ACAM Assumes Health Care Reform Leadership Role...
The American College for Advancement in Medicine (ACAM) - To Train its Members on How To Get Health Insurance Reimbursement Under the NEW Health Care Reform Laws, and more...
Opinion by Consumer Advocate Tim Bolen
Monday, November 10th, 2014
ACAM will make its announcement this weekend at its annual meeting in Las Vegas, and will provide more information.
In the US, the term "Health Care Reform" can start an argument anywhere you look, and listen, with good reason. Democrats and Republicans, these days, are at each other's throats over the issue. The recent mid-term national elections had many winning Republicans chanting "Repeal ObamaCare..." to their prospective voters. And, the voters listened. To hear all of the rhetoric you'd think that the idea of Health Care Reform is dead. But, it is not - in fact, the opposite. Both Republicans and Democrats see the need for reform - they just disagree on many of the ways to reform it.
It takes some work to get by the political rhetoric spewed out by both camps, and get down to the essence of the disagreement. But, it is not impossible. Frankly, the differences are NOT that great, considering the extent, and complexity, of the overall, health care reform task. What is very interesting to what is called "alternative medicine" providers is that BOTH camps want AltMed paid for by insurance. More, health Insurance companies are desperately trying to find popular AltMed providers for their networks, but they can't find them.
Yes, you read that right. That was NOT a typo. Can't find them? That's right. AltMed providers are INVISIBLE to the health insurance system.
Invisible to the insurance system? Yup. There may be a building sitting on a Main Street in Anytown, USA, full of cutting-edge practitioners, and health insurance executives, and their families, make use of them, but when those Health insurance people get back to the office, and turn on the health insurance computer system, they are NOT going to find those practitioners, and that whole cutting-edge practice in the files... Why is that?
A lot of reasons come to mind, answering the question "why is that?"
Before We Answer That Question...
Let's talk about the problem, first, from a different perspective. Health Insurance, these days, is not what it used to be. Fifty-two percent of all US workers, these days, do NOT have conventional Health Insurance (like Blue Cross, Aetna, United Health Care). They get their health care coverage from their employer's self-funded plan. The employer’s healthcare plan may be managed by Blue Cross or Aetna, and the employee’s insurance card may look like it comes from a big company, but the employer is the insurer. Fifty-Two percent.... And, that fact, alone, changes the health care dynamic. Why? Self-funded plans have much more latitude in choosing benefits. They want cost savings, ie; cost effective health care.
Cost-effective health care? Almost a year ago I received a call from an associate looking for AltMed health professionals in two major cities. The AltMed health care professionals I could find, easily, but putting them in an insurance network and having them file claims using standard health insurance formats was something else. So, I made some more phone calls, and I found this health insurance contractor who was ALREADY working on this problem. After awhile I set up a meeting, with them, with some other people. One thing led to another, and, a proposal was made to several Health Care Training organizations. Several months ago, ACAM's President, Allen (Buddy) Green MD said: "Are you guys available for lunch tomorrow?" And, after a meeting with ACAM's Executive board, and an acceptance by the full Board, the serious planning began, right there.
So, what ACAM, and their partners in this project, are doing is three things: (1) Training health care practices how to set up their offices, including their Superbills (Patient Encounter Forms), to make their training, and their protocols, and practices, VISIBLE to the Health Insurance industry to (a) first, get patients reimbursed by their own insurers, (b) then get reimbursed themselves directly, and (c) be visibly DESIRABLE to local PPO networks for contracts, and patient referrals.
Sound simple? Well, it isn't. It is a lot of work - but it is not only possible, but it is the future of health care. ACAM, and their partners, are guiding it.
Why is this possible, but not push-button? I'll answer that this way: All conventional protocols have long been recorded, and measured, by insurers. Advanced health care protocols, and prescribed remedies are not captured and measured - so they have to be PUT INTO the system. Is there a way to do this? Yup. In fact, one of the partners in this project already has been showing providers how to successfully make their practice visible to the insurance industry. The system is working and can be expanded right now.
