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Happy New Year and greetings to my friends and colleagues. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and more notably, you and the profession. I’m here to help you to make sure that you get information that keeps you up to date and moving and there’s nothing better to get knowing what’s going on than let’s get ready for 2025.
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So let’s go to the slides. Let’s talk about are you ready? for 2025? Are you really setting yourself up? Realize this is that first week, so everyone’s back in. Let’s get things ready. Let’s be proactive, not reactive. So the first thing I will tell you to do, you want to start thinking if you’re doing any insurance, but for that matter, even cash, we’ll get into it.
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Are you prepared? For insurance, I would say prepare for understanding What’s going on for plans in 2025? Is anything changing? It’s time to go back through to see what’s new for certain plans. Now, keep in mind, if I have one person that works for a company and has insurance A, another patient that comes in from the same company with the same insurance, I don’t have to go through all of that if I do one thorough way of going through that policy on one person, so long as everyone has the same policy.
So the first thing I want to look at is, What’s going on with deductibles? Has there been any changes for 2025? Did it increase, decrease, stay the same? By example, though acupuncturists don’t directly bill Medicare, you’re involved now. The Medicare rates, of course, did make a nice increase. We’ll get into that.
But the Medicare deductible did go up 17 to 257, which means if Medicare went up, might other plans. Yeah, that’s a hit and miss, but check. One thing I’ll point out though, that a lot of times acupuncturists are not familiar with, however, is that deductibles may roll over, meaning that they will not have a new deductible at first of the year if that person saw a doctor in the last quarter, and what this means is, let’s say by example, you don’t go to the doctor at all.
You’re a patient, and in December you go to the doctor, you have a $1,000 deductible, you have to go and you meet that deductible. Then January 1st sits and you’re like, oh my God. I gotta pay the deductible again? I just they don’t punish someone in that way. Most plans will have some type of rollover for a person who’s seen the doctor within the last part of the year.
So it’s worth checking. Often that may not be the case, but it’s worth looking into. So I would check to make sure. Most importantly, We want to know deductible so we can make patients aware of what they’re going to pay. And keep in mind, we also want to check on not just deductible, but what’s happened with any coverage.
Has there been any changes to the benefits? Is the acupuncture benefits better, worse, or the same? By example, a lot of people have said, Sam, I heard that the Medicare Advantage Plans were getting rid of acupuncture. They were not. So long as the person has the standard one that has what we call gosh, I gotta think of the term, but it’s where you’re going to have just a acupuncture benefits that are there all the time.
Realize all plans under Medicare have the regular benefits, meaning, MD supervision, but for those that have routine acupuncture, it will cover for pain management. Look to see if any of that’s changed. Many of them may or may not have it, so always check. Don’t assume. Regular Medicare did not update.
You will still need for regular Medicare Part B medical supervision. Do check though, because this is something that’s occurring with some of these Medicare Advantage plans and others, is the requirements for pre authorization. Many of the Medicare Advantage plans continue to have it, but the ones under United, at least some of the plans, and others under Humana, will require pre authorization, which means they all allow you to do the first visit, but then you have to request more after that.
Not that it’s that hard, it’s all online, but it’s just something to know. You don’t want to bill out assuming it’s being paid and they later say, oh it requires pre authorization, because often they will not do a retro authorization. So do check to make sure what are the coverages, what are the changes, are the number of visits the same.
Are they combined with anything? Is there any limits? And this is something to keep in mind. The limits to acupuncture benefits under insurance are limited to what are they covering under the diagnosis they allow. By example, Cigna has probably a 500 code list of things they cover. Aetna has a list that’s about 25.
So you can see clearly one more that’s going to have a little bit more or possibly more. So know what those plans cover. Don’t assume. Some plans will cover fertility. You want to check to make sure it does it. And here’s my point. Get as much information about beforehand so we can make sure that we understand what’s going on with what are we going to bill and how we’re going to be paid.
Because one thing to look at is what’s going on for fee schedules for this year. And I want to talk about just your common CPT codes. I don’t care about things you don’t do. Most acupuncturists, of course, are going to do exam codes, E& M codes. Acupuncture, of course. And then maybe a handful of therapies.
