Let’s talk about what’s going on for the new year and just beyond that and continue with the topic on dealing with how do we deal with fees?

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Greetings to all my friends, colleagues, and people that just follow along. I’m glad that you’re with me. Let’s talk about what’s going on for the new year and just beyond that and continue with the topic on dealing with how do we deal with fees? What about updates? Should we change it first the year?

What should I charge? And this is something I go through in a lot of detail in our seminars, but I wanna give you a chance to kinda get feel for it. So let’s talk about your 2023 fees and what’s happened with RVUs and should we be maximizing payments? Let’s get to the slides and let’s focus in on that cause I wanna give you some tools that will help you start to understand what should be my fees.

What’s reasonable, and I will say the fee you choose is what you choose, but I want it to be from some knowledge, not just because of I think that’s what it’s worth, but the true value. So I want you to think of it from a standpoint of what do patients look at, mean, for the most part, Beyond the factors of, are you gonna help me?

And we’ll do a separate show on that. Let’s talk about what the biggest common question is for most patients are. What does it cost? How much is it? That’s what everyone wants to know. Cause they’re looking, Hey, can I afford it? Is it reasonable? So we’ve gotta remember, how much should I charge? What?

What is my fee? Where did I come up with it? Am I going by what my friend said? And let’s face. Do your friends know what they’re talking about? Have they really set up a fee schedule based on any knowledge other than going this is what I saw someone else do? You remember what your mom said about what others do, so let’s do with a little bit more of knowledge.

We think of it from this way. You should chart what is reasonable. What’s fair? I often think, what would you pay? That’s a good way to look and go what would I pay? What is the value of this service? What is a half hour? What is an hour value of time for this type or level of service? Always think the value people will always buy based on value.

If you think of it, have you ever chosen a medical provider of any type because they were. , did you look? Oh, who’s the cheapest office visit? Not at all, I think. I don’t think that’s how anyone ever chooses now. Certainly. . It could be prohibitive if it’s too expensive, but certainly we all want quality in the best providers.

So always be careful. Is cheap always better? No, it’s the value of the service. The better you service, you give, the more expectations. Those expectations being met are what I want. We all know if we go to a 99 cents store, What are we, the expectations of the goods there compared to a higher end retailer?

So should we change this? Does it change yearly? Is it something we should update in a sense? I think it should at an ex to an extent. Just bear in mind, I know some of you’re thinking, but Sam, I belong to Ash, or I belong to this plan, and do they update yearly? They generally don’t. However, I’m gonna give you a little tip, particularly for those of you who are members of my.

Or the American Acupuncture Council Insurance Information Network. Remember, one of the things we do with you yearly is to focus in on your fees. Let’s make a look at what are you charging, what is fair, and it should go up. And if you have some of these managed care plans, are you aware of the techniques and things you can do to get an increase in your fees with them?

There are things you should be doing cuz it’s not stagnant unless you allow it to be stagnant. But let’s talk about it from this standpoint. What is usual customer and reasonable? In other words, what is the. Customer reasonable price for your area. What are people charging? It’s what’s charged by most doctors or any healthcare providers, other acupuncturists in your area.

And remember, you wanna look at it. It’s not just your fees. But it’s the fees of other types of providers. What is the medical doctor down the street charging, say for an exam or a therapy? Certainly the things that we do that are similar might and should be within that same range. I want it to fall within a range with other doctors, not necessarily just acupuncturist.

That’s gonna be part of it, but certainly what is fair and reasonable. . Now, where I think most people never look though is the understanding of the value of each service. So what I’d like to do with you today is focus in on understanding of the value, and we use something called RVU or relative value units.

And what these are standard units of a comparison of one service to another and the value comparatively. So in simplest way, let’s say a service is worth one and another service is worth. , what would that tell you? Oh, the one that’s worth one is double the price or value. The one that’s worth 0.5 or the other one is 50% less.

So it’s an easy way for developing a fee schedule that’s based on, look, I know if the insurance is gonna pay me one price for this code, I can tell you what the price is for others. This RV dates back all the way to a Harvard study, and so this goes into CMS insurance companies. Work comp, personal injury, and others all use this as a method to help establish relative and fair fees across the board.

So Medicare and others. Now you’re gonna say Medicare doesn’t cover that. We’ll remember Medicare Advantage plans, but Medicare does set at least a value. So you can start to understand how do I use this to help set my own fees? So I want you thinking of what is my usual reasonable fee, but think what is.

What is re what is someone paying? What? What is someone willing to pay? And then let’s remember, can you really have dual fees for the most part? No. You can have a small discount for cash and you can go back to a previous course I did on that. But bottom line is once you establish a fee, you do have to collect it.

So I wanna be careful here. Some of you can have insurances that pay a lot of. For a code and services. I have providers in the New York area, Florida, and almost any state that can bill, and you’re gonna think, I’m kidding, that are getting two to $300 a visit just for acupuncture and maybe just two or three sets of needles.