But, that's not enough.
Let me give you an example of the breadth of the problem...
I go to a lot of meetings with strategists and their groups. One of those groups is trying to solve the Autism problem. The group knew that I was the negotiator between ACAM and the their new partners so there were obvious questions, like? "Tim. Biomedical approaches to autism work. Can we get them paid for by health insurance?" My question, in response was " Can you give me an example of what you call the biomedical approach?" They did that, and it soon became clear that a whole lot of protocols, and remedies, had to be further documented so they could be put into the system. So, I made some more phone calls and found that it is possible to get cutting edge procedures, and products, quickly into the system once the protocols were properly identified.
The REAL Health Care Reform...
What the heck is ObamaCare? The real name of the legislation that passed is "The Affordable Health Care Act." I will be blunt. I am a Conservative Republican from Orange County, California and I very much like "The Affordable Health Care Act." Yes, there are parts I don't like, but, overall, it sure beats what we had before. There are three parts that are important to AltMed providers; (1) The fact that ALL health insurance claims filed after January 1st, 2014 must be filed electronically, eliminating personal handling of claims. (2) All insurance company claim systems are tied together in one main computer system, so that cost effectiveness comparisons can be made continuously. (3) There is a non-discrimination clause in the Act, meaning that if an insurer offers to pay for birthing services they cannot just pay for an OB/Gyn, they have to pay for midwives if that is what the customer wants (providing that the midwife is VISIBLE to the insurer).
The Republican Plan - reads, for an AltMed provider, even better. It is from the Heritage Foundation, and it is called "Health Care Reform: Design Principles for a Patient-Centered,Consumer-Based Market." Below is an excerpt of what are described as the Key Principles:
"The fundamental objective of a patient-centered health care system is to maximize value for individuals and families so that they receive more benefit and better results for their health care dollars, both as patients and as consumers buying health insurance. Only when individuals choose and own their own health insurance will the other actors in the system-health plans and providers-have the right incentives to deliver better value in the form of improved results at lower prices."
See what I mean? No matter what happens in the coming years regarding Health Care Reform AltMed is going to become mainstreamed. Why? Because it works, and it is cost-effective. More, patients like it.
So, what is it ACAM, and their partners in this project, offering to do?
Thought you'd never ask. I have here, on my desk, a signed copy of the "Letter of Intent" between the parties. Although specific details are confidential, remember, I was the negotiator. There is stuff I CAN tell you, and WILL tell you right now, about what is coming. It is this: ACAM wanted an exclusive for their members for this training and they agreed to meet three criteria to get that. (1) They agreed to provide a minimum number of practices, per year, for training (2) They were aware that the contracted partners wanted a controlled situation for the first two-hundred practices set up - like a Pilot Program, (3) They agreed to set up training, in addition to this insurance project, for health practitioners to use a paid for by insurance bio-medical approach to autism, and other neurological disorders, which the partners would provide a protocol for, and (4) They agreed to work with the partners to set up insurance paid-for protocols for other social problems involving Veteran Issues, etc.
In other words what ACAM and its partners, are offering is a PROCESS, NOT AN EVENT. Cutting-Edge practitioners, like ACAM members, are used to doing this very thing.
The First Course offering...
Just below is an excerpt for the original proposal. It is pretty explanatory:
Surviving and Thriving in Obamacare - This course is a workshop designed to set up the cutting-edge medical practice to not only survive, but to thrive, by leveraging the mandates in the Affordable Care Act (Obamacare) to the practice’s financial advantage.
The Affordable Care Act, popularly, or unpopularly, known as Obamacare, is changing, significantly, the way medical care is going to be reimbursed in the future, and the changes began January 1st, 2014.