What I care about are those codes. Here’s some really good news. The relative values For the first set of acupuncture, both manual and electrical have increased substantially. For most of you, if you’re billing the VA, this literally means you’re getting about a 20 percent increase in that allowed rate.
That’s pretty significant, which means that may roll over into other plans because plans that use Medicare, which include VA, Personal Injury Work Comp, et cetera, will be increasing. Now, the downside to this, of course, It’s not going to affect your ASH. It’s not going to affect your Optums. Now, if you’re part of ASH, certainly if you’ve been in a while and you’re a tier six, I will be looking for, have I done a protocol to ask for a raise?
That’s something to be thinking of, but do take a look and think of, wait a minute, how much it’s increased. Now be careful. Relative values tell you what to charge from one code compared to the other. So I want everyone to start a little bit differently. Literally, you’re going to see a large increase. in the first set.
If you want to get more details of that, I’m going to tell you. Come to our seminars with the American Acupuncture Council right at the end of the month. Keep you updated there. If you’re a network member with me, just get in contact with me. I’ll get you set up. But really, this is a significant difference for you, particularly when it comes to things that are related.
VA, of course, but everything else related, which is going to be and so forth, which means prepared to understand. W for this year? What type do we have in place? Make are always aware of your think of what’s the numbe ask beyond if you can hel
Make sure you get something new for the year. Now, if someone’s on an ongoing care plan, they started in December, I’m not concerned, but someone coming in new this year, always have them sign a new and updated financial agreement so there’s no surprise. That’s why we have the No Surprise Act. Make sure they’re aware of what their costs are going to be for what services are covered.
And maybe some services that are non covered. By example, on some ASH plans, they don’t cover massage, which the patient can be charged for. Therefore, we got to make sure they’re aware of it. The bottom line is, just like for you, if you go someplace, you want to know the cost, make sure your patients are aware of their cost as well.
Which means, are you doing anything financially with How do you set up properly for a cash discount? Outside of California and Minnesota you got to be very careful. They allow some big differences but for most states you can make a 5 to 15 percent so if your rates raise up that should be the same thing for cash.
But what about prepays? I do think prepays should be something that every office offers. I’m not going to say it’s absolute that every patient’s going to want one, but I’m going to tell you some patients are. And it’s a good way of creating another revenue stream because people can see it as affordable.
And remember, prepays allow you to discount more than a 5 to 15%. Now what about your assignment of benefits? Remember, patients need to sign a new assignment in the new year. They want one up to date. If you’ve not seen someone in a long time even, Make sure they’re signing a new assignment. What is the assignment?
That just tells the insurance company, pay the doctor. This is something many of you may have gotten letters asking you about that for the VA. Not a big deal. Should always be on file. I would just make it at first of the year. As patients come in, they sign a new assignment January 1. Which means we’re always offering compliance.
Our compliance when it comes to HIPAA. What have you looked there for a while? Have you seen, is my privacy notice up to date? Does it have everything that I do? Which by example, Almost everything is open. What if you say, Hey, I want to make phone calls to remind you about appointments. There’s nothing wrong with that, but in order to do because that may not be private, the patient has to give permission that, oh yes, you can call and leave a message, because that line may or may not be private.
So keep that in mind that if I’ve not done anything to update, have I looked at it? Do I have all the things in place? Do I have business associate agreements? Who am I working with, whether it’s a billing service or an electronic record company? Are they all HIPAA compliant? They should be, but make sure you’ve got things in place protecting ourselves.
Now, what about your office policies? Things that you do in the office. There’s nothing wrong with updating those. And I would say two things to look at. Do you have a no show policy? Some offices like to have those. If a person doesn’t show up, do they get charged? Outside of the VA, you may do so do keep in mind, if you have a no show fee, make sure the patients are made aware beforehand.
What about credit cards? There’s nothing wrong with obviously taking credit cards, debit cards, but can you charge extra? You can, but let’s be careful. It’s not a percentage. You could have a fee that says, if you choose to use a credit card, there’s an additional 1, 2, 5 transaction fee, depending on the amount.