Now that’s great. I love that. But here’s my problem. If I’m charging one patient $300, what do I have to charge other patients? $300. But what if one I. 300 to the insurance and the insurance pays the whole thing. Whoa, yay. Happy. But what if I bill another insurance and I bill 300 and it only pays a hundred?

How much does a patient owe you? $200. So you have to collect the difference. Let’s be careful. Don’t set your fees off of your wealthiest patients. at the same token. Don’t send ’em off your Ps, but somewhere in the middle of ’em what is fair and reasonable. So let’s talk about your current fee structure.

I’d like you to do a little bit of a class with me. This is what I do at our seminars and network. I’m gonna give you a little taste of it. What is your current fee for acupuncture? Just manual. 9 7810. Let’s just go with that code. What is The way to do it? What is your fee for 9 7 8 1 1. So compare the.

Okay. Let’s also look at something else though. How about a mid-level new patient exam? 9 9 2 0 3. And then how about maybe massage? Now I just picked these four codes cuz they’re common. We can certainly do any of the codes, but let’s just stick with these as a reasonable way. What do I charge?

Cuz here’s my concern. This is something I deal with all the time, whether it’s a member or someone at our seminar. , they have a fee for one code that’s fair and reasonable, but yet when they charge the other code, they charge far below. And so in other words, what if you’re billing $30 for something that some insurance or a patient is willing to pay?

64? If you bill 30, how much they gonna pay you? 30. So what if you had billed. They would’ve paid 60, but you didn’t know. And that’s what I wanna help you with is give you an idea of starting to know what these things are actually valued at. Let’s say you bought a house 20 years ago and you went to sell the house today, would you just say, Hey, I paid 150,000 for it.

I think I’m gonna charge, 200,000. I think most of us would say no. You gotta do a review of the neighborhood. What are the housing selling for? Cuz you might find out maybe the houses are selling for 500,000 know the actual value. So here’s the relative value of those four codes. 9, 7, 8, 1 0 is 1.14.

They make a, what does that really mean? You’ll see when we reference it because of 9 78, 11 is 0.86. So what I want you to really see the difference here, if you look at the difference between those two numbers, It’s about 28%, or we just round it to say 30% or 25. Either way you want to go. Let’s do it even simpler.

Let’s say, and again, this is probably too high. Let’s say you charge $114 for your first set of manual acupuncture. A little high, but okay. What would be the cost of the second set? 86. So we’re gonna use this in a way to start to establish that. If you can tell me the fee of one. , I can tell you what the fee should be of any other code based on the price of that one by giving its relative value.

So by example, notice 99 2 0 3 has a value of 3.3 th 3.33. Now, that’s not quite three times as much, but you can see it’s pretty darn close, isn’t it? And then how about massage 9 7 1 2 4. And here’s a area I see commonly acupuncturist undervalue. You’ll notice the price of massage. Has a slightly higher value than your second set.

I can’t tell you how many times I’ll see someone charging their second set at 60 or $75 and the insurance pays it, but then they’re billing massage at 30. Why are you billing a code half the price when it’s worth basically 5% more? So I wanna start to make these make sense. Now, the good news is it’s what you wanna do.

If you said to me, Sam, I know I could charge. But I choose not to because hey, I have so many cash patients, I gotta keep the price low. I’m all in on that. I don’t have any issue there. So long as there’s a reason, don’t let the reason be. I didn’t know. Most offices in our network, once we do this fee review, always get probably a 30 to 50% increase in revenue.

Cuz truthfully, most of you are billing maybe eight or nine codes, and I’m gonna say half of those codes, if not more , you have literally the wrong value. So let’s work with this and how do we make this work? So let’s just say for example, you charged $60 for a 9, 9, 7, 8, 1, 0. That’s just your fee.

I’m not saying how I came up with it. I’m just saying, someone says, Sam, that’s my fee. I charged 60 for the first set. Great. Tell me that and I’ll tell you the price of other things. So how do we do this? We’re gonna take the $60 and divide by the code’s relative value. So you’ll notice we do 60 divide by 1.14, and it gives us a value of 52 63.

What I do with that number is I take that number and I multiply it by any other code’s, R V U to tell me the price of that service based on a $60 price of the first set. In other words, if an insurance company pays me one price for one thing, I can tell you what they’re gonna pay for something else based on relative values.

And I’ll give you examples of this coming up. Now, somebody gonna say Sam, I belong to as H. Remember as H is a per diem. , they don’t follow this. And this is of course why they like you to join. Because they can say, now we don’t have to pay you a fair fee. We’ll just tell you what we’re gonna pay.

And I’m not saying that’s necessarily horrible, but it does mean that it’s more proprietary and they can choose how much they’re gonna pay. So bottom line is, let’s do it, 52 63 multiplied by 0.86 is 45, 26. So what I want you to take away is if your first set is 60, what should be your second? , basically 45.

