Re: [openhealth] Re: list of diagnoses and procedures
Alex Caldwell wrote: Thanks Tim, I was going by the agreement on this page on the CMS site which links to the download for the Excel file: http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf It did not seem to me as restrictive as what you are quoting there. I notice many doctors do things with CPT, such as having them printed by a local printing house on their own customized superbills. I've never heard of anyone being pursued for that. It would seem that if you included a subset of the CPT codes that you use in your own practice in order to interact with Medicare for billing transactions in the course of your own business, and you get them yourself for your own personal use, not distributed with the EMR, but just loaded into it by yourself, it would not violate the conditions. I cannot see that loading a subset of CPT codes into your EMR would be any different than printing them on a superbill or having your coder enter then into your claims. But that's just the way I look at it, which may not hold up. I imagine CMS and other 3rd party payors and clearinghouses must have agreements with AMA to use CPT. Do their agreements extend in any way to cover individual providers that do business with these 3rd party payors that use CPT? Alex I should have provided a reference for my quote. It is from the clickable license agreement on the AMA site. https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?checkXwho=done As far as interpretation I would refer you to your attorney. That's what we did. Of course use for submission to Medicare etc is covered under the referenced DFARS. Cheers, Tim -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ EMAIL: [EMAIL PROTECTED] SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
Tim Cook wrote: I should have provided a reference for my quote. It is from the clickable license agreement on the AMA site. I should have probably also noted that they are available from the AMA on CD in ASCII for less than $100 / year. So it would be cheaper to purchase them than to pay for an attorney's interpretation of the license or risk raising red flags about open source projects circumventing their copyrights. Just my 2cents. Cheers, -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ EMAIL: [EMAIL PROTECTED] SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed]
[openhealth] Re: list of diagnoses and procedures
The AMA CPT codes have a tortuous history and are currently in a legally ambiguous place supported by aggressive AMA lawyers. It is similar to the legally tenuous position of the RIAA that they can control what you can do with the music you have purchased. A short history. In testimony before congress in 1997, T. Reginald Harris, Chairman of the AMA CPT Editorial Board stated: The AMA has taken additional steps to make CPT available over the Internet and is expected to complete an agreement with the HCFA in the very near future. Under the agreement, complete public access to HCFA data files containing CPT will be available, free of charge, both domestically and internationally. Congress then passed legislation mandating use of the CPT codes for medical billing. However, the AMA did not make the codes freely available domestically and internationally. Instead, they have been selling the codes under very restrictive licensing agreements and in fact earn tens of millions of dollars a year from these fees. The AMA has been very aggressively policing misuse of the codes (for example, taking legal action against people who have made the codes freely available on the Internet). Their legal position is tenuous and has never been tested fully in court. Instead, they have relied on the intimidation of their lawyers to produce compliance. Similar cases such as Feist v. Rural Telephone and DrewTech v. SAE have produced results which would seem to prohibit the AMA from charging for the codes. That said, it is probably best not to challenge the AMA. Our corrupt politicians should address the problem but of course, they will not go against a big contributor. You can buy the codes for use (under their restrictive license) from the AMA and that is probably the best course of action. /Mark Alex Caldwell wrote: --- In openhealth@yahoogroups.com, Tim Cook [EMAIL PROTECTED] wrote: Alex Caldwell wrote: The way I interpret the agreement on the site, I believe it is OK to do this as long as you just do it just for yourself for your own internal use, but you are not allowed to re-distribute them. So perhaps it would be OK to distribute the Open Source EMR minus these codes, but include instructions for the user for downloading this file and importing the codes themselves into their own personal copy of the EMR: DISCLAIMER: IANAL but Grant and Limitations. You, as an individual, are authorized to use CPT only as contained in the CPT®/Medicare Relative Value Payment File (the File) solely for your own personal information and only within the United States. specifically EXCLUDES any use outside of the (Excel) file and any use outside the US. It goes on to say that you are prohibited for using them in place of purchasing the CPT book or creating any derivative work. When we licensed CPTs for use in FreePM the AMA was very attentive to the distribution and we had to submit quarterly audits to them. I suggest you ensure you adhere to their licensing restrictions I understand they are very aggressive in pursuing their copyright on their government granted monopoly. Cheers, -- Timothy (Tim) Cook, MSc Thanks Tim, I was going by the agreement on this page on the CMS site which links to the download for the Excel file: http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf It did not seem to me as restrictive as what you are quoting there. I notice many doctors do things with CPT, such as having them printed by a local printing house on their own customized superbills. I've never heard of anyone being pursued for that. It would seem that if you included a subset of the CPT codes that you use in your own practice in order to interact with Medicare for billing transactions in the course of your own business, and you get them yourself for your own personal use, not distributed with the EMR, but just loaded into it by yourself, it would not violate the conditions. I cannot see that loading a subset of CPT codes into your EMR would be any different than printing them on a superbill or having your coder enter then into your claims. But that's just the way I look at it, which may not hold up. I imagine CMS and other 3rd party payors and clearinghouses must have agreements with AMA to use CPT. Do their agreements extend in any way to cover individual providers that do business with these 3rd party payors that use CPT? Alex --- In openhealth@yahoogroups.com, Alex Caldwell [EMAIL PROTECTED] wrote: --- In openhealth@yahoogroups.com, Tim Cook tw_cook@ wrote: Alex Caldwell wrote: The way I interpret the agreement on the site, I believe it is OK to do this as long as you just do it just for yourself for your own internal use, but you are not allowed to re-distribute them. So perhaps it would be OK to distribute the Open Source EMR minus these codes, but include
Re: [openhealth] Open Source (and available for download) CPOE system?
