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Pelvic Floor and Postpartum – Krystal Couture

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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.

Hello everyone, and welcome. I’m Dr. Krystal Lynn Couture. The pelvic acu. And before we get started, I wanna say a special thank you to the American Acupuncture Council for hosting this vlog. If you haven’t been to the American Acupuncture Council website, you absolutely should go there because there are amazing vlogs like this one that are filled with little nuggets of gold for acupuncturists and.

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They do a really nice job of sharing those teachings in little bite-size bits. So let’s get started with today’s workshop. We are going to be talking about postpartum and the pelvic floor. I. So what’s inside our workshop today? We’re going to be talking a little bit about sitting the moon or sitting the month.

We’re gonna talk a bit about miscarriage and abortion. We’re also going to have a chat about some postpartum challenges that moms could encounter. We’ll talk about the healing process that one goes through. Through the postpartum process. We’ll talk a bit about the hormones, we’ll talk about the perineum, and we’ll talk about uterine involution.

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So here we go. Alright. Sitting the moon or sitting the month, lots of cultural traditions, including Chinese tradition around the globe, suggests that the mom and the baby really spend the month or the moon. Being protected, being nurtured, being nourished, bonding, and recovering with each other. That means there’s very little demand.

On the mom and on the baby, except for healing and coming together in harmony with each other and the outside environment, right? Western tradition suggests that recovery period postpartum after childbirth, there’s an acute period of 24 hours, a subacute period of 24 hours to six weeks, and then a delayed recovery period, which is six weeks to six.

Months. And so there’s a difference in how Western terminology and how Eastern terminology looks at the postpartum recovery period, and what is encompassed within that. So let’s get into sitting the moon. The traditional recommendations are lots and lots of rest for the mom, and this is really bed rest including 10 hours or more of sleep per night.

The body has just been through an immense transformation and a major outsourcing of. Energy or expression of energy, right? So rest and sleep are really important. During that first month, it brings in the support of family members, friends and nurses to maintain the cooking, the cleaning, and other household tasks.

It’s really not part of traditional culture that these things are done by the mom while she has the new baby at home. Another part of sitting the moon that is done in traditional cultures is abdominal binding, and that’s really to help reduce the laxity in the abdomen and restore the proper pressure.

Within the abdominal cavity. And we’ve talked a little bit about pressure within some of our workshops here, right? So the abdominal pressure directly impacts the pelvic floor pressure. Now you can imagine after the birth process that the pressure change is going to be pretty significant.

Abdominal binding helps to bring that pet pressure. Back to a normalized state, and it’s also going to help with the pelvic floor healing as well. And of course, eating and nourishment are going to be such a big part of this sitting the moon period. And also of course, for milk production, right?

We wanna make sure that moms are getting the right nutrition into their body. That’s going to be satisfying, that’s going to be nourishing, that’s going to fill the coffers with what might have been depleted. During the pregnancy and then during the birth. But of course, it’s also important to remember that balance, right?

So not eating too excess is another important facet to the postpartum dietary kind of idea. Okay. And then of course, maintaining warmth in the body, right? As Chinese medicine practitioners, it’s very rare that we recommend cold. We tend to go toward warmth. Warmth is particularly important for new moms postpartum.

It continues to help to support the movement and the consolidation. Of the qi, right? So again, it’s that harmonization. What is too much, what is not enough? Let’s balance that out and the right types of warmth are going to be supportive in that way. Okay, let’s talk about some of the traditional restrictions that are going to be part of sitting the moon in Chinese culture.

And these would include washing one’s hair. We know that is a restriction as well during menstruation. It continues, of course, into postpartum. Bathing avoiding a draft is gonna be really important. Lifting, especially lifting the baby. And in traditional cultures, actually even, so I’m Italian and looking back into Italian culture, this is also a, a philosophy there as well. So it goes across the sort of folklore and the tradition of medicines around the globe. So lifting the baby, all that weight can help and support the mom’s poor posture, right? So we have this laxity in. The body after the birth, right? So the abdominal muscles are stretched and they’re weak, and generally there’s this forward tilt of the pelvis, which means the back muscles are tightened and those glute muscles are stretched.

So there’s this imbalance, and until that balance is restored within the body, whenever the mom is doing lifting, she’s facilitating. More of that poor posture. So lifting whenever possible is something that should be done by the nurse, by the family members, by community. And I think that’s the biggest key when we’re talking about sitting the moon and cultural tradition, is that community is such a big part of these traditions.

Where in Western society it’s almost mom’s gotta do so much. By herself and if she’s lucky, dad gets, a period of postpartum time as well. So dad can help a little bit, but it’s really leaning into community is so helpful. So as acupuncturist, if we can provide our clients with resources for accessing community for our postpartum moms, that’s such an amazing asset.

Okay. Another thing, climbing stairs, again that contributes to poor posture and also too much load on the body and change in the abdominal pressure. Nursing in sideline position is so important. Any watching TV reading or. Now we say scrolling as well. This is all going to be things that take the mom’s energy or put in energy that is going to impact what she is sharing with the baby, right?

And also shedding tears. And of course, we all know the Chinese proverb that says one teardrop from a postpartum women is worth 500 kilograms of gold. So just keep that in the back of your mind and share that with your clients. Let’s talk about miscarriage for a moment. Miscarriage is considered to be more serious than childbirth, according to Giovanni Macha.

