Academy Reimbursement Committee: Monograph and Hotline Moving Forward

The Academy's Reimbursement Committee is very excited about the progress we are making toward providing Academy members with information and services to help ensure fair reimbursement. Below we describe several of our projects that soon will be released. We welcome, as always, your comments, suggestions, and assistance.

Quarterly Reimbursement Monographs

As a follow-up to the Reimbursement Committee's first publication, The Physician's Guide to HIV Reimbursement (2001), we will soon initiate a quarterly series of educational monographs devoted to the billing and coding regulatory issues unique to our specialty. These monographs will identify and discuss the appropriate documentation and highest allowable billing codes.

In addition, we are seeking contributions from Academy members of unique and challenging office visits to include in the series to highlight particularly interesting issues. If you can assist us in this endeavor, please e-mail a brief case history and description of your office visit to reimbursement@aahivm.org. We would also appreciate any suggestions of specific types of visits that you would like included in these monographs.

After searching far and wide, we have recently enlisted the services of a consulting firm to assist us in researching and developing these educational monographs. We are confident their depth of experience in assisting physician specialty organizations with reimbursement and educational efforts will greatly benefit Academy members.

Reimbursement Support Lines

Another service we offer beginning in September to assist our membership in resolving reimbursement issues is a toll-free hotline, 877-REIM HOT or 877-734-6468, for Academy members to obtain answers to their billing and reimbursement questions. A response will be available within 72 hours. Our reimbursement specialists will service these support lines and provide detailed research needed to answer questions about federal, state, and HMO/PPO reimbursement and billing guidelines.

HIV-Specific CPT Reimbursement Codes

HIV Specialists currently play a unique and evolving role in medicine. We provide our patients with high-level specialty services such as antiviral medication management, interpretation of specialized viral resistance tests, counseling services in nutrition and behavior modification, and management of complex medication side effects, as well as providing patients with primary care.

As time marches forward, these services will become increasingly more complex and time-consuming. Insurers are getting a bargain by paying us the same rate for providing both primary care and specialty services to their subscribers. One could ask for Medicare and other third-party payers to explain why, as specialists, HIV treatment providers are paid no more, and sometimes less, than the average general internist.

The Reimbursement Committee has begun discussing the process for identifying and implementing HIV-specific CPT codes and RBRVS reimbursement that appropriately reimburse HIV specialists for their time and expertise.

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