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:

  • Title VI of the Civil Rights Act of 1964, 
  • Americans with Disabilities Act (ADA)
  • Patient Protection and Affordable Care Act (PPACA, also known as the ACA for short)

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:

  • They have to demonstrate proficiency in both English and the patient’s language as well as proficiency in medical terminology
  • Minor children may NOT be used as an interpreter unless it’s an emergency situation
  • You cannot try to talk the patient out of using an interpreter

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)

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K
April 12th, 2021 - Wyn Staheli, Director of Research
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
Properly Reporting Imaging Overreads (Including X-Rays)
April 8th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
March 31st, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
Understanding Skin Biopsy Codes
March 23rd, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
How Reporting E/M Based on Time May Lose Money
March 18th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
COVID-19 Vaccines
March 10th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association