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2023 Fee and RVU Updates – Sam Collins



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?

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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.

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.