Coding and Reimbursement

ACP provides help for its members when they experience coding or reimbursement issues. With the changes happening in the healthcare industry as well as social and economic factors that affect medicine, ACP hopes to provide members with resources and advocacy that will address your coding and reimbursement needs.

RESOURCES

Ask Dr. Phleb

ASK Dr. Phleb is the ACP's Dear Abby for members. If you have a specific question about coding and reimbursement, submit your question here.

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Document Request

Coding and Reimbursement documents can be provided to ACP Members. If you wish to receive any one of the member documents listed below, please check off the boxes of the documents you wish to receive and enter your name and email and submit. Please allow 2 business for electronic delivery.

Varicose Vein Guidelines (available to non-members as well)
Ultrasound Guided Sclerotherapy Guidelines (available to non-members as well)
Standard Phlebology Codes
AMA Press Release about the recognition of Phlebology
AOA Press Release about the recognition of Phlebology
BCBS website links
American Board of Phlebology Information
Venous Disease Reference List
AMA Self Designated List
Introduction to Phlebology Letter written by ACP President (This letter is sent with a combination of other documents to inform the insurer that phlebology is indeed a recognized sub specialty. It helps inform them about our history, science, and mission.)
Specialty Support Letter written by ACP President (This letter is used for denials from insurers using specialty as a reason for denying reimbursement.)
Sample ERISA Letter (A letter asking insurers to provide the scientific documentation behind their denial. ERISA is a federal law and they are required to provide documentation within 30 days.)
Sample Carrier Workbook (A document for practices that summarizes all the insurers you have worked with and the guidelines required by that insurer, contact information, website and date last updated. This helps you stay current and minimize reimbursement losses.)
Patient Advocacy Letter(You can help your patients advocate for themselves by having them write to insurers or if you write on their behalf using this sample letter.)
Sample Medical Collection Billing Letters ( Collection letters can be a good way to document and ensure that debtors are in receipt of their bill, using return mail service. It can be effective in enticing debtors to make payments or schedule payment plans.
Tips on Medical Billing Collection (Warning signs, methodology, psychology and scripts)
Multiple Vein Coding Instructions (Explains what codes and modifiers are needed when you treat multiple veins in a single visit.)

DISCLAIMER (MUST READ): With respect to documents available from this server of ACP staff, neither the American College of Phlebology nor any of their employees, makes any warranty, express or implied, including the warranties of merchantability and fitness for a particular purpose, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represents that its use would not infringe privately owned rights.

Copyright Status: The American College of Phlebology retains a nonexclusive, royalty-free license to publish or reproduce these documents, or allow others to do so, for personal purposes. These documents may be freely distributed and used for non-commercial, scientific and educational purposes. Commercial use of the documents available from this server may be protected under the U.S. and Foreign Copyright Laws. Individual documents on this server may have different copyright conditions, and that will be noted in those documents.

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ADVOCACY

According to the latest survey, members let us know that advocacy in regards to reimbursement is high on their list of needs. As a registered 501(c)3 organization, the ACP is limited on the amount of advocacy we do in particular with lobbying. However, we realize that this is a large concern for our members so we are maximizing our efforts in a few ways. With only 2000+ members, ACP is too small to be significant in the eyes of the government or insurance industry. However, by combining our efforts through patient advocacy, coalitions, and affiliations patient advocacy, and other grassroots efforts, we will be able to leverage that number and position our selves to be more significant.

PATIENT ADVOCACY

Through public education, we will let people know how to identify venous disease, proper treatment options and who should perform these treatments. We have created a public education plan that includes articles and tv specials that point potential patients to the American College of Phlebology for their vein care needs. Members can be searched on a number of websites and referenced in a few articles. Check out our press page for the latest PR resources.

Insurance issues have always been an issue. ACP can help our members help their patients with sample letters and methods on how to ensure that patient needs are heard. As mentioned above, our membership numbers are not high enough to impact an insurance company, but if every ACP member had 5 of their patients write their congressman, we could potentially have 10,000 letters. This is how we can make an impact.

COALITIONS:

IVIGRC or The Intersocietal Venous, Insurance and Governmental Relations Committee

With the increasing availability of more effective and tolerable minimally invasive treatment options for superficial venous insufficiency, utilization of various venous treatment options have understandably increased.  Although those who provide the vein treatment consider this to be appropriate insurers have viewed this phenomenon with skepticism on one end, and near panic on the other.  As a result, insurance companies have instituted an increasing number of restrictive and inappropriate measures for the patient and the doctor to endure so that treatment can be approved.  In many cases, denial of reimbursement is the end result.

As a result of all this, many medical professionals have felt the need for professional societies with an interest in vein treatment to address these issues. It was determined that a joint task force comprised of leaders from these societies and could address the aforementioned issues and make recommendations to insurers for the appropriate assessment of the need for, and determination of, treatment coverage.  To this end, the American College of Phlebology, the American Venous Forum, and the Society for Interventional Radiology have formed an Intersocietal Venous, Insurance, and Government Relations Committee (IVIGRC) chaired by Dr. Ted King for the purpose of confronting some of the baseless policies which insurers use with current evidence-based medicine and outcomes data that supports best practice methods.  The IVIGRC’s intent is to provide guidelines for patient care that are supported by contemporary, objective, published data, which will effectively increase patient access to venous care and, at the same time, provide much needed information to insurers who would benefit as much from our efforts as would our patients. We will send out news bulletins on any progress that is made.

AFFILIATIONS

ACP and MGMA(Medical Group Management Association)

ACP and MGMA have been corresponding about establishing benchmarks phlebology, which is relatively unknown in the industry. To do this, we will ask our members to participate in a number of MGMA surveys, like Physician Compensation and Cost Survey. To participate, goto www.mgma.com

 

ACP and AVF (American Venous Forum)

The AVF created the American Venous Registry as a way to improve patient care. They conceived the idea of a comprehensive venous disease registry and identified the following goals:

• Standardize the collection and analysis of clinical information on venous disease
• Identify practice patterns for venous disease diagnosis and treatment nationwide
• Answer research questions
• Provide a real-time clinical practice tool to enable individual participating physicians to improve their patient care

The AVF has asked the ACP to contact their membership and encourage them to participate. Physicinas and industry partners will be able to draw conclusions about treatment efficacy, which will help the specialty of phlebology. To participate, go to http://veinforum.org/index.php?page=venous-registry .