Standardizing Medical Claims

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<p>Federal regulations originally designed to streamline the health care system may unintentionally limit coverage for vital child developmental services, a new Commonwealth Fund report finds.<br><br>
According to <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=18131&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D290754%26%23doc290754">How Medical Claims Simplification Can Impede Delivery of Child Developmental Services,</a> by George Washington University researchers Anne Markus Ph.D., Sara Rosenbaum J.D., Alexandra Stewart, J.D., and Marisa Cox, M.A., provisions in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that require health insurers and providers to use standardized billing codes for medical claims leave little discretion to individual insurers.<br><br>

To comply with HIPAA, state Medicaid agencies must eliminate some payment codes that have been tailored to the special needs of Medicaid-enrolled children; this process can lead to reduced coverage for mental health services, early intervention, physical and speech therapy, home care, case management, transportation, and other services not usually provided in private physician practices.<br><br>

The authors say that federal policymakers should consider revising the law so that states can preserve coverage of services targeting children at risk for developmental problems.</p>