AHA and CMS Establish Clearinghouse to Enhance Understanding of Healthcare Common Procedure Coding System

WASHINGTON – January 6, 2006 – In a joint effort to improve the quality of care available from healthcare providers to patients by enhancing insurance billing processes, the American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) are collaborating on a clearinghouse to address questions on better using the Healthcare Common Procedure Coding System (HCPCS). HCPCS is a national standard code set used by healthcare practitioners, providers and suppliers throughout the United States when filing insurance claims for drugs, medical devices, and other items and services.

With the implementation of prospective payment methods that use HCPCS for billing and payment by Medicare and other payers, hospitals and healthcare professionals face a growing need for advice on HCPCS codes. The clearinghouse, which will be managed by the AHA, will serve as a centralized point of contact to provide reliable interpretations of how established codes should be used. It will also educate hospitals, policy makers, and the public on HCPCS coding.

The AHA's Central Office will handle the clearinghouse functions and provide open access to anyone with questions regarding HCPCS coding. Questions along with supporting documentation may be faxed or mailed to the AHA, Central Office on HCPCS. The form to submit a question may be downloaded from www.ahacentraloffice.org . To promote further understanding and interpretations of coding, quarterly publications will be available to assist providers in properly using established HCPCS codes. Questions relating to the codes generally used to report professional services, the Current Procedural Terminology (CPT-4) Codes, will be directed to the American Medical Association. This service will be made available immediately.

Supporting the AHA clearinghouse will be an Editorial Advisory Board (EAB) for Coding Clinic for HCPCS, which is a voluntary board that includes CMS and other stakeholders in the healthcare community.

The HCPCS was established in 1978 by CMS to provide a standardized coding system for describing the specific items and services provided in the delivery of healthcare. Medicare, Medicaid, and other health insurance programs use HCPCS to ensure that insurance claims are processed in an orderly and consistent manner. Furthermore, in August 2000, the Department of Health and Human Services designated HCPCS as a national standard code set, under the Health Insurance Portability and Accountability Act (HIPAA), for use in all electronic transactions relating to payment for the items and services it covers. Details of a memorandum of understanding between AHA and CMS regarding the clearinghouse can be found at www.ahacentraloffice.org.

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