A substantial part of physicians’ office overhead is related to providing codes for insurance claims. And a major part of the revenue of the American Medical Association (AMA) is derived from its exclusive copyright on the Current Procedural Terminology (CPT) codes required on Medicare claims.
“CPT codes do not aid in the diagnosis or treatment of any patient,” writes Dr. Lawrence Huntoon in the summer 2012 issue of the Journal of American Physicians and Surgeons, http://www.jpands.org/vol17no2/huntoon.pdf. Their main purpose is to collect payment from third parties, and they are also useful for data mining and system gaming.
“Elimination of CPT coding is the epitome of administrative simplification,” Huntoon explains. Physicians who opt out of third-party contracts and Medicare and bill patients directly can pass along substantial savings to their patients in this way. Also, time not spent on coding or remaining current with ever-changing requirements can be spent caring for patients.
Insurance companies, however, are not happy if patients submit the old-fashioned kind of itemized bill to request the reimbursement to which they are contractually entitled. Insurers want physicians to perform the clerical function of coding, at no cost, although the insurer will certainly object if it disagrees with the code the physician submits. Some insurers attempt to deny payment to their subscribers if the physician does not provide a CPT code.
State medical associations and licensure boards may collude with insurance companies to force physicians to practice in a way that serves the insurance industry and the CPT coding monopoly.
Claims processing, including the assignment of CPT codes if the insurer wants them, is the responsibility of the insurer. Physicians who have no contract with the insurer should not be forced to provide unpaid labor to the insurer for this function, writes Huntoon.
“It is also inappropriate for insurers to foist the responsibility for coding onto patients… This is an abusive insurance practice and an onerous imposition on patients.”
The Journal is an official publication of the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties, (www.aapsonline.org) which was founded in 1943 to defend the sanctity of the patient-physician relationship.