Look for more information on VistA at http://worldvista.org http://hardhats.org and downloads at.http://sourceforge.net/projects/worldvista The VivitAs are ISO images ready to *boot* run on a PC with a 512MB or larger USB drive. The SemiVivA distributions are ready to load onto a PC that already has Linux loaded on it. For instructions, look at the news releases at http://sourceforge.net/projects/worldvista and for help look over archived messages and join the hardhats list at http://groups.google.com/group/hardhats Regards -- Bhaskar -- Sent from my BlackBerry Wireless Handheld - Original Message - From: openhealth@yahoogroups.com openhealth@yahoogroups.com To: openhealth@yahoogroups.com openhealth@yahoogroups.com Sent: Sat Dec 09 01:06:12 2006 Subject: Re: [openhealth] Open Source (and available for download) CPOE system? What about VISTA/CPRS? try windows demo at http://www1.va.gov/cprsdemo/. The VistA system is public domain software, available through the Freedom of Information act on the VA website. Not sure if there are any others out there that are freely available.. Cheers Jubal -- Dr Jubal John, MBChB, PGDipBus (Health Informatics) On 12/9/06, szegedportland [EMAIL PROTECTED] wrote: Hello Group, I will need open source and readily downloadable (with registration or without) CPOE system for academic research purposes. I would appreciate if you can point me to a download link or a contact person's email. For this project the type of OSS license is not really important but the code should be available for free (and legal) customization (particularly the user interface). It will be an academic research project. Thank you for your help in advance! Imre Solti, MD, PhD [Non-text portions of this message have been removed] Yahoo! Groups Links [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n On 12/9/06, mspohr [EMAIL PROTECTED] wrote: The AMA CPT codes have a tortuous history and are currently in a legally ambiguous place supported by aggressive AMA lawyers. It is similar to the legally tenuous position of the RIAA that they can control what you can do with the music you have purchased. A short history. In testimony before congress in 1997, T. Reginald Harris, Chairman of the AMA CPT Editorial Board stated: The AMA has taken additional steps to make CPT available over the Internet and is expected to complete an agreement with the HCFA in the very near future. Under the agreement, complete public access to HCFA data files containing CPT will be available, free of charge, both domestically and internationally. Congress then passed legislation mandating use of the CPT codes for medical billing. However, the AMA did not make the codes freely available domestically and internationally. Instead, they have been selling the codes under very restrictive licensing agreements and in fact earn tens of millions of dollars a year from these fees. The AMA has been very aggressively policing misuse of the codes (for example, taking legal action against people who have made the codes freely available on the Internet). Their legal position is tenuous and has never been tested fully in court. Instead, they have relied on the intimidation of their lawyers to produce compliance. Similar cases such as Feist v. Rural Telephone and DrewTech v. SAE have produced results which would seem to prohibit the AMA from charging for the codes. That said, it is probably best not to challenge the AMA. Our corrupt politicians should address the problem but of course, they will not go against a big contributor. You can buy the codes for use (under their restrictive license) from the AMA and that is probably the best course of action. /Mark Alex Caldwell wrote: --- In openhealth@yahoogroups.com openhealth%40yahoogroups.com, Tim Cook [EMAIL PROTECTED] wrote: Alex Caldwell wrote: The way I interpret the agreement on the site, I believe it is OK to do this as long as you just do it just for yourself for your own internal use, but you are not allowed to re-distribute them. So perhaps it would be OK to distribute the Open Source EMR minus these codes, but include instructions for the user for downloading this file and importing the codes themselves into their own personal copy of the EMR: DISCLAIMER: IANAL but Grant and Limitations. You, as an individual, are authorized to use CPT only as contained in the CPT(r)/Medicare Relative Value Payment File (the File) solely for your own personal information and only within the United States. specifically EXCLUDES any use outside of the (Excel) file and any use outside the US. It goes on to say that you are prohibited for using them in place of purchasing the CPT book or creating any derivative work. When we licensed CPTs for use in FreePM the AMA was very attentive to the distribution and we had to submit quarterly audits to them. I suggest you ensure you adhere to their licensing restrictions I understand they are very aggressive in pursuing their copyright on their government granted monopoly. Cheers, -- Timothy (Tim) Cook, MSc Thanks Tim, I was going by the agreement on this page on the CMS site which links to the download for the Excel file: http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf It did not seem to me as restrictive as what you are quoting there. I notice many doctors do things with CPT, such as having them printed by a local printing house on their own customized superbills. I've never heard of anyone being pursued for that. It would seem that if you included a subset of the CPT codes that you use in your own practice in order to interact with Medicare for billing transactions in the course of your own business, and you get them yourself for your own personal use, not distributed with the EMR, but just loaded into it by yourself, it would not violate the conditions. I cannot see that loading a subset of CPT codes into your EMR would be any different than printing them on a superbill or having your coder enter then into your claims. But that's just the
Re: [openhealth] Re: list of diagnoses and procedures
That leads me to ask: does the AMA claim copyright on the CPT codes themselves, or just on the descriptions of the codes? If the latter, I think there would be a lot of merit in a community project to create and maintain new descriptions. I've been told that the AMA's descriptions are not very physician-friendly. Rod www.sunsetsystems.com On Saturday 09 December 2006 10:18, 80n wrote: This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n
[openhealth] Re: list of diagnoses and procedures
Copyright covers expressions of ideas and as such covers the AMA's descriptions. Theoretically, if you wrote different descriptions, they would not be covered by the AMA copyright. However, the AMA has been very aggressive in defending their monopoly on the codes so they might threaten a community project. There is also the issue of the codes themselves. Even though you can't copyright lists of numbers (codes)... the famous telephone directory case, the AMA might try to claim that they own the numbers also. /Mark --- In openhealth@yahoogroups.com, Rod Roark [EMAIL PROTECTED] wrote: That leads me to ask: does the AMA claim copyright on the CPT codes themselves, or just on the descriptions of the codes? If the latter, I think there would be a lot of merit in a community project to create and maintain new descriptions. I've been told that the AMA's descriptions are not very physician-friendly. Rod www.sunsetsystems.com On Saturday 09 December 2006 10:18, 80n wrote: This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n
Re: [openhealth] Re: list of diagnoses and procedures
I think, then, a good web-based community project would be the creation of a whole new set of codes and descriptions. However the codes would happen to map one-to-one with the CPT codes, and the mapping would be created/shared only among those with CPT licenses. Publications that reference CPT codes could be trivially changed to reference the new codes, and individual practitioners would have no need or use for the mapping table or anything else containing CPT codes. Rod www.sunsetsystems.com On Saturday 09 December 2006 13:18, mspohr wrote: Copyright covers expressions of ideas and as such covers the AMA's descriptions. Theoretically, if you wrote different descriptions, they would not be covered by the AMA copyright. However, the AMA has been very aggressive in defending their monopoly on the codes so they might threaten a community project. There is also the issue of the codes themselves. Even though you can't copyright lists of numbers (codes)... the famous telephone directory case, the AMA might try to claim that they own the numbers also. /Mark --- In openhealth@yahoogroups.com, Rod Roark [EMAIL PROTECTED] wrote: That leads me to ask: does the AMA claim copyright on the CPT codes themselves, or just on the descriptions of the codes? If the latter, I think there would be a lot of merit in a community project to create and maintain new descriptions. I've been told that the AMA's descriptions are not very physician-friendly. Rod www.sunsetsystems.com On Saturday 09 December 2006 10:18, 80n wrote: This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n
Re: [openhealth] Re: list of diagnoses and procedures
Payers will always invent excuses to reject claims. However in my experience the CPT description is not submitted as part of a claim. Rod www.sunsetsystems.com On Saturday 09 December 2006 14:53, Peter Holt Hoffman wrote: I have a question about this though: don't at least some payers reject claims where the description is not 100% identical to what the AMA publishes? -- Peter. --- In openhealth@yahoogroups.com, Rod Roark [EMAIL PROTECTED] wrote: I think, then, a good web-based community project would be the creation of a whole new set of codes and descriptions. However the codes would happen to map one-to-one with the CPT codes, and the mapping would be created/shared only among those with CPT licenses. Publications that reference CPT codes could be trivially changed to reference the new codes, and individual practitioners would have no need or use for the mapping table or anything else containing CPT codes. Rod www.sunsetsystems.com
[openhealth] Re: list of diagnoses and procedures
I can confirm this from doing my own billing in my practice. Only the code numbers are used. The descriptions are not included, neither on the printed CMS 1500 claim forms, nor the electronic ANSI X12 837 format. Alex Caldwell --- In openhealth@yahoogroups.com, Rod Roark [EMAIL PROTECTED] wrote: Payers will always invent excuses to reject claims. However in my experience the CPT description is not submitted as part of a claim. Rod www.sunsetsystems.com On Saturday 09 December 2006 14:53, Peter Holt Hoffman wrote: I have a question about this though: don't at least some payers reject claims where the description is not 100% identical to what the AMA publishes? -- Peter. --- In openhealth@yahoogroups.com, Rod Roark rod@ wrote: I think, then, a good web-based community project would be the creation of a whole new set of codes and descriptions. However the codes would happen to map one-to-one with the CPT codes, and the mapping would be created/shared only among those with CPT licenses. Publications that reference CPT codes could be trivially changed to reference the new codes, and individual practitioners would have no need or use for the mapping table or anything else containing CPT codes. Rod www.sunsetsystems.com