And this is also true in a lot of the traditions, right? So women who’ve had a miscarriage or in abortion for that matter, the postpartum cycle could actually be extended. And the reason for this is because the natural cycle of pregnancy. Is interrupted, it is changed. The body has an expectation to complete a cycle when it is not going to complete that cycle.

That is a huge interruption in the cycle, in the energy of the cycle, and of course within the hormones. So not having completed the cycle can create quite a struggle within the body, mind, and spirit. Let’s look at some statistics here. Postpartum complications from a 2024 study actually showed that 35% of women experience pain with sex.

32% experience, low back pain, 31% experience urinary incontinence, 34% anxiety. 19% experience rectal incontinence, 15% experience pain I’m sorry, fear of childbirth. 11% peroneal pain, specifically 11% secondary infertility. Prolapse is 1.4 to 13.7%. So those numbers were a little bit varied depending on where the study was looking.

And then that’s with a vaginal delivery with a c-section. The prolapse is were 2.4 to 21.2%. So there’s a lot of variation there and that’s something I think that needs a little bit more research. But as you can see, there are pretty big. Statistical indications that show that there are a lot of postpartum complications.

And as acupuncturists, guess what? There are a lot of ways that we can support our clients, especially if we specialize in pelvic care, postpartum depression as a complication. I gave this its own slide, so in 2009. 2010, there was 9.4% of women reporting postpartum depression. In 2021, that number jumped by 104% to 19.3% of women.

Now, of course, during this time, there was the covid, so that was part of it. Also, women are talking more about what’s happening in their bodies, right? Women are starting to be more and more aware of what’s happening. This increase was noted across all races and ethnicities. There was also a substantial correlation between postpartum depression and obesity.

So these are all important things for us to be aware of with our clients. Okay, so I’ve included this chart for you to have a look at. You can go ahead and pause here if you like, to look at this interplay between the intrinsic and extr extrinsic predispositions to pregnancy, labor and childbirth, and medium term and long term maternal complications.

And you can see that these go out long after childbirth that we can still be seeing. Complications, which include prolapses and that sort of thing. So what does it take postpartum to heal, particularly to heal the pelvic floor? I shared a little bit of this slide in our pregnancy workshop, but we’re gonna go into more detail here.

First off is organ alignment and function. If you watch my pregnancy presentation, you know there are major changes within the organ systems in the body during pregnancy, which means that the body kingdom. Is out of order. There was a renovation that happened within the Body Kingdom, and that’s okay.

That’s not a bad thing, but balance needs to be restored. We need to help moms to find proper alignment and of course, utilizing the meridians. Is going to help those organs to come back into balance within the whole of the body kingdom. Now, the uterus size and position, we’re gonna talk about this more.

There are major changes that occur with the uterus size and position. It needs to expand, it needs to move up in the abdomen during the pregnancy, and now. We want the uterus to go back to size. I talked a little bit about ab abdominal binding as a strategy. That’s one way for sure, but there are also other ways that the body can naturally support itself in the uterus responding.

To its natural size and position. Then there’s the perineum that requires healing. There’s the ligamentous and joint recoil and positioning. All those ligaments in the sacrum and the hips and the back have stretched out. Why? They needed to support a baby and then they needed to push a baby through, right?

So we needed space for that. So that recoil. Needs to happen. The fascia, the diaphragms, and the postural alignment, there is going to be a whole new systematic alignment of the body that’s going to occur postpartum. I. Now if moms are not in a state where they’re able to take care of themselves, it’s really hard for that ligamentous recoil and those fascia and diaphragms to align and the posture to be appropriate for our clients through the postpartum phase.

And then, as it’s harder and harder to get it back as time goes on, right? What we have to put in is a lot more. The muscles of the abdominal the abdominal wall, the back, and of course the hips and the pelvic floor, they all went through changes as well. They were all stretched or tightened, so they need to return to some sort of harmony.

Okay. Blood and fluid leveling. We know about bloods and fluids in Chinese medicine. This is a big part of what we do. There’s a lot more fluid in the body when one is pregnant and then there’s a change in that fluid, so that’s going to be a pressure equalization once again, that occurs and it needs to be right.

For where the body is and what the body is going through. For example, a mom that’s nursing is still going to have an increase in fluids, different fluids, different energy, but they’re still going to have that increase. So we’re looking for the harmonization of where they’re at that moment. And then we’re looking at the energetic flow and the meridian flow, and then we’re looking at emotional harmony, right?

So there are a lot of things going on with postpartum moms. We talked about hormones in just about every one of our workshops here. We’re gonna talk about ’em one more time so we can see that at birth we have an increase in progesterone, estradiol, and cortisol. Those and those are all going and placental tigen.

So those are all going to increase. They’re gonna spike at the gradually increase and then peak at. Birth, and then they drop right off. That is a major change. Then we see oxytocin and prolactin come in and they have these peaks and valleys. These peaks and valleys are going to be impacting what is happening in the mom’s body and how her healing process is going to occur.

So when do hormones return to normal after childbirth? Okay. The common response is that, you’ll hear from your western doc is within six months, hormones return to pre-pregnancy levels. Period. Done. Okay, great. In theory except there is very little evidence-based research on postpartum hormones.

In a timeline form, there is research on postpartum depression being linked to decreased progesterone and decreased estrogen. There are studies beginning to emerge that show women who give birth at an older age may have different hormone responses. So basically what we’re saying here is there’s a lot of questions.