Now, I’d probably round up a little bit to 46, but you can see here that difference. Now, if you did the percentages, you go, wow, that is actually about 25% below. How about for an exam? And this is where I see often acupuncturists weigh under value. Notice the price of the exam is about three times as much because 52, 63 by 3.3 3, 1 75, not quite three times, but you see it’s pretty darn close.

And then of course, we look at 97, 1 24 massage at. Notice it’s 47, 36. Now, that’s not a lot more, but notice it’s higher. So think of it, if I’m billing this service at 30, would the insurance still covered? Sure, but what would’ve they paid? And so I want you to think along the lines of, let RVs help you establish a fair and reasonable schedule so that you’re not undervaluing.

Or if you decide saying, Sam, I can charge more. I choose not to. That’s. It’s a choice you made, not one. You simply were not aware of. And what I generally find is most people go, oh, I had no idea. So let’s take a look here. This is from New York. I just chose New York. Why not? It could be any state.

What you’re seeing in front of you is one of the things we provided our seminars, if you come to one of our seminars or order the recording, we give you your state’s fees and codes. And this one particularly is for New York Medicare. I’m gonna go Sam Medicare let’s remember. also is the fees for the VA and these prices often Arthur’s starting point for most insurances, which I’ll illustrate to you in just a second.

So let’s take the New York fees and we’ll just pick the second column. The second column here, I believe, is the Bronx. The first one is Manhattan. A lot of people think Manhattan’s more expensive technically. No, the Bronx is. Anyway, we’re gonna take the 45 13. That’s the charge. So we’ll take 45 13, divide by 1.14.

It comes out to 39 70. So notice if we take 39 74 and multiply by 0.86, it gives us 34 17. Now you’re gonna notice here 34 16. So that’s off by a couple of pennies, but, or a penny. But notice it’s cuz I didn’t take the numbers fully out. It would probably round down. But what I want everyone to see is, oh, those values actually make sense.

So let’s take a look. Remember I said. 9 9 2 0 3 is gonna be roughly three times the amount. So notice if we have 45, 13. We take 34 17. Oh, I did. I didn’t do the math properly. It’s 34. 17 times 3.33. It would be 1 32. Now you’ll notice it comes out to 1 34, or excuse me, I’m say 39 74 comes out to 1 32 33. Now notice that’s 1 34.

Is that pretty close to within? So I want you to start to see the values. And by the way, you can see here the value of other services. By the way, the VA is covering these and insurances do use this. So notice if you’re doing just simple infrared heat, a hot lamp that’s worth only $8. Cuz it doesn’t have that high of a value.

But this is a simple way of you starting to look at, do my fees make sense? Let’s look at massage notice. Massage is 35 76. Notice here massage 35 48, but that is a little higher than 9, 7, 8. You may wanna look at and just say do I want to use Medicare fees as maybe a starting point? I still will say these are on the low end, but probably as a starting point in most states, you’re gonna find that what they’re gonna do is take these Medicare rates or RVs and use that to help establish fees.

So let me give you some examples. In Texas, all they do there is they take whatever the RV U is and multiply by 64, 38. Now you’ll notice that’s about double the. Notice in Utah, it’s 59 or 52. Heck, in Michigan they allow 200% of Medicare. So let’s go back to this for a moment. Let’s just say you charge 200% of Medicare.

That would mean your first set would be 90, and then the additional set would be about 70. . So again, notice that about 25% difference. So as a starting point, that may be for some of you that might be a little high though. But here’s something interesting. Notice Boeing, any person that works for Boeing and has their Blue Cross Blue Shield, they literally allow as much as 175% of Medicare.

California work comp 140% Pennsylvania one 13 or one 10 depending. Maryland has a conversion. I wanna highlight, many of you aren’t aware of your own state. This is why our network members or people come to the seminar, get that information and go, oh my goodness, I have way undervalued. Now, my point to it is I don’t really care that what you charge, if you’ve got a good reason, I wanna make sure you have what you’re charging.

There is a reason it makes. Are you undervaluing? Cuz you simply didn’t know. So I’m gonna give you an opportunity to do that. We have a calculator. This is free. So you’re gonna get your fees for those four codes based on your price. So you don’t have to do the calculation, simply take up your phone, bring it up to the screen, open your camera, and you’re gonna send a text.

To 2 0 9 7 5 1 6, and you’re gonna text to that r v. Just put rvu. And what you’re gonna get is an RVU calculator that you’re gonna put in your price for 9, 7, 8, 10, and it’ll tell you what the values would be for the other services within that. Now you might say how do I know what I should charge?

It is what you’re already charging, and that’s something you wanna look at and say is the fee that I’m charging in the first place, does it make any sense? As a general rule for. . I would say most of you should be probably one and a half times Medicare, one and a half times. Medicare, by the way, is about $60 because the price for Medicare usually for a first set is around 40 to 45.