Cutting-edge health care practitioners, like those trained, Certified, and Fellowshipped by the American College for Advancement in Medicine (ACAM) have had a natural reluctance to deal with health insurance carriers. Insurance issues are difficult enough to deal with when you are a conventional practice, and, as many practitioners have found, can be deadly for those leading health care into new areas.
But what if you could eliminate all those problems? And, for instance, have a system in place that gets, first, your patients, and eventually your practice, significantly reimbursed for your services?
Billing insurance has become so complicated that practices trying to do their own billing these days are putting themselves at risk. Why? Because billing rules are changing faster than any practice can keep track of.
The first common sense approach to electronic insurance billing is to use an independent fixed fee, and affordable, medical billing service that specializes in cutting-edge practitioner treatment reimbursement - and does it inexpensively.
Ask yourself this – would your patients be willing to pay, to you, $15.00 US per claim, to have a billing expert - totally knowledgable in billing for cutting-edge practices, like yours, submit, for them, a detailed, error free, claim on their behalf? The claim will be formatted to fit into the health insurer’s electronic systems so that those claims can be processed automatically, without human interference.
It gets better. One significant advantage to a cutting-edge practice is that the electronic billing system used by the independent biller is “common” to all insurers. And, when claims are billed with these systems, the insurers have the ability to compare the cost effectiveness of treatment methods provided by ACAM-trained providers with conventional medical outcomes for any diagnosis.
The course is designed to give practices an understanding of how insurance reimbursement can be supercharged without requiring the practice to do more than set up for success.
Why? How? Because, at the end of the training, each practice will be set up with several things: (1) a “Superbill,” to efficiently document the patient visit, specifically designed for the practice This form will dovetail, automatically, with the electronic billing service, and hence, the health insurer, (2) provider and practice code numbers that document all services offered as well as each practitioner’s “Scope of Practice” in a way that is totally understood by the health insurance industry (3) detailed, and automated, treatment documentation for the sub-coding necessary to justify the use of a specific CPT or Diagnostic codes for a service provided.
Practices will easily use this specially designed Superbill to accurately document each patient visit. This same Superbill is then sent to the medical biller who then creates and sends an insurance claim directing the patient’s insurance company to cut a check to the patient for the services you provided.
Those attending will learn why and how this Superbill can better manage a practice while also documenting each, and every, service that the practice provides in a way that gives the medical billing service the information they need to generate claims that will pass through the insurance company’s automated reimbursement system without triggering a red flag or causing an insurance adjuster to manually review the claim – a frustrating and extremely time, and labor-consuming, process. AND, when a claim examiner does get involved, your patients have a professional biller advocating for maximum reimbursement."
So, What does all this mean?
To the cutting-edge health care practitioner that works with the Pilot Project to get all that data entered into the health care system computers it means that, at first, they will get their patient's claims paid in a very big way (not everything, and not all at once, for it is a process). They will, of course, draw more patients when those patients find out they can get services, they want and need, paid for. Practitioners that take the second course (neurological issues like autism) will be bombarded with new patients who previously had nowhere to go. Official Statistics show that one in sixty-eight children now get autism. The CDC says that one in six children have neurological problems.
To the general patient this means better choices from their insurance dollar.
To the parents of autistic children this means not just hope, but real results.
Who is working on this?
This has been a top-secret project. But, at the ACAM event this coming weekend at the Green Valley Resort in Henderson, Nevada, a booth has been provided for the ACAM partners. There, if you are interested, you can get answers on the insurance portion of this project. Lots of them. Training classes should commence after the first of the year.
Many more meetings are underway before training for a final paid-by-insurance protocol for neurological issues, including autism, is set up. There has been a whole secret team working on this for a while - health professionals, product providers, attorneys, insurance people, the CARE Clinic people, Health Freedom people, and of course, Thriiive.com (Dana Gorman). Teri and Ed Arranga of AutismOne have been in on it from the start. In short, we intend to wipe out neurological issues, including autism, as soon as possible.
Tim Bolen - Consumer Advocate
Reprinted with permission