July 1999


ABC accepted on important taxonomy committee

ABC is making sure that the O&P profession is properly represented in the federal governments new electronic billing system with its presence on a new, independent taxonomy committee.

The Healthcare Provider Taxonomy and Provider Characteristics and Resource Code Maintenance Committee invited ABC to join. ABCs representatives on the committee are Glen Ellis, CPO, and Dwain Faso, CO, FAAOP.

ABCs involvement will give us input into setting up the numerical codes that specifically identify our certification in the new electronic billing system established by the federal government.

The committee was developed because the Health Insurance Portability and Accountability Act (HIPAA) requires the Health Care Financing Administration (HCFA) to develop a specific set of provider specialty codes that relate to electronic billing.

The taxonomy code list is the specified code set for provider specialties in the implementation guides for the HIPPA transactions. ABC and other groups are trying to assure that their specialty certification is reflected in this new coding system. Our participation is critical to ensure proper representation of the O&P profession.

Other voting members of this committee include: the American Dental Association; American Medical Association; Blue Cross and Blue Shield Plans; Health Care Financing Administration; Kaiser Permanente; American Podiatric Medical Association; American Board of Nursing Specialties; American Academy of Physician Assistants; American Occupational Therapy Association; and J. Norman Consulting, Inc.

From a marketing standpoint, it is a powerful inducement to have our certification reflected in the coding system. It will also identify our certified O&P providers to third-party payers.

This committee will be responsible for maintaining the Healthcare Provider Taxonomy and Provider Characteristics and Resources (PC&R) code lists. This means that the committee will be maintaining a standard, comprehensive list of provider specialties, as well as a list of provider characteristics.

The PC&R code list is intended to be used to respond to questions regarding a health care providers characteristics and resources when applying to or registering with an entity. It is not intended to be a comprehensive list of services rendered by a health care provider.

The objective is to meet the business needs of the user community while avoiding redundancy in the codes. The committee will be responsible for fulfilling all of these needs, but it has the freedom to determine how any particular one actually will be met.

A 70 percent or higher approval by the voting members present will be necessary to effect changes to the code lists. The method for making changes is to send them through a Web site, which is the official collection point for the taxonomy. Proposed changes will be considered and voted on at the upcoming meeting. For cases in which a request does not result in a change or addition to either of the lists, a recommended solution within the existing codes will be provided.

Our representatives to the committee will want to review the definition of orthotics and prosthetics currently being used in the code set. By participating, ABC also will be able to have some influence in the taxonomy process as it relates to orthotics and prosthetics.

The need for the taxonomy code list was identified during the development of both the HCFAs National Provider System and X12N Task Group 2 Workgroup15s Healthcare Provider Information transaction set.

Work regarding these codes began with the identification and coding of an external provider table, which would codify provider type, classification and area of specialization for all health care providers. The intent was to combine specialty code lists from multiple sources into a single coding structure to be used with the Healthcare Provider Information transaction set.

In August 1997, the taxonomy code list was published and is currently available through the Washington Publishing Companys Web site: www.wpc-edi.com/Taxonomy.

The Healthcare Provider Taxonomy and Provider Characteristics and Resources Code Maintenance Committee began its work last October and subsequently met last February. As indicated in the committees guidelines, at least one meeting will be held per year.

Other potential advisory committee opportunities are currently available and will be available with various organizations in the future. If you are interested in being nominated for an advisory committee seat, please contact Abbe Daly, director of marketing, at 1650 King Street, Suite 500, Alexandria, VA 22314-2747, (703) 836-7114 ext. 3049, fax (703)836-0838, or e-mail to: . Please indicate your knowledge base (such as workers compensation or managed care).

Presently, ABC is seeking individuals who are interested in being nominated for a committee of the American Accreditation HealthCare Commission/URAC, which sets standards for and accredits managed care organizations. URAC has three committees: The Workers Compensation Standards Committee, The Health Standards Committee, and The Accreditation Committee.

The Workers Compensation Standards Committee develops accreditation standards for workers compensation managed care programs. The Health Standards Committee develops accreditation standards for managed care programs that administer health benefits. The Accreditation Committee reviews applications for managed care organizations that seek accreditation and recommends which ones should receive it.

ABCs interest in obtaining advisory committee seats reflects our marketing goal of targeting key decision-making committees both inside and outside of government, in order to impact the formulation of policy that affects our profession and the ways in which O & P services are provided to patients.

We are working to create a greater understanding of ABC certification and accreditation, which ultimately will lead to a greater demand in the marketplace for ABC-certified O & P practitioners and ABC-accredited facilities. Our plan is to work to change market conditions in this way. We will be targeting key advisory committees of federal and state health and disability programs, third-party payers, associations, and other organizations.

We believe that, through our participation on the advisory committee level, we can both raise the consciousness of these groups concerning the value of ABC-certified O & P practitioners and also have a voice in many key policy decisions made by these organizations that directly impact the way in which we provide our services to patients.

Abbe Daly is the director of marketing for the American Board for Certification in Orthotics and Prosthetics, Inc.