So again, 60 would put you about right in that range, but nonetheless, start to really make sense to your fees. Don’t go another year under valuing. And let’s face it, most of you were billing probably eight to 10 codes, maybe a little. , but I’m gonna guarantee all of you probably have quite a few of those that are not right.

I’m gonna implore you to come to a seminar or use our network. I offer a service where if you join or the American Acupuncture Council does, I become part of your team. You literally, I become a staff member. So if as an acupuncturist, can you imagine you have a staff member for $693 and it includes two seminar.

Unlimited support where we do meetings like this. What is your fee schedule? Let’s audit your notes. Let’s take a look at work comp. How? How do I deal with Medicare and all these other things? We can get one-on-one. A lot of you are missing out because you just don’t have the information or you’re paying a lot of money for someone for a simple phone call.

We do much more than that, so I’d employ to take a look. I want you to be successful. Your success is ours. I teach continued education courses. Go to our website. Lots of upcoming courses. Guess what? You won’t. If you’re not successful, none of those. So we have a vested interest, myself and the American Acupuncture Council.

So I’m gonna say go out and let’s be more successful and let make me part of that team. I’ll tell you, we’ll get you to the right place. Take care everyone. Until next time.

So I wanna give you a short primer on what you must do in order to make sure the documentation you are using meets the standard to make sure you get paid.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi everyone. This is Sam Collins, the coding and billing expert for acupuncture, your Advocate, and I’m part of the American Acupuncture Council, specifically the network. We’re always here to help. We’re always here to help make sure your practice is better, and that’s what the American Acupuncture Council is about.

We wanna make sure that your practice continues to thrive and prosper. 2023 is right here, and one of the questions I get as the coding and billing expert is, how do I document acupuncture? And this has been an ongoing issue for many acupuncturists because of course, unfortunately there is a lot of bad information that’s out there as to what you’re gonna require to do.

So I wanna give you a short primer on what you must do in order to make sure the documentation you are using meets the standard to make sure you get paid. And more importantly, making sure the patients has documentation of the services they received and the outcome. So without further ado, let’s get started.

Let’s go ahead and get to the slides. Let’s talk about documenting acupuncture for compliance, for accuracy, but ultimately payment. Let’s make sure you’re getting paid for what you do. And of course, prevent denials. Now, I’m not gonna be too worried about denials if we do the right types of things. So let’s talk about documentation generically.

Documentation is such that an acupuncture should maintain accurate and complete records. It’s what we do for our patients. Forget insurance or anything else. We have to reflect what was done to assure that what was done was compliant and protects us as well. We should ensure that they’re C correct also, to make sure we’re getting the proper payment for services and we can support that.

Good documentation practices also assures that your patients receive the appropriate care from you as well as it becomes the record for future. If they have to have go to another provider, they can make sure it’s there, realize it’s part of their permanent legal record that we’re required to keep. And I’m not saying it has to be fancy.

but it has to adequately meet the needs of what we do as acupuncturists or what you do. I’m just your advocate. So the few things that I’m gonna focus in on today is gonna be acupuncture, but I wanna highlight all the things. E and m services or exams should reflect the level of service that you’ve provided and it wouldn’t match the code.

or price that you build? Of course the acupuncture itself must reflect the time and the points, and this is what we’re gonna focus on. There’s often a lot of misunderstanding on what is required for documentation or acupuncture. We’re gonna clear that up. And then if you’re doing any therapies, let’s make sure that the therapies are identified specifically where they’re being applied by example.

You just don’t wanna check off, I did infrared heat, but tell me where you. for how many minutes? So we know what the intensity and time, so we know comparatively how we do it the next time. So we have to make sure that in a way that if someone were to read what we’ve done, They know what we’ve done. They wouldn’t have to guess by just checking I did acupuncture.

They would know where did we do it? What were the points? How much time did we spend? And these are the problems I run into as the coding and billing expert. I’m contacted by state boards, department of Defense, meaning the va. The wa Hoag, world Health Organization and almost every carrier out there, including malpractice carriers that deal with documentation issues.

So I wanna give you the definitive way of making sure this is correct. You’ll notice here, this is a denial if you’re not familiar from the company, UnitedHealthcare, and it quite frankly, is a very good pair of acupuncture. And you’ll notice it indicates. The information submitted does not contain sufficient detail to support the services.

So what is it that they’re missing? And you’ll notice they’re missing it on the initial set. And the follow-up sets. So notice it says the documentation submitted, does not indicate the time was personal, one-on-one contact with the patient, and the duration of the needle placement or retention. Therefore, it cannot be supported.

So we have to start to look at what is it that we need. So the American Acupuncture Council, we provide at our seminars, this list here of the acupuncture codes, their description, but more specifically also the details of what the requirements are. So let’s pull this up a little bit. As you’re familiar with, acupuncture has four codes.

