codes are an essential tool when computers are used to reduce
paperwork and costs. Codes are also essential for managing the healthcare
supply chain.
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Question:
3) What kind of care is represented by ABC codes?
Answer:
The codes reflect care that is not described by conventional or allopathic
centric code sets. ABC codes describe nursing, behavioral health, alternative
medicine, ethnic and minority care, midwifery and spiritual care.
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Question:
4) Will other areas of healthcare be addressed by ABC codes?
Answer:
Yes. ABC codes can reflect any healthcare service or supply that is not
prohibited by law and/or not already coded in other code sets.
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Question:
5) How else are codes used?
Answer:
Codes are essential to the delivery of healthcare. Practitioners use them to
accurately describe care provided. Insurance companies and healthcare
policymakers use them to determine if treatments for a given diagnosis are
effective or ineffective.
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Question:
6) Who uses codes and in what specific ways?
Answer:
Virtually every practitioner and organization in the healthcare system uses
codes for medical record keeping, practice management, billing, processing
insurance claims and for designing and managing benefits. Researchers use codes
to identify what care works best.
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Question:
7) What are the risks of incomplete, inaccurate or imprecise codes?
Answer:
Inadequate codes lead to inappropriate payment, fraud, fines (of up to $10,000
per claim), inaccuracy and incomplete data collection.
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Question:
8) How do ABC codes fill gaps in healthcare business processes?
Answer:
ABC codes map to medical codes required for use in electronic claims to generate
data. For a demonstration of this mapping, please visit www.ZipClaims.com. ABC
codes support managed care contracting, claims forecasting, practice
management, insurance billing, claims processing and third party reimbursement.
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Question:
9) How do ABC codes help automated business processes?
Answer:
ABC codes digitize information to simplify data collection,
analysis and reporting. They fit into industry standard forms (1500) and help
practitioners itemize and justify their charges.
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Question:
10) What is an RVU and why are RVUs important?
Answer:
RVUs (Relative Value Units) establish the financial worth of specific
interventions in relation to other interventions. RVUs are assigned to each
healthcare code to support health economics studies, health insurance benefit
plan design, managed care and provider contracting, utilization and clinical
practice management, claims processing, outcomes research and a variety of
actuarial analyses.
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Question:
11) How do RVUs get assigned?
Answer:
ABC Coding Solutions licenses ABC codes to Relative Value Studies, Inc. (RVSI),
to develop RVUs for services represented by ABC codes. RVSI conducts surveys of
the integrative healthcare practitioner communities to establish RVUs and then
licenses the RVUs back to ABC Coding Solutions. RVU’s are developed by Relative
Value Studies, Inc. More information about their processes can be found at
www.rvsdata.com
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Question:
12)What are relative value conversion factors?
Answer:
RVU conversion factors are monetary multipliers that convert relative value
units (RVUs) into payment amounts. CFs are reported as dollar figures. They
reflect healthcare practice costs in a particular office, group practice,
healthcare institution or region. They take into account cost-drivers such as
overhead (e.g., malpractice insurance), rent, salaries and the cost of living.
For example, the CF in a West Coast region might be $6.50 while a CF in a rural
state like South Dakota might be $5.25.
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Question:
13)How are RVUs used?
Answer:
RVUs are typically multiplied by regional conversion factors (CFs) to establish
a dollar value for any intervention. For example, an RVU of 5.0 associated with
ABC code CBAAA would be multiplied by a conversion factor of $6 to establish a
fee of $30 for a mind-body treatment. For another service, the RVU might be
10.0 and, with the same conversion factor of $6, the baseline value would be
$60.
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Question:
14)Why are scope of practice guidelines attached to ABC codes?
Answer:
In contrast to the laws for conventional medical doctors, the laws for 80% of
licensed healthcare practitioners vary by state. Scope of practice guidelines
help practitioners avoid fraudulent billing by assuring they are billing within
their scope of practice.
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Question:
15)How are scope of practice guidelines used with ABC codes?
Answer:
ABC codes help practitioners and organizations identify healthcare products and
services they can legitimately be provided to patients. Legal practice
guidelines added to ABC codes help the insurance industry and practitioners
avoid malpractice and fraudulent billing.
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Question:
16)How are scope of practice guidelines developed?
Answer:
ABC Coding Solutions’ rules engine references thousands of laws regulating
multiple healthcare professions. The references are then used to help
practitioners avoid fraudulent billing by assuring they are billing within
their scope of practice.
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Question:
17)Are ABC codes compatible with other codes and systems in use
today?
Answer:
Yes. ABC codes work side-by-side with medical codes. ABC codes fit into the same
business forms, data fields, software applications, information systems and
business processes as older medical codes such as CPT® and HCPCS II. They also
help fill gaps left by the retirement of state-specific HCPCS III codes.
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Question:
18)Who can use ABC codes?
Answer:
Anyone can use ABC codes. Please visit www.ZipClaims.com to learn how ABC codes
mapped to medical code sets are used document and enhance the process of filing
electronic claims.
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Question:
19)Do you have any tools to help a practitioner or clinic conduct
electronic HIPAA transactions?
Answer:
Please visit, www.ZipClaims.com to view a demonstration of using ABC codes to
facilitate filing of electronic claims.
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Question:
20)Can I order ABC codes from the web site?
Answer:
Yes. Please click here to proceed to the shopping cart.
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Question:
21)How are ABC codes developed?
Answer:
ABC codes are developed in an open and unbiased manner that reflects the
official training, practices, vocabularies and terminologies of healthcare
professions. To submit a code request please click here.
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