Now, and what I mean by that is, you’re going to charge 5. If they’re only charging 15, that seems a little steep, but what I’m getting to is having a fee. What it has to be a separate from the charges. You can’t say the more you charge, the more of the fee, but there could just be an allowed rate.
That’s allowed so long as patients are told beforehand. Make sure, of course, too, you have consents on file. If you’ve not seen a patient in a while, if you’re seeing them from, an ongoing plan from, November, December to now, I think we’re okay, but if they’re coming in with a new care plan, they need a new consent.
Okay? Make sure also that you have the difference between covered versus non covered. Okay? The patients know what is covered, but what is not covered, I want to make sure they understand that’s going to be out of pocket. They’re going to understand that. I want to make sure if we’re doing cash or prepay, the compliance is we have things on file so that no patient comes back and says, I’m upset because I don’t feel it was fair.
Now you may think I never do insurance. I’m not worried about that. Realize. You can get complaints and other things from the board based on this if a patient makes a complaint. Put things in order. Have them to make sure all the agreements are there. And do remember, it’s always documentation, whether it’s going to be financial agreements or what you’ve done for treatment.
And again, I don’t care cash or insurance. If it is not written down, it didn’t happen. So make sure the documentation has what’s going on. A quick review of what you done. You know what a SOAP note is? The S. A review of the chief complaint. and how the patient is changing as a result of care. Is it better or worse?
In other words, it’s what they’re telling me, subjective. The objective is, what did you find? The tongue was coated. The pulse was wiry. There’s muscle spasm, loss of range of motion. And then your assessment is nothing more than your diagnosis. And then from there, your treatment. So for acupuncture, and this is the area we run into the most problems when we deal with audits.
Remember, if you have insurance through the American Acupuncture Council, you have audit protection. So if you’re audited, they’ll help defend you, but it’s hard to defend because if you don’t document what you’ve done for acupuncture, please make sure you’re documenting the time you spend face to face with the patient, as well as the points of each set.
And remember that 15 minute, or if you will, 8 minute rule that follows. If you’re doing therapies are fine. Just make sure that the therapies are documented properly. What am I doing? Where am I doing it? You can’t just check off if I did infrared heat. But tell me, oh, I did infrared heat to the lumbar spine for 15 minutes.
Again, not very complicated, if you will, but document it in a way that it can be seen when what was done. And again, if it’s timed, make sure time is there. When you’re doing an exam or E& M code, are you making sure that if you’re billing a 99203 or a 202, is that clearly the value? A 202 would mean that you spend at least 15 minutes, a 203, 30, or at least one complaint or multiple complaints with strain and sprain.
Make sure that if you’re billing a code, know why. If you’ve never attended a seminar with me, I’m going to encourage you to go, what is the requirements for E& M? I think a lot of times people really misunderstand that. And I’m going to emphasize time. Acupuncturists do spend a lot of time. Document it.
There’s a value to you. That’s getting you prepared for 2025. Document what you’ve done and ultimately the patient getting better. Your practice thrives off of people understanding and having access to you. The understanding Is this going to help? Then they come in and go, wow, that did. There’s a value to that.
Make sure people understand that. For me, the biggest difficulty for acupuncturists is getting yourself out there. Being prepared for 2025 would be, if I have back pain and I’m looking for an acupuncturist, how am I going to find you? Have you set up a network of people that refer? Does your website do it?
Does the signage in front of your office when I pass by, does it let me know what’s going on? Practices thrive based on, of course, patience. And we thrive based on you. We’re here to be your resource. The American Acupuncture Council, of course, more than the malpractice side, I deal with the network side.
We’re here to help you. One on one, a resource. By example, are you aware of what’s happened with the fee schedules? I’ve given you a little bit of that. What about new codes for phone calls and telemedicine. That’s changing for this year as well. It’s more than what we could do in this short time, but I just want to make you aware, be proactive, not reactive.
I look forward to all your success. I hope to see you all at a future seminar. Until then, my friends take care.