Two of the codes are for manual acupuncture, meaning, and certain needles with no electricity. And then the other two are for electro acupuncture, meaning inserting needles with electricity. In both instances they work the same. So let’s make sure we understand what these codes mean. They say for 9 78, 10 it says acupuncture one or more needles.

So the first thing you’ll notice what we need to document. Is that we’re inserting needles, so you have to have, what points are you inserting? That’s number one. And then of course it says without electric stimulation. So it means nothing there other than just the manual insertion. But then it says initial 15 minutes of personal one-on-one contact.

So we’re gonna highlight just on the basis of this code, you’ll notice there are two things you must have. You must have the time. That you’re there with the patient, but also the points of insertion without both, it’s not billable. So be very clear in your documentation each time you do a set of acupuncture, how much time did you spend and what were the points of each set?

Because notice 9, 7, 8 1 1, the additional set gives you the same parameters, each additional 15 minutes of personal one-on-one contact along with reinsertion of needles. Now, I’ll be very honest, I’m not a big fan of that term reinsertion because it gives a connotation that you may be taking a needle and putting it back in.

And of course, that’s of course against clean needle technique. So we have to be clear that it is inserting a new. an additional needle. So again, points and time and notice. It’s the same for electro. Whether you’re doing electro or manual, we have to have points in time. The difference for electrodes indicate what needles were electrified.

That’s all we have to do. So think if there’s two things, you must have time. and points, but let’s be clear, what does this time indicate? This time, as you notice, each code says 15 minutes, and I wanna make sure everyone sees that the 15 minutes. That’s true. But for 15 minute codes in C P t, same applies for physical therapy services.

Whenever there’s a time code in this way, time doesn’t follow 15 minutes, but what’s called the eight minute rule. So the actuality is that do you have to actually spend 15 minutes for a single. You don’t, you could potentially spend as little as eight minutes. Now, frankly, I don’t think too many people are gonna spend as little as eight minutes, but nonetheless it could be.

So let’s talk about how this 15 minute session is defined. What is this 15 minutes? Is it the time that you’re inserting the needles or is it more than that? So you notice here it says this means that the physician acupuncturist is in the room with the patient and is actively performing a medically necessary.

that is a component of acupuncture. And so what does that include? Literally everything. As soon as you walk in the room with the patient, that’s an activity of acupuncture because you’re asking the patient, Hey, how are you feeling today? Because notice what this includes, the history, any day-to-day evaluation, tongue pulse, palpatory findings, range of motion, whatever you do, including cleansing the hands, choosing and cleaning the points.

Inserting, manipulating, adjusting, anything like that, but also including removal, the disposal of needles, as well as completion of chart notes. So what I want you to think of acupuncture begins when you walk in the room and say, hi, Mrs. Jones, how are you feeling today? That literally is the starting point of the first set.

Because it includes that pre-service, the intra service and post-service work, even the time as you’re finishing with the patient, giving them home recommendations and writing it down. So what I need you to do is to document that. What time did you enter the room? What time constituted the first set, if you will, or when you left or came back.

Just make sure it’s there. And frankly, you can do it one of two ways. If you want to indicate that I spent 12 minutes, 15 minutes, 18 minutes, that’s. If you would prefer to indicate I started at 10 and ended at 10 22, that’s fine as well. But you’ll notice as I mentioned, the eight minute part of it. Notice one unit or one set of acupuncture could be as little as eight minutes.

Now for the first set, that’s pretty easy. I don’t think anyone’s gonna spend less than eight, cuz it includes all those things. Now the additional set, though, is also eight minutes. But notice how this. It’s eight minutes plus 15 because the second set must have a minimum of eight, which means you must complete the total time of the first.

What I’m getting to is you can’t do eight minutes for the first eight minutes for the second. That’s not two sets. Eight plus eight is only 16 minutes, which means one set. So a second set doesn’t begin until you spend 23 minutes or more face to. notice for the third set does the same thing. It’s 38 minutes, which means two sets, two full-time, 15, 15, 30 plus eight.

So it’s always eight into the next. And remember, there must be additional insertion. So by example, if you have a patient, they come in, you spend maybe eight to 10 minutes interviewing palpating and inserting the needles, and those needles remain in the patient for 30 minutes. You then remove those needles, sit the patient up, discuss with them, even though the total time might have been 30 minutes because of the retention, there was only one insertion.

So remember, whatever is the minimum, if it’s the insertion or time, it’s gonna default to the lesser. So be very clear because you have to indicate the time of active care. It’s not just the time that the patient is resting on needles. So be very clear that rest time is. If you’re leaving the patient arrest on needles, often you’re not in the room anyway, so that time wouldn’t count.

So be clear in the notes, how much time was spent face-to-face, what were the point of each set. Now, along with that, what I wanna focus, oops, I move that. Excuse me. Let me move this up. Here we go to make sure you can see where this comes from. This is a document from the company Regents, which is part of the Anthem Blue Cross Blue Shield Network.

