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

July 1st, 2019 - Wyn Staheli, Director of Research
Categories:   HCPCS Coding   Compliance   CPT® Coding  
0 Votes - Sign in to vote or comment.

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.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Eliminating Consultation Codes?
October 10th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255. United Healthcare announced they ...
Hypertension & ICD-10
October 7th, 2019 - Raquel Shumway
Hypertensive Diseases and ICD-10. Helps and examples for these codes.
CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
2020 Official ICD-10-CM Coding Guideline Changes Are Here!
October 1st, 2019 - Wyn Staheli, Director of Research
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...
The New ICD-10-CM Code Updates Are Here — Are You Ready?
October 1st, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases. Chapter 2: ...
New Codes for Dry Needling
September 30th, 2019 - Wyn Staheli, Director of Research
Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association