Keywords

ABC codes, clinical nurse specialist, HIPAA, insurance, NHII

 

Authors

  1. MOLINA, SYNTHIA BS, MBA

Abstract

A specialized set of insurance-related codes for integrative healthcare will increase the national influence and patient-specific effectiveness of clinical nurse specialists (CNSs) and others in the US healthcare system because virtually every participant in the healthcare system uses codes for some critical purpose. Inadequate codes prevent decision makers from having essential health-related information at their fingertips. ABC codes improve business processes and health industry efficiencies in the same manner that universal product codes (UPCs/bar codes) improved the retail operations and the retail industry. The codes are essential to research, management, and commerce. In healthcare, the combination of ABC codes with older medical and dental code sets allows many essential business processes (such as forecasting, practice management, insurance billing, claims processing, and third-party reimbursement) to be fully automated. The codes also help digitize information to simplify data collection, analysis, and reporting. This improves the quality of data and accelerates the speed with which conclusions can be drawn from those data about what works in US healthcare and why. By offering CNSs more complete, accurate, and precise information on best practices, ABC codes help ensure that CNSs and others can generate better outcomes in addressing health-related challenges faced by patients/clients, nurses, and nursing practices, and the nation's health-promoting organizations and systems.