But the reason I included it is I wanted you to see how they indicated it as well. They note the acupuncture codes as we’ve talked about, but notice it indicates seven minutes or less of a single service is not billable. That’s true for any time service. If you do only seven minutes of. That doesn’t count either.

So make sure it’s at least eight minutes and notice the same protocol. Eight to 22 would be 1, 23 to 37 would be two, but that includes that you’re doing a second insertion and so on it goes. So that sounds good. That doesn’t seem too hard, but I know for many of you, you’ve come to me and say, Hey Sam, you’re the expert.

Can you give me an example? So here’s an example of an office, and this is one that actually was. and past. I wanna make sure you can see that this is what you need to do, or at least something similar. Notice how clearly it’s indicated here. Treatment set one, it says the face-to-face time. It then indicates what points were needle.

It then notices that there’s eim added to two of the points, which means is this enough to bill for one set? Absolutely face-to-face Time, 20 minutes with those insert. and electricity electrical set. Then notice though it does something unique. It says needle retention after insertion was 12 minutes.

That’s fine if the patient’s resting on needles indicated. Then when you come back in the room, then you’ll indicate again after the patient rested with needles. Maybe they were withdrawn and repositioned. Do. Keep in mind, you do not have to withdraw needles for an additional set. It could just be more time and insertion.

So notice second set says face-to-face. Time is 18 minutes. It then highlights the points and then talks about if there was e-stim. But notice how clear this. From this, I bet you could all perform the service. What I want you to think of is that you should document in a way that another Accu Acupuncture could read it and go, oh yeah, I’m familiar with that.

Now you could argue maybe Sam, it doesn’t take me 20 minutes to insert those. I agree. It doesn’t take 20 minutes just to insert, but all the things that go on before the insert. During, and then of course even after just resting on needles doesn’t count. So anything you’re doing, that’s the component of it.

I want that time to count. So be very clear in your notes. The time acupuncturists generally indicate they spend more time with their patients than most other providers, and I would agree as an acupuncture patient I can certainly say that. I just need to make sure you document it. So here’s one simple example to do it.

Notice points and time for each one. Let’s do another example of a soap note. Now, this is an example SOAP note for those of you that are part of the American Acupuncture Council Network. In our ACU code, we have a template of this that you can use, but let me show you how it works. What it does is it gives a breakdown of the treatment, so you’ll notice what it.

It gives a very simple, what were the sets? Notice set one, two, or three. If you have more, you would just add a line, but notice it indicates the points and then the face-to-face time. Now this one’s a little different. This one indicates five 20 to 5 45. Either ways acceptable. If you wanted to put 25 minutes, that’s fine.

Notice the retention time is separate. They just make sure retention time doesn’t count towards face-to-face. And then notice each set does it that way. So don’t make this overly complicated. Make your notes in such a way that someone can read it. You can show them the time you spent face-to-face the points, and then do that same thing for each set.

Just realize that in order to bill for three, as you can see here, there’s gotta be more than 38 minutes face-to-face and insertion. So let’s take a look. This is 25. Notice this one’s only 10. Now it’s 10. Still enough? It is because it has to be at least eight. But remember, for three sets we need 38 minutes.

So 25 for the first. 10 for the second that brings us up to 35 plus an additional 20. That’s 55, so that’s more than enough than it would be required for the time. In fact, if there were a fourth insertion in there, could that have been a fourth set? Maybe. What I wanna point out though is that you might look and go why did they spend 20 minutes on this one?

At the end, when you remove the needles, is there time you spend with the patient taking the needles? Discussing with them the treatment. Realize all of that is a component, so I need it to be clear in your notes. Give me the time you’re with the patient for acupuncture. Remember, exams are separate, but for acupuncture as well as the points of insertion.

And remember, could it be one point? It could be. Generally it’s multiple, but it could be. Then notice the other thing. Notice the infrared heat. Infrared heat, lumbar spine for 20. , not a problem. There again, very clearly. What I want you to think of is, could you read this note and perform it and think of that as the gold standard.

Another provider can read it and clearly identify this service and could perform it. Again, you might say you spend less time because I know acupuncturists could put needles in fast, but remember, it’s not the time you’re putting the needles in only, but all the things that lead up to during and after that are a component, so don’t over complic.

But do make sure it’s there. When someone looks at it, can they clearly see the time? Can they see the points of insertion? Of course, we all know that this year, 2022 is the year of the tiger. Next year is the year of the rabbit. But what I’m gonna say to you is, you know what? Acupuncture is always in the year of time.

You bill a time related service. You need to indicate. Now remember, it’s face-to-face time. If the patient is resting on needles, that doesn’t count towards face-to-face unless while they’re resting, maybe you’re stimulating. That could work, but not just the period of resting. I know the acupuncture side go to often what she does is she’ll spend 10, 15 minutes insertions.

