How medical claims simplification can impede delivery of child developmental services
- Collection:
- Health Policy and Services Research
- Contributor(s):
- Markus, Anne. Rosenbaum, Sara. Stewart, Alexandra. Cox, Marisa. Commonwealth Fund.
- Publication:
- [New York, N.Y.] : Commonwealth Fund, [2005]
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Child Health Services -- organization & administration Delivery of Health Care -- organization & administration Insurance Claim Review Child Infant Insurance Coverage Insurance, Health, Reimbursement International Classification of Diseases -- economics United States United States.
- Genre(s):
- Technical Report
- Abstract:
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA) seeks to achieve greater efficiency and effectiveness in the health care system by requiring payers and providers to use standardized procedure codes for payment claims. HIPAA has a significant impact on the translation of benefit designs into medical claims payment standards. This presents challenges for children with Medicaid coverage, since the Medicaid program employs a unique definition of medical necessity that ties coverage to childhood growth and development. To comply with HIPAA, state Medicaid agencies must eliminate local payment codes, a process that may result in reduced levels of coverage for children, particularly for primary health and support services such as mental health services, early intervention, physical and speech therapy, home care, case management, and transportation. To avoid unintentional reduction of child development services, the authors suggest revising HIPAA to allow states to customize payment coding to their unique coverage standards.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101255038 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101255038