Each body is different, and I think when we’re able to transparently answer that question with our clients so that we’re not setting them up for an expectation that may not be reality, I think that’s when we’re going to be able to come in. With our compassion, with our knowledge, with our awareness, and really support them through the process and say, each experience is individual.

Your experience is your own experience, and here’s what we’re gonna do to help you in your process based on what in your clinic. Okay, so estrogen muscles. Let’s talk about the healing process. What we know is estrogen preserves muscle mass. It supports muscle repair. It helps muscles to generate force.

It increases collagen content. It plays a role in muscle metabolism, and it presents muscles against apoptosis. Okay, what we see, remember that gradual increase of estrogen and then that estrogen drops off after the birth right? So we are going to be in a diminished state of estrogen while the body is trying to recover those muscles.

The sudden decrease in estrogen can create decreases in muscle suppleness, strength, power, recruitment, and function. Of those pelvic floor muscles, and of course the abdominal muscles, the back muscles, all the muscles of the body are going to be impacted. But the pelvic floor in particular, because that is where the baby had to find its way through, now talking about progesterone, what we know about progesterone, it supports muscle relaxation. It supports protein synthesis within the muscles, and it maintains connective tissue elasticity. And what happened to progesterone? Same thing. We had that gradually increase and then a drop off. The sudden.

Decrease in progesterone can contribute to muscle weakness, proprioceptive confusion, and stiffness within the tissues, right? So we’re really at a disadvantage. The body is at a disadvantage to naturally recover on its own with zero intervention. Zero thought about the pelvic floor, zero thought about the abdomen.

The perineum tears occur in 80 to 90% of first time moms. A first degree tear is just the skin being impacted. Second degree impacts the skin and the muscle. Third degree is going to be a tear that includes the skin, the muscle, and it’s a partial tear of the external anal sphincter. Fourth degree includes the skin, the muscle, and is a complete tear of that external anal sphincter.

Now an episiotomy is when they do a surgical cut to try to control the the tear or to expedite the birth sometimes they’re done in emergency situations, sometimes they’re done to prevent serious tearing. The research on whether or not an episiotomy actually can prevent. Serious tearing is questionable at this point.

There is not good evidence to show that. That’s a topic for your client to have conversation with their midwife or their OB about. The stretching and expansion of the perineum is a natural process. The perineum will start to expand at the end of the pregnancy. That’s a good thing.

We want the perineum to expand. That’s going to help the process. Two to eight weeks after the birth, depending on the stretch and the tear. Intensity. The perineum generally starts to return to its pre-pregnancy state, to its unstretched state, and of course that varies significantly based on whether or not there is tearing.

There is some evidence that’s coming out, that perineal massage, that breath work, that relaxation can all really help with reducing the risk of perineal tearing. Now of course if the perineum does tear, that’s another implication, right? For what we have to do to address the pelvic floor. Okay, let’s talk about uterus, involution really quickly.

Okay, so this is the womb. Returning to its pre-pregnancy shape and size, involution begins as soon as the placenta is delivered. So basically the body just doesn’t get a rest. It does not get a rest. It goes through this pregnancy phase, which is a lot. It goes through the birth, which is an extreme amount of energy, and then the placenta is delivered, and then the body is oh, okay.

Now we start. Now we start again. So it’s the next part of the process. It’s that return as the uterus contracts to deliver the placenta and subsequently continues contracting, right? It starts to decrease in size. That contraction with nothing there to hold the shape kind of makes it start to shrinking.

Process. Involution, they say, takes about six weeks total. With more oxytocin in the body from breastfeeding, they say that the involution actually takes a little bit less time. Signs of involution include the Lok qia discharge, and of course postpartum cramping and contraction. Now pelvic floor muscle recovery postpartum.

A 2022 study found that at 12 months postpartum falling of vaginal delivery. The pelvic floor muscles are not yet fully recovered compared with their mid pregnancy values. Okay, so that’s not even talking about their pre-pregnancy values, that’s talking about mid-pregnancy values. This number should be concerning to you as a healthcare provider.

Some contributing factors that we see here are going to be a vaginal delivery, of course, versus a c-section tearing or episiotomy the size of the baby, difficulty of the delivery. What we know about the pelvic floor muscles is that it takes six to 12 weeks to build muscle. Muscles do not build themselves, so that means that it takes effort working with the pelvic floor to restore harmony.

And to restore balance. So where do we come in as acupuncturists? As acupuncturists, we have some amazing tools within our toolkit that can really support clients. And these tools are of course going to include using TCM. To help rebalance the patterns in the body and restore and nourish the system.

We, of course, have herbs that will do the same or whatever else is needed. We have moa, which really helps to consolidate and warm and activate blood flow within the muscle tissues. We have our gua, we have cupping, which, you know, cupping a little bit. Perhaps questionable considering there might be depletion, but it could be helpful in an isolated spot if there is particular tightness and over contraction.

For instance, if we have that imbalance that I talked about earlier with that serious anterior pelvic tilt and those back muscles are just. Squeeze down. The qls are just really tight. Those paraspinals are really tight and the abdomen is really stretched and the glutes are really stretched.

Cupping on that specific area could help to reduce the excess that’s in that area, distribute that throughout the body so that we can achieve a little bit more of a neutral tilt. We also have things in our tradition that are from the deep traditions of Chinese medicine, like pelvic steaming, like pelvic smoking.