She then leaves the room for a while. I’m sure she’s probably treating someone else the time she’s gone. She comes back in the room and generally at some points, once she comes back in the room, that time. and then again, the time she spends with me, even after the needles, taking them out, doing the notes and so forth.

So just make sure time is there. The thing I run into that’s difficult for me to defend is when I don’t see any of that in your notes. So be clear for acupuncture time. And points must be documented. If you do, you’ll resolve almost every issue I’ve run into when it comes to acupuncture documentation.

Let’s get ready. How many of you have an expert on staff or someone you can go to? I am the expert. Let’s get ready for 2023 updates, coding changes, fees, and all those things are gonna be occurring soon. Go to our site, go to our network. We’re there to help. We’re always gonna be a resource for you. The American Acupuncture Council is always your.

don’t be afraid to reach out. Be careful. Don’t use Dr. Google. Go to a trusted resource. Until next time, everyone wishing you the best.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi everyone. Welcome to another episode with the American Acupuncture Council. I’m Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, as well as the profession in general. This episode is gonna deal with a very common question that I get whenever I’m teaching a seminar or doing our network services.

People always ask, Hey, Sam, I got a payment. Now the insurance company is asking for money. What can I do? Is there anything I can do to fight this back? What if they recoup the money? There are many things you can do, and there’s laws and statutes that are on your side. Never assume what they tell you is correct.

Let’s face it, you do an insurance verification, you bill the insurance, they pay it, and then they come back later and say, Hey, we paid you money six months ago. Turns out we shouldn’t have. So let’s take a scenario like that. The insurance company pay. . Then they come back and say, Oops, we shouldn’t have paid because there were visits that were applied towards the whole overall benefit.

Maybe it’s combined with chiropractic, maybe with physical therapy, and now they want it back. What are our rights? What do we do? So let’s go to the slides. Let’s talk about what laws and things protect you in understanding how we have to deal with this. This is not uncommon. Now, I don’t want this to scare you off.

This doesn’t happen a lot, but it happens enough. You have to know what your rights. What are my rights when someone says, We shouldn’t have paid you and we want this back? So here’s a letter and please note everyone, this is a letter from Federal Blue Cross Blue Shield and notice what it’s saying. Dear Billing Department, they’re talking to us directly in regards to the request for repayment for claim.

The request made to you was a voluntary overpayment request. Because you are in network provider, you do not have to pay back any overpayment if the overpayment was discovered 365 days or more after the claim was finalized. So I wanna take a look at this letter and notice what they’re stating here.

They’re stating that they can request an overpayment if you are in network, but not if it’s over 365 days. So notice that’s why the letter says a voluntary overpayment realize most often when an insurance company is requesting a re. they’re doing. So just to see if you’re willing to pay it. So by example, let’s say a policy, as I mentioned, has 20 visits per year.

You verify it and they pay it, and then later they come back six months later, a year later and say, Oops, it turns out the patient already had visits with some other provider. Therefore, we shouldn’t have paid you. Frankly, whose fault is that? You did the proper verification, you bill it, they paid it.

Now they’re saying, Oops, we made a mistake. We want you to pay it back. So notice that’s why this says voluntary. So even though this provider is in network, they’re saying please pay us back. My issue is gonna be no thanks. Why should I pay you back if it’s your mistake? In essence, what they’re saying is, we made a.

And the patient’s benefits weren’t there. Therefore, we want you to pay back our mistake. My rule would be, no, you go to your insured, That’s who you made the mistake with. Cuz essentially what they’re trying to push you to do is you pay them back and now go after the patient. Why would we have to go after the patient if that’s your insured?

That’s where you’ll notice the difference here. Notice it says here, the request made to you was volunt. And because you are in network and it’s over 365 days. So notice now the difference if they had done this within 365 days because you’re in network, they can take it back. This is one of the downsides of belonging to an insurance you give them to right to recoup.

Even when the error wasn’t yours. It was their own mistake. So it’s one of the downsides of being in network. Now, if you were out of network, could you just completely refuse this and say, Actually you could in the absence of fraud, where something you build wrong or maybe they paid you twice, you are under no obligation to refund this.

I’m gonna point you to this is a letter that we use for those in our network, or those that come to a seminar that deals with an insurance company that has paid you and then subsequently wants it back. So notice at the top it says, We received your letter where your company’s requesting re refund the payment, and you reviewed the benefits and nothing here shows otherwise.

So let’s move down here. It says, I feel that you have do not have the right to place this burden upon my office by asking us to correct your error. And this is backed up by Case Law. Notice it says, I would like to bring your attention to cases involving the Federated Mutual Insurance Company, and essentially it says the insurance company is in the best position to know the policy limits and must bear the responsibility of their own mistake.

So again, if you’re out of network and the insurance is asking for this back, understand if they made the mistake and paid more than they should. Maybe there was a deductible, they didn’t apply or they just applied more visits than the plan allows. They have to bear the responsibility for it. And again, case law noting dating back to 1974, so for many of you may not have even been born yet.

