The American Medical Association (AMA) is one of the most influential organizations in the health care industry, and the largest organization of physicians and medical students in the United States. According to its mission statement, the AMA’s chief goal is to promote medicine and the improvement of public health. Founded in 1847, it has been an important organization ever since and has influenced the development of health care in the country up to the present day.
As can be deduced from its membership, the AMA promotes the betterment of America’s health care system as determined by the leadership of physicians. The AMA’s most recent five-year plan encourages health care advancements to be directed as much as possible by physicians and promotes the advancement of the doctor-patient relationship. In the long history of the AMA it has taken both bold and controversial stances over the past decades, and is one of the most powerful lobbying forces in the country today. It directs its political influence through its political action committee AMPAC.
A quick introduction of the AMA does not immediately reveal its direct connection with the medical billing and coding profession, although because of its size and scope it can no doubt be assumed it has an important influence. Indeed it does have an important effect on medical billing and coding professionals, both in determining industry standards and in advocating physician preferences when it comes to medical billing and coding.
One of the largest impacts the AMA has on medical billing and coding professionals is through its sponsorship and development of Current Procedural Terminology (CPT), the standard terminology used in billing and coding to describe the specific medical services provided. Billing and coding professionals will encounter CPT whether they are dealing with private insurance companies, hospitals, physicians, or Medicare and Medicaid.
CPT determine how much medical providers are reimbursed by the Medicare and Medicaid programs. Not exactly directly, but in the following method: the AMA has a group called the Specialty Society Relative Value Update Committee (RUC) which makes recommendations on the value of the health care services provided. This value is not referring to an actual dollar amount, but is a consideration of the health care provider’s expertise and worth of provided services. The RUC then makes their recommendation to CMS, the agency that oversees the Medicare and Medicaid programs, which accepts these recommendations about 90 percent of the time. CMS then inputs these suggestions into a formula which spits out a dollar-value amount for medical services provided.
Also extremely pertinent to the medical billing and coding profession, the recent delay of one year for the implementation of the ICD-10 was also thanks in part to pressure on Congress by the AMA. It believed the switchover to the ICD-10 would have been far more costly than originally predicted. It also played an instrumental role in the previous year’s delay in the ICD-10’s implementation.
In summary, the AMA plays a very important role in determining the figures used and rules medical billing and coding professionals play by. When these fundamentals of the profession are altered, it has an enormous effect on the industry as a whole. At any place where the goals of physicians and billing and coding professionals overlap the AMA would be a powerful ally, with the converse holding true as well.