Like abdominal binding, right? There are a lot of complimentary techniques that we can use to support our clients. Beyond that, if we get to know the pelvic floor in a deep way, then we’re gonna have the opportunity to support the pelvic floor, to evaluate the pelvic floor to. See where there are weaknesses to see where there are excesses, to see where we’ve got, stretch and tightening, right?

Because the left side and the right side might be different. Maybe the person who was having her baby had a leg length discrepancy, so everything on the right side, including the pelvic floor, is really tight. And then maybe there was a little tear going toward the left, and the left side is super duper weak.

So helping us to expand our practice by understand the pelvic floor really helps us to support these postpartum clients. So if you are with me today you probably know that this is my fifth workshop In my series we did a pelvic floor intro. We did a pelvic floor and menstruation, pelvic floor in fertility, pelvic floor in pregnancy.

This is pelvic floor and postpartum. We’ve also got a pelvic floor and menopause workshop coming up for you. Here are some references. I just wanna say, once again, thank you so much for being here. I really hope you enjoyed this workshop as much as I enjoyed sharing this material with you. Once again, I’m Dr.

Krystal Couture, the Pelvic acu, and this workshop has been sponsored by the American Acupuncture Council.

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Microneedling Neck and Hands – MIchelle Gellis

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Hi, my name’s Michelle Gellis. I am an acupuncture physician, and today I am going to be presenting on microneedling for Aging Hands, neck and Chest. So a little bit about me. I have recently published a hardcover 500 page book on treating the face. So you might wanna check that out. And currently I’m on the doctoral faculty at Yoan University, former faculty member and clinic supervisor.

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At the Maryland University of Integrative Health for about 18 years. I’ve been published several times in the Journal of Chinese Medicine, regular columnist at acupuncture today, and I’ve been teaching facial acupuncture classes internationally for about 20 years. So today I’m talking about a couple of specific topics within the general heading of microneedling.

So I’m gonna be talking about microneedling for the neck, chest, and hands. So I’m gonna go over the benefits of microneedling, how it works, contraindications, some special considerations when you’re microneedling the hands, neck and chest. And then some technique techniques. So why would we do microneedling?

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Microneedling is a great alternative to injectables, things like Botox and fillers and surgery to address things like fine lines, acne scars, loose skin, large pores, crow’s feet, lip wrinkles. Skin discoloration, like dark spots, stretch marks, and even hair restoration. So what does it do exactly?

How does it work? Microneedling stimulates your body’s own collagen production, the micro. Stimulate your body to produce collagen, and it also increases the absorption of any product that you will put on your skin by up to a thousand percent. And in my book, I have pages and pages of references to studies and white papers that have been done on microneedling and how it affects the skin.

I. So the benefits are, there’s very little downtime. It’s very low risk, highly effective, and the collagen that’s produced is your own collagen. So it’s very natural. It’s. Relatively comfortable. There’s very little pain and the results can last up to five years from a series of treatments. There are some indication contraindications.

You don’t want to do microneedling on people that are on blood thinners. People that are undergoing chemotherapy or radiation, people that have really any kind of moderate to severe conditions that are open or oozing that might require medical care, psoriasis, eczema, active acne, that’s pu warts, other things like that.

If you’re not sure, look it up. Speak to your patient’s doctor. Have them speak to their doctor before you start microneedling over any skin condition if your patient has keloids or if they are pregnant. These are all contraindications. So real quick education of the skin. This right here is the stratum corneum.

And so this hole piece right here is the dermal layer and the epidermis. And right at the base of the epidermis is this layer called the stratum basal, and this is where the stem cells. That produce new keratinocytes are formed. So you really don’t even need to get down into this dermal layer, which is where the blood vessels are.

So just by staying in the epidermis, you can stimulate the growth of. New fibroblasts and collagen. So the way the fibroblast stimulation works is these needles puncture. This would be like the head of a microneedle pad, puncture little holes into the skin. They heal very quickly, but they damage the epidermis, and the epidermis heals itself with new healthy skin.

So when we’re doing microneedling, we are going to use different depths for different parts of the face and the neck. And the neck and the chest are very sensitive. The skin on the neck in particular is very thin on the chest. It’s a little thicker. But you really wanna dial it down when you’re working on the neck itself.

So when you’re microneedling, you want to take into consideration the depth of the. Skin, the thickness of the skin that you’re needling and how deep you want those needles to go. Because on a microneedle pen, the needles go up and down and they’re going to penetrate into the skin, and there is a dial on microneedle pens showing you how deep the needles are going to go.

As I mentioned, skin on the neck and the chest can be very sensitive and thin. It can be crepey on the chest. There can be a lot of dark spots on the chest. On the neck, you can get loose and wrinkled skin. So here is an example of an aging neck, and you can see how thin and delicate the skin is here, and then when you’re working on the chest, you get these deeper wrinkles and folds and a lot of sun damage because the sun, when we’re out, the sun is going to hit our chest.

A lot of times we put sunscreen on our face, we put on our hat, but our chest is exposed. So this is an example of what a patient might look like before microneedling and then after, just so you can get an idea, they’re going to be red, but they, there shouldn’t be any bleeding when we’re talking about the hands.

The hands as people’s. Hands get older, they can get very bony veiny, and the veins can be right up at the surface. Their hands can be very sensitive. The skin can be very thin, and because the hands and the feet are so far away from the heart. The healing capacity, there’s the blood flow to the hands and the feet isn’t as good as the rest of the body.