The next case goes from here for national Western Life Insurance Company. And it says in the absence of. A healthcare provider is not legally obligated to run refund payments. It receives from an insurer if the insurer subsequently determines they were paid in error. So let’s do this example. You call, the plan says they cover acupuncture.

Great. You bill it, they pay it, and then six months later they say, Oops, it turns out we don’t cover acupuncture. Whose fault is that? You did everything properly. What they’re saying is, pay us back and you chase the patient. My rule would be, You go after your own patient. That’s why that one said voluntary.

You’re under no obligation to pay this. So when you were out of network, , you may completely push back on this with citing these two case laws, because if there’s nothing wrong with the claim, you didn’t bill anything in error. There wasn’t something billed that you didn’t provide, or they didn’t pay you twice.

If someone pays you twice for the same data service, you do have to refund the overpayment of that. But outside of that, the answer is absolutely no. Again, if you’re out of network. Now, why is it different if you’re in. It’s different when you’re in network because part of the contract we sign, when we join these insurances, it literally says in the contract, Should we make an overpayment?

Even if the error was on our side, we can recoup the money. And I’m sure many of you, almost Sam, that’s happened to me before. They just take the money from another patient. They will if you’re in network. If you’re out of network, they should not be because they have no right to that. In fact, the case law stands up, but let’s talk about if you’re in network.

Notice it said one year. Now that’s the federal statute, which is generally equal to what the billing time is. So if the billing time is one year, they have one year to recoup again, if you’re in network. So if you are in network, they can recoup. Within the timeframe of the statute of limitations, and that’s where this is a little bit different from state to state.

So I’m gonna give you a little breakdown here. This has every state, and you’ll notice it can vary from some, That’s one year, 36 months, five years, two years, all the way down to as little as 30 days for some. And some states don’t have any, which to me means it defaults to the federal statute. But always know the statute of limitations.

Just like an insurance. You know how some insurances are? You have 30 days to bill 60, 90, or one. The same thing applies here for a recoupment. The state law will break it down. So is it one year or otherwise? So know your state and whether or not you can push back. My rule would be always send a letter like this in a response when you are out of network.

Even in network, I would use the same protocols, but then follow up with the statute of limitations. Do not be. To push back. The assumption is often you don’t know better and are just gonna pay, cuz we’re afraid of the insurance we’re gonna get in trouble. If they could recoup it in network, they probably would’ve.

So take a look here. Here’s an Aetna claim, and notice what it says As a result of a routine claims payment, we previously notified you that there were some differences between the amount paid and the amount, which you should have been. That’s their own issue. So notice and I highlighted it in yellow, it says, Our records indicate the overpayment as noted on the enclosed document, is not eligible to be offset from future claim payments.

In other words, you’re outta network. So we can’t force you to pay it back, but we’re gonna please say therefore we must request you issue a check or money order payable to us in the amount that’s requested. You know what my answer to that is? No thank. Why would I voluntarily send it? When do they ever voluntarily say, Hey, you know what?

We’re not paying you enough. We’re just gonna go ahead and pay you more. Know your rights. Don’t be afraid to push back when there’s a request for overpayment. Was it truly overpaid? Did they pay you more than you billed? That you would’ve to pay back the amount over what you build? Or if they paid you twice.

But if you’re out of network and they later decide, they didn’t feel they should have paid it too. That’s on them. They should know their own policy. And the Statue of limitation applies for those of you who are in network, just like they put a limit to the time that you can send a. They will have limits to when they recoup.

This is why a lot of providers think maybe I don’t want to be in network, cuz I give them a little bit of power that’s part of that tradeoff. We did this in an earlier talk with you of trading off what is it worth it or not. Now this doesn’t happen enough to where it’s gonna major problem, but it’s something to note within your rights because many times they’ll just send you a letter hoping you’ll pay.

Let’s say you send a hundred of these letters out, maybe 50 of the doctors know the rule. They’re not gonna pay it, but the other 50. That’s an easy way for them to recoup money by simply having people not aware of what their rights are. Notice. These plans aren’t necessarily there for you. Always be able to push back and know where the laws fit.

That’s what we’re here to do. That’s what the American Acupuncture Council is there to do. We always wanna enhance your practice as I do. For those of you who would want to have help, just what we’re doing now where we can deal with this one-on-one via phone or Zoom or otherwise, you may wanna join our network.

Take a look at our site. You can do the QR code or go directly to our site. Remember, it’s aac info network.com. We’re always here. The American Acupuncture is always going to be your resource, your place for help. And remember, first of the year is coming. What’s gonna be changing, lots of things, codes, fees, and otherwise probably time to get to a continuing education seminar with the American Acupuncture Council Network.

I hope to see all of the future date. Until then, best wishes everyone.