美国烟草使用治疗提供者的计费做法。

Billing Practices Among US Tobacco Use Treatment Providers.

机构信息

Alpert Medical School of Brown University (ELB); Rhode Island Hospital (ELB, LEH); Mayo Clinic College of Medicine and Nicotine Dependence Center (MVB); Steeplechase Cancer Center at Robert Wood Johnson Barnabas Health University Hospital Somerset (CK); University of North Carolina at Chapel Hill School of Medicine (AOG, CR-M); Rutgers Robert Wood Johnson Medical School (MBS); Florida State University College of Medicine Tobacco Program (MD); Fire Department of the City of New York Tobacco Treatment Program, IQuit Smoking at Jersey City Medical Center RWJ Barnabas (MPB); Business Practices Committee of the Association for the Treatment of Tobacco Use and Dependence (ATTUD) (ELB, MVB, CK, AOG, CR-M, MBS, MD, MPB).

出版信息

J Addict Med. 2018 Sep/Oct;12(5):381-386. doi: 10.1097/ADM.0000000000000423.

DOI:10.1097/ADM.0000000000000423

PMID:30044243

Abstract

OBJECTIVES

The US Affordable Care Act (ACA) now requires almost all health insurance plans to cover tobacco use treatment (TUT), but TUT remains underutilized.

METHODS

We conducted an anonymous online survey of US TUT providers in 2016 regarding their billing practices.

RESULTS

Participants (n = 131) provided services primarily in medical and behavioral health settings and were from a variety of professions. Most provided intensive individual (>15 minutes per session) and/or group counseling. Although most reported that their organization accepted at least 1 form of insurance, only 34% reported that TUT services were billed, with about equal proportions endorsing billing under their own independent tax ID and "incident to" billing under a supervisor. Half of billers (52%) reported using at least 1 Current Procedural Terminology code. The most common codes were 99406 and 99407, but 18 unique codes were specified. Themes of qualitative responses (n = 101) included concern about how to initiate and sustain adequate reimbursement, and experiences with billing not being "worth" the time or effort.

CONCLUSIONS

Overall, results demonstrate a need for providers, administrators, and billing managers to work collaboratively. Even with the ACA mandate, and consistent with prior reports, reimbursement rates may be inadequate for intensive counseling. Areas for advocacy include recognizing that TUT requires similar intensity, expertise, and reimbursement as other substance use disorders and chronic medical conditions; giving Tobacco Treatment Specialists the ability to bill independently; and improving coordination between intensive therapies validated in research and "real-world" logistics.

摘要

目的

美国平价医疗法案（ACA）现在要求几乎所有的健康保险计划都覆盖烟草使用治疗（TUT），但 TUT 的使用率仍然很低。

方法

我们在 2016 年对美国 TUT 提供者进行了一项匿名在线调查，了解他们的计费实践情况。

结果

参与者（n=131）主要在医疗和行为健康环境中提供服务，来自各种专业。大多数人提供密集的个人（每次会议>15 分钟）和/或团体咨询。尽管大多数人报告说他们的组织至少接受一种保险，但只有 34%的人报告说 TUT 服务已计费，大约有同等比例的人赞成以自己的独立税务识别号计费和以主管的名义“随诊计费”。一半的计费人（52%）报告使用了至少 1 个当前程序术语代码。最常见的代码是 99406 和 99407，但指定了 18 个独特的代码。（n=101）定性回复的主题包括对如何启动和维持足够报销的关注，以及对计费“不值得”花费时间或精力的经历。

结论

总体而言，结果表明提供者、管理人员和计费经理需要协作。即使有 ACA 的授权，并且与之前的报告一致，报销率可能不足以支付密集型咨询的费用。倡导的领域包括认识到 TUT 需要与其他物质使用障碍和慢性疾病类似的强度、专业知识和报销；使烟草治疗专家能够独立计费；并改善在研究中验证的密集治疗与“现实世界”后勤之间的协调。