So you can have some reduced healing capacity. So you wanna be very careful not to go too deep. So for a patient like this, when you’re working, you wanna make certain to avoid any prominent veins and to pay attention to any dark spots. I. This was a patient of mine came to me for three or four microneedling treatments, and this is what they looked like before and this is what they looked like after their third treatment.

I had just. Treated them. And I had dabbed at this spot right here, but you can see this spot here is almost completely gone. And just overall the skin on the hand looks much healthier. Little bit about the protocol. You wanna make sure if you’re working on their hands, that the patient washes their hands.

And if you’re working on the chest, you can use a neck. You can use a makeup remover wipe with some rubbing alcohol on it to get that clean. You wanna make sure you put gloves on. And if they would like numbing cream, you can put numbing cream on. I usually recommend like a 5% lidocaine cream, and then you’re going to let that sit for about 20 minutes.

You remove that either with a cotton pad or a makeup remover, white and. Then whatever area you’re working on, you wanna make sure to spray it or wipe it with alcohol, and then you’re going to apply your serum. I recommend hyaluronic acid serum. The product that I use is made by. A company called AccuLift.

It has vitamin C, hyaluronic acid, and collagen. And then you’re going to adjust the depth of the pen and the needle lengths and the speed of the pen according to how deep you’re going to go, depending on the thickness of. The patient’s skin. You’re going to use an up and down technique, and if you’re working on the hands, you’re going to go up and down.

So you’ll be going like this, you are not gonna go across the hand this way. And then if they have any spots, you would use a stamping technique and again, avoiding any prominent veins. For the neck, you’ll be working up and down and on the chest you can go up and down and left to right and use a stamping technique.

When you’re setting up expectations for your patients the results can take. Up to two weeks to see any sort of improvement. And I recommend four to six weekly sessions and the appointments are one month apart. So I’m sorry, not weekly sessions, four to six monthly sessions, and if they wanted to come in for some nano needling, which is a much more superficial.

Needling. It’s more of an exfoliation. They can do that after their skin is healed. So usually within a week. And they do need to know if they’re using any prescription products that they will absorb more quickly. When you’re setting up expectations for your patients, you wanna take into account their skin type, their age, lifestyle, diet.

How much sleep they’re getting. Water, they’re consuming what their skincare routine is, their genetics. Talk to them about their family and how they aged. Of course, your TCM diagnosis, I always include, I. And acupuncture treatment with my microneedling. And any blood, she yin deficiencies, excesses, stagnations, things of that nature.

Some of the possible side effects could be some pinpoint bleeding, redness, itching, burning, a little skin irritation or some pigmentation that should say changes. You also wanna send your patient home with some take home instructions. Let them know they could be red Peel flake for about 24 out 12 to 24 hours and schedule their next appointment for a month out. Soothe their skin with either aloe and Orica blend again. AccuLift has a calm spray. It has green tea.

And aloe and tica and CBD and some other things that are very calming to the skin. They shouldn’t put any makeup on the day of, stay out of the sun. No exercise because sweat can irritate the area, use very mild soap. And after the treatment they should start on a skincare routine. So this is what a microneedle pen looks like.

You have needle cartridges wall charger, batteries, extra batteries, and that way you can plug it in. It should come with instructions and a nice long cord. I recommend a minimum of 18,000 RPMs on the speed for the needles to go up and down for it to be effective and that you should purchase a medical grade pen.

The less expensive pens that are sold online usually are for home use for single person use. Professional pens have anti backflow technology and they are meant the pen is meant to be used for long-term use on many patients. And then the needle cartridges go in the sharps container afterwards.

So this little snippet I just showed you was a little piece of a much bigger class. I teach a four hour microneedle in class and a bunch of other classes live and recorded. You can check them out@facialacupunctureclasses.com. And any of the products I’ve talked about today, you can find@uluskincare.com.

Thank you so much, and thank you to the American Acupuncture Council for this opportunity

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Optimize Your Google Business Profile (GBP) for Better Google Rank

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Hi there. My name is Michelle Grasek. I am the host of the Acupuncture Marketing School podcast and a practicing acupuncturist. And today we’ll be talking about how to optimize your Google Business profile so that you rank higher in a Google search and can get more patients. And before we dive in, I’d like to take a moment to thank the American Acupuncture Council for the opportunity to be here with you today.

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Alright, let’s get into the slides. Okay. So today we’re going to talk about, first, how does your Google business profile actually impact your search engine optimization? And for the sake of brevity, I’m just gonna call the Google Business profile your profile from here on out, instead of saying the whole phrase.

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We’ll talk about why it matters, and then we’ll talk about how important it’s to complete every section and make it keyword dense with the keywords that your ideal patients are looking for, the kind of people that you wanna treat more of. And then we’ll talk about some very specific steps to increase your visibility.

Basically to get Google to pay more attention to your business and your profile. So let’s make sure we’re all on the same page. Many of you are familiar with this already, but a Google Business profile is essentially a free resource provided by Google where you can fill out all of the. Important, relevant information about your business to help people decide if they wanna work with you, if they feel like you’re a good fit.

And I like to think of your profile as having two main purposes. One is so that potential patients. Can learn about you, as I just said, and decide if they wanna keep researching. Are they interested? Do they wanna click through to your website? Maybe they decide they are interested and they can just click through and make an appointment from your profile without even making an appointment, or, sorry, without even going to your website first.

