Current Procedural Terminology, Book Review Example

The lecture presented a viable approach for reimbursement of diagnostic/ laboratory tests using innovative healthcare systems. The challenge that exists in creating a uniform reimbursement system includes understanding the difference benefits given to Medicare covered and privately insured patients. Some of the benefits that the insured often have are hospital services, physician services and diagnostic services. However, their ability to accept these services to be covered by the insurer will be dependent on their access to evidence-based clinical information about the diagnostic tests.

Furthermore, the lecture shows an insightful approach to making research coverage decisions and Current Procedural Terminology/ Healthcare Common Procedure Coding System codes application. By examining relevant existing diagnostic procedures, allowed by private insurance and Medicare, a cost efficient technological process can, therefore, be created. This involves determining how, when and why a patient received reimbursement and any recommended technological approach. Furthermore, the assigned CPT codes for every diagnostic procedure, as well as any technological add-on and related HCPCS codes are identified. In the case that CPT codes for the molecular diagnostic device are not identified, then a BCBSA technological assessment together with local and national coverage search, would help in discovering the qualification criteria for reimbursement.

The lecture also mentioned viable methods for finding reimbursement rates for the relevant CPT codes.  This involves utilizing diagnosis-related groups for the inpatient system and an ambulatory payment category for the outpatient system. Other places to covered technology reimbursement rates is the HSPCS Physician Fee Schedule. This involves getting the product of the resource based relative value scale and the conversion factor to reach the Medicare value going to the physician. However, some questions that arise from the lecture are, how will Obama Care affect the reimbursement basics in the future? And what will the insurers choose to cover since the introduction of the Affordable Care Act.