In March 1996, Alternative Link began compiling terminology to describe alternative medicine, nursing and other integrative healthcare interventions.

The Company first established criteria for evaluating the legitimacy of each term. For example, to be designated as official terminology, each term needed to represent the services or supplies delivered by at least one type of CAM practitioner that 1) provided healthcare services, 2) held a license as a healthcare provider in at least one state, and 3) had access to malpractice insurance for the licensed healthcare practice. Each term also needed to be reviewed and accepted by a predefined number of SMEs.

Alternative Link hired an SME on holistic medicine to identify terms that could be considered candidates for official terminology. The SME queried nationally certified schools and alternative medicine clinics to secure terms used in academic institutions and private practice.

To identify terms that described distinct massage techniques included in massage therapy training, Alternative Link queried the Mesilla Valley School of Therapeutic Arts.

The Company then elicited formal reviews of the terms from additional academic institutions, national associations of practitioners and other SMEs.

With feedback from these SMEs, Alternative Link organized terms under broad categories or section headings including the following:

Alternative Link also developed "E&M" terms (similar to those used in CPT codes for Evaluation and Management Services) to reflect practitioner behavior in taking patient histories and delivering evaluation and management services for CAM.

Alternative Link entered terms and corresponding category designations into a database. The Company then designed intake forms to collect 1) additional terms missing from the database, 2) information on average hourly rates, and 3) estimated charges for individual interventions.

The Company printed out terms from the database and used these in a survey instrument administered between January and June of 1997.

On a separate intake form, respondents listed circumstances associated with individual episodes of care that might influence fees, e.g., standard fee schedules, hourly rates and extenuating circumstances.

In total, over 120 practitioners of acupuncture, massage therapy, chiropractic, naturopathic medicine and holistic medicine participated in the above surveys, in 11 separate meetings.

Alternative Link characterized interventions delivered by each practitioner type and established usual, customary and reasonable (UCR) charges as the 10th to 90th percentile of reported fees.

In May of 1997, Alternative Link hired an SME on CAM claims management. This, SME, a former preferred provider organization (PPO) network developer for an insurance company, supplied non-proprietary information about the contracting, claims anagement and coding systems used by such companies. The information described non-proprietary aspects of business processes used to process claims for alternative medicine practitioners in a dozen or more states between 1995 and 1997. The consultant also supplied non-proprietary information about the relative values used by such insurers to negotiate fees with CAM providers in those states.

Alternative Link developed models based on this information and sent approximately 1,200 terms and corresponding fee ranges to SMEs for their comments.

Alternative Link reviewed the SME feedback and identified overlaps in terms: 1) similar terms and expanded definitions that had essentially the same meaning, and 2) similar terms but with different expanded definitions and different meanings.

The Company addressed these issues by 1) rewording definitions to meet multiple user needs or 2) clarifying terms and expanded definitions. In both cases, Alternative Link contacted the organizations that did the original review to verify the appropriateness of the changes.

To develop nursing terms for the ABC code set, Alternative Link worked with the developers of three nursing terminology systems:

Alternative Link determined that the nursing terminology development and management processes were sufficiently controlled to be viewed as an extension of the Company's internal business processes. The Company also determined that it met or exceeded its own criteria for establishing legitimacy of terms. With the support of SMEs, Alternative Link refined the terms for use in ABC codes and designated the terms as o fficial ABC terminology.

To develop terms for midwives, Alternative Link worked with NIC, three in-house SMEs on midwifery, and an instructor at the National College of Midwifery. Members of the Midwives Alliance of North America subsequently reviewed the terms for accuracy, precision and appropriateness.

To develop terms for mental health interventions, Alternative Link worked with NIC and HHCC. An SME provided additional insight on appropriate hierarchical placement of these terms within ABC codes.

To develop terms for Oriental and western herbs and botanicals, Alternative Link compiled information from reference materials recommended by nationally certified academic institutions focused on CAM. In-house experts in homeopathic remedies relied on additional reference books to develop terms for homeopathic remedies. Alternative Link organized these interventions by scientific name.

To develop terms for interventions that require training beyond core curricula of nationally certified academic institutions (e.g., reflexology, guided imagery and non-clinical hypnotherapy), Alternative Link reviewed recognized certification or continuing education courses and nationally recognized training standards. The Company then ensured expanded definitions for the terms made note of the additional training requirements.

Ongoing development of terminology that comprehensively describes interventions of alternative medicine, nursing and other integrative healthcare is at the core of our efforts and endeavors, and we encourage users of the ABC codes to help us expand and improve the code set. To request new terminology and codes, please click here.