But that first function is. For the potential patients, it’s information for them to make a decision. And then the second function of your profile is really to let Google understand what your business is all about and what you like to treat and who you like to treat so that it knows when your business.

Is the relevant answer to a question that someone has typed into Google. So let’s think about the purpose of Google or their goal for a moment. So we’ll take a tiny tangent here. Google’s goal is to provide the best possible user experience, which means providing the most helpful and relevant and correct answer to whatever question someone types into a Google search.

And. Your Google business profile, obviously because it is owned by Google, is a direct line for Google to better understand. Who you are and who you want to treat, so that when someone types in a question, for example, acupuncture near me, or natural pain management near me natural fertility remedies, et cetera, then Google understands whether or not your business is the answer to that question.

And really what we’re doing in. Filling out your profile as completely as possible and packing it with keywords is you are helping Google help you, right? Because if your business, if you are a fertility specialist, if your business is the best answer to a question such as natural fertility remedies, you are me or acupuncture for fertility near me, then Google wants to know that it wants to help you.

It wants to rank you higher in a search because it cares. About that user experience. Do you remember? Ask Jevs, I’m really dating myself right? No one uses Ask j Eves anymore. I don’t even know if it exists because it did not provide the most helpful and relevant answers to a search query the way that Google did.

And Google does not want that to happen, right? It doesn’t want to become like Ask j. Eves. So it really actually wants to provide the best answer. So again, what we’re doing in filling out your profile as well as we possibly can is helping Google to help you find the patients who are a good fit for you.

Okay? And it’s important to remember that, I think it’s 77% of people when they’re picking a new healthcare provider, they are Googling first, they’re doing an internet search to learn what they can about different healthcare providers in the area, and they’re really looking for reviews, right?

And so the reviews are just one portion of your profile that really matters to potential patients. But. We really, we can’t underestimate how important your Google business profile is for people who are in the market for a new acupuncturist. Okay? It makes a big difference in whether or not they’re going to pick you.

And because your business profile is so integrated with Google and helps Google to understand your business in a big way, that means that your profile can really impact where you show up in an organic search, where you show up in the map pack. And I’ll exit the slides really quickly and show you what I mean when I say that.

I googled acupuncture near Cana, which is a town close to where I live. And the first thing that comes up is called this part is the map pack. Okay. So you can see there’s. A sponsored this person paid for ads, right? And then it’s the same person right here happens to have the most Google reviews.

That’s probably one of the reasons that they’re ranked at the top of the map pack, not just that they pay for advertising, but this here is really the map pack, the top three. That were chosen as the most relevant for this search query. And then you have the map. And then of course, as you scroll down, you have the organic search results in a list.

So your Google business profile can really impact where you show up on these pages. And I will click right here. And this is the Google Business profile. Okay. Just to make sure we’re all on the same page, you could see all the different sections and we’ll talk about the ones that are the most important.

But really you want to fill out every section. So if you pardon me, I’ll come back to the slides here. If you take only one thing away from this talk, it’s that the more complete. Active your profile is the more likely you are to rank above your competitors. And active simply means that you are regularly adding things to your profile.

And that could be new images or videos. It could be updating your office hours to make sure they’re correct. If you change them, and it would also be adding what are called updates. Sometimes they’re called posts to your Google business profile. Basically, Google prefers accounts. They prefer profiles, they prefer websites, social media, et cetera.

When they’re creating your search engine optimization score and deciding where you rank, they prefer profiles that are updated regularly instead of. Stagnant or abandoned, right? So if you set up your Google Business profile, when you set up your business, I don’t know, five or six years ago, and you haven’t touched it since then, Google’s going to consider your business to be less active and less relevant than the people who are updating their profiles regularly because Google, again, really wants to provide the best answer to someone’s question and.

Businesses that are regularly updated simply look more relevant. Google can trust that business is active. It’s running maybe it’s busier. Basically someone’s paying attention to it, and so it is going to prefer to show that business compared to a profile that has not been updated in a long time.

Okay. So before we dive into all these tips, I would say that if you already have a Google business profile, which is probably 90% of people watching this, maybe 95 remember also that Google, any software, anything on the internet is constantly being updated. They’re always adding features and sections.

So I would really recommend using this opportunity to go back into your. Profile and scroll through every step. Let Google walk you through and see if there’s any sections that have been added that did not exist when you first set it up and fill those in completely. I would also recommend adding some new photos and making sure that you start posting updates, which we’ll talk about in a moment regularly.

But even if your profile’s all set up, just go back through and make sure it’s complete. And I have some recommendations for using keywords in different sections. So let’s get into that now. So when we talk about your profile being complete. You also want to make sure that you are incorporating keywords that your ideal patients might be searching for, because again, you are pretty much teaching Google when you are the right answer to a person’s question.

Okay? So think of it this way, if you are a fertility specialist, but your Google profile doesn’t say anything about fertility, and someone types in fertility, acupuncture near me, and you have a competitor who’s. Profile talks about how they mostly treat fertility patients. Obviously Google is going to rank that person higher in the search because it’s more relevant to the particular question at hand.

Okay. So if you know that you have a niche and you want more of a specific kind of person, you have got to talk about that person, their symptoms, their goals in your Google business profile. When I’m talking about keywords, I am talking about, what are the things that people are searching for in relation to fertility, right?

