Q/A: Do I Really Need to Have an Interpreter?

July 1st, 2019 - Wyn Staheli, Director of Research
Categories:   HCPCS Coding   Compliance   CPT® Coding  
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Question:

I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true?

Answer: 

Yes! There are both state and federal laws that need to be considered. The applicable federal laws are:

The ACA requires providers who receive federal funds to provide oral interpreters and written translated materials to both limited English proficient (LEP) patients and deaf and hard of hearing (HOH) patients. This requirement has been in effect for awhile but some 2016 revisions brought about a greater emphasis on the need for meeting this requirement.

In 2016, two significant changes were made to section 1557 of the ACA:

  1. Providers must use qualified medical interpreters when treating LEP or Deaf and HOH patients.
  2. LEP patients now have the right to sue providers for language access violations

In a press release dated June 27, 2019 regarding a case involving a deaf individual, Roger Severino, OCR Director stated "Our system of informed consent breaks down when medical facilities fail to communicate effectively with patients."

Some key points regarding the interpreter are:

It’s significant to note that all 50 states have their own laws regarding treating LEP, deaf and HOH patients. Just like HIPAA privacy and security rules, your state laws may differ from these federal laws so you need to find out what the requirements are in your state. Your state professional association may be have this information readily available.

Alert: You MUST have a Language Access Plan as part of your Compliance Plan.

Even though this may seem like one more administrative burden, it is law; and the results of noncompliance can be quite costly since this type of violation is generally not covered by medical, malpractice insurance. According to an article by InDemand Interpreting (see References below), one study reviewed 1,373 medical malpractice lawsuits and 35 of those cases had a language access complaint. “The carrier paid a total of $2,289,000 in damages or settlements and $2,793,000 in legal fees on these 35 claims. ($5M total or $142,857 per case.)”

There are some payers (e.g., Medicaid in Utah or Montana) which will pay for interpreter services if the provider bills for the services using code T1013. However, others (e.g., Medicaid in Arizona) might require them to be provided free of charge. Be sure you know the rules for your payers before submitting this code for reimbursement.

The 2020 ChiroCode DeskBook and Find-A-Code’s specialty-specific Reimbursement Guides will include a new “Other Compliance Concerns” segment which details more about this as well as other compliance concerns; such as harassment, privacy, and copyright violations. Be sure to pre-order your 2020 copy today.

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