You can brainstorm what are all the questions that your ideal patient might put into Google that could potentially indicate that they’re a good fit for you and lead them to acupuncture and your website. Okay? And of course, if you’re an orthopedic specialist, you or you only treat runners, whatever it is, you would wanna think about those keywords instead.

So let’s talk about your profile briefly. Some of these things will be obvious. Again this is also for people who are just filling out their business, Google business profile. So when you are. Initially setting this up, and you can go back and change this if you’ve already set it up, as I mentioned, and some things don’t match up like they should, but you have to make sure that your business name, address, and phone, what’s called the nap or the NAP, are identical across all different platforms on the web.

So if you’ve got your Google Business profile, you’ve got your website, maybe you have a Yelp account, maybe you’re on, I don’t know, MapQuest your. Business name, address, and phone number have to be identical. An identical address. Means literally identical, right? However you write like suite one or like room 400 has to be the same on each one.

Why? Because this consistency again indicates to Google that your business is reliable and trustworthy and professional. Okay? If you’ve got a different address, for example, if you moved and you never updated those. Other platforms like Yelp, where if you changed your office hours and they’re different across every platform, it’s confusing and it doesn’t seem as the inconsistency isn’t as professional for Google.

It’s going to rank other businesses higher who have that consistency, right? Because it’s all about that user experience. It wants to feel confident it’s providing the right answer to a person’s question. Okay? So make sure that your name, address, phone, and I personally think office hours as well are identical when.

When you’re filling out your profile to all the other places where they’re found on the web, okay? And then the category you wanna choose is acupuncturist. I know this seems obvious, but some people choose wellness like a wellness center because they’re not sure. But if you are not a legit wellness center, and what you want is more acupuncture patients than choose acupuncturists.

Remember we’re teaching Google what kind of people to send us. We’re teaching Google about our business. So if you’re an acupuncturist, choose acupuncturist. Okay. And then for services or treatments, this is a great opportunity to incorporate those keywords that we were talking about earlier. You have the chance on your profile to put in each kind of service that you offer.

So I would list them out all individually. Include everything that you offer. So you could say initial treatment, follow-up treatment. You maybe you have cosmetic acupuncture. You offer cupping separately. Guha facial separately. Okay. And then for each of those, you have a description area. So really maximize that descriptive area with those keywords that your ideal patient might be searching for.

So you could say initial treatment, and then you could expand upon that. So of course you would say 90 minutes, $150 initial intake and treatment for, and think about your specialty or your niche or the things you love to treat, right? For example, for pain management, digestion, and anxiety, et cetera.

Okay? So take the opportunity to put some of those keywords in the description for your services. And then of course, in your business description, this is a space where you can. Absolutely maximize on those keywords. So you have 750 words in this space. I would max it out. That’s my recommendation. Make sure that you say your business name and your location and mention the.

Treatments or the services that you offer, but also be sure to talk about the symptoms that you treat symptoms, conditions. And you can even describe your target market if you like. Again, if you have a niche, you could say, treating marathon runners, helping them recover from injury so they can perform at their best or so that they can, run their, continue their training while they’re recovering from injury.

Feel free to describe your ideal patient in your business description, and if you have any awards or PR like media that you were featured on, all of that is social proof. I recommend putting that in the business description as well. I. Okay. The next thing of course is, and this is obvious, you definitely wanna put your website and your booking link on your Google business page.

Photos and videos are very important and I mentioned earlier I adding new ones. This is helpful again, because Google likes to see that your business is fresh. It’s relevant, it’s active. Someone’s paying attention to it, so you don’t have to, have new professional photos taken. Just take a picture of a new corner of your office that looks attractive on your phone and pop it onto your, profile. Okay. And put a caption, use keywords in the caption, ageless acupuncture treatment room where we help patients have babies, we help them improve their fertility naturally. Something like that. Okay. And you can now add videos to your profile 30 seconds or less. And remember.

Google loves rich content like photos and videos, so you definitely wanna add a video and it can be very simple. Just do an office tour where you walk from the outside of your building into your treatment or into your reception area. Show your treatment rooms, okay? You can put a little text on top of the video if you know how that just says, office tour.

Okay. I wouldn’t use audio. I don’t think people are listening to audio on these videos on your profile. You can add captions if they’re speaking but make sure you add lots of rich content like photos and videos and add new ones. I would say once a month. So the next suggestion I have is that there is a section on the Google Business profile where you can ask and answer your own questions, and I highly recommend doing this.

You can ask a question as the business owner, but it will show up as a anonymous, and then you can answer that same question and that the answer will show that you are answering as the business owner. So let me show you what this looks like.

Okay, so on this profile you see you’ve got the Google Business profile over here on the right. So if we scroll down, you’ll see this question that says section that says questions and answers, see all questions, and then there’s a button to ask a question. So what you really wanna do in this section is ask the questions that your ideal patients might be putting into Google and ask the frequently asked questions that you truly get all the time from your patients.

See, for example, can acupuncture help with IBS? Oops, that’s not what I meant to do. And then the person answered and there was a bunch of keywords in the answer. Okay. So really think about what are the questions that your ideal patients might have like that. Let me go back a minute. Think about the questions that are helpful for people to make a decision to come see you, right?

Like to help them know if you’re the right fit for them. And so that’s one category of q and a. And then the other is what are the questions that they might be putting into Google that you wanna show up for? Okay, so again, if you’re a fertility specialist, you could ask, how many treatments do I need for fertility?

And then answer the question with lots of keywords. How does it work for fertility? And answer the questions can you help with this specific thing? I’m dealing with this, et cetera, et cetera, et cetera. Okay. Again, you’re just teaching Google about your business so it knows when you are the answer to a question that someone puts in.

The next idea that is really important is adding regular updates on your Google Business profile. And I’ll exit and show you what that means. So sometimes these updates are referred to as posts. So you can see here they are in this section. And if you scroll through, you can see previous posts. Okay.

And if you click, you can see that. You get a little bit of text, whoops, sorry. But not a ton. And then there’s a call to action button with a link that you can choose what to link it to. But these are not really blog posts and they’re not really social media posts. You could think of them as just updates or announcements.

I do think that if you are writing blog posts sharing them in the Google Business profile as an update and. With just a couple sentences saying, Hey, are you struggling with IBS? I recently wrote this article about acupuncture for IBS. Click here to read more. Or if you already know you wanna try acupuncture for the symptom, click here to make an appointment.

But the idea here is that you are including keywords. That description of the update and that you are posting updates regularly. So most experts say, Ooh, once a week. If you could do once a month, I’d be really happy with that. Twice a month is super. I think every week is if if you’re feeling super organized and motivated, but just try to be regular about it again, because Google prefers when your profile is active.

Okay. We talked about images already, and then the last thing, which I’m sure does not surprise you at all, is an emphasis on collecting reviews because this is also a way to show Google that your business is active. When you are regularly getting new reviews and think about these reviews, what people write, especially if they share about their symptoms, is going to be filled with keywords that your other patients are going to be searching for.

Okay? The way that I tell my marketing students and marketing clients to think about reviews is to make it a strategy. Have a strategy where once every four to eight weeks and put it on your calendar once every four to eight weeks you are reviewing. The people that you’ve seen in that timeframe, look for people who you’ve seen like four to eight times who are consistently happy with their results.

They like acupuncture, they like you. Basically, you’re looking for people who feel like a slam dunk to write you a five star review, and then email them your request, and I suggest emailing. You can ask them verbally, but also follow up with an email because you must send them the link that goes directly to your.

Review page on your Google business profile. Do not expect people, if you say, Hey, will you write me a review? And they’re like, yeah, I’d love to. They’ll probably won’t do it because they won’t remember. Even if they have good intentions and they have to figure it out for themselves. They have to Google your business.

They have to find your profile. Then they have to figure out, where do I leave this review? What do I click on? It’s not gonna happen. If you wanna actually. Get reviews, you have to send them the link. And so when you sign into your Google Business profile as the owner of the profile, there’s a section that says Get more reviews.

If you click on that, it will give you the short link that goes directly to the page where all they have to do is click the number of stars, type the review, and hit submit. Okay, so that’s gonna make a huge difference in the number of reviews you actually get is sharing that direct link. Okay? And I put on here consistency wins this game because I.

If you are regularly asking patients for reviews, you are over time going to accumulate way more reviews than people who are passively waiting for their patients to do it for them because they won’t do not expect your patients to do this work for you. Even the ones that are very happy, very few people are thinking to themselves.

I should write this business a review, especially if they’re not business owners. It is not top of mind. You have to be the one who asks them to write a review. Okay this is like a crash course in Google business profile and I’ve given you a bit of homework, some things to think about, but really, again, if you take nothing away from this, just remember.

Nothing away from this except this concept that the more complete and active your profile is, the higher you’ll rank in a search. Okay. So I do hope this was very helpful and you are always more than welcome to ask me questions. Feel free to send me an email. Oops.

Feel free to send me an email, michelle@michelleGrasek.com. I love answering your marketing questions and yeah, thank you so much for being here. I’d like to thank the American Acupuncture Council. One more time for the opportunity to be here with you.

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Why Google Reviews Matter to HIPAA – Perry Barnhill

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Good morning. Good afternoon, everybody. Welcome to Fearless Acupuncturists. This is Dr. Perry Barnhill, and today we’re gonna talk about Google reviews and how to respond to them properly. Properly go to slides.

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Again, this is Dr. Perry Barnhill and I wanna welcome to the webinar on how to respond to Google reviews in a HIPAA compliant way, such that you keep yourselves outta trouble. That’s the goal. We wanna respond to reviews properly and legally in a positive way, and at the same time keeping ourselves out of trouble with any kind of HIPAA violations.

All right, here we go. So why do Google Reviews matter? We know these reviews impact our online reputation. They’re very important. We know it builds positive engagement with potential patients, even existing patients we know patients check reviews out all the time. As a matter of fact, we check reviews out and Google reviews on primary, people we go to see, doctors we go to see.

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So it’s really important. It builds. Engagement with the SEOs and compliance with HIPAA is very crucial, as we all know in all patient communications, especially public facing communications such as Google reviews. So understanding HIPAA in online interactions, and let me just go over a little bit of HIPAA overview.

As we know, HIPAA protects. Patient health information, just the acronym PHI Protected Health Information and PHI includes all kinds of things that can identify the patients. Things such as their name. We know that’s pretty basic. Their IP address, their face. There’s so many things that it can be related back to the patient.

It is protected health information and violations. I know you hear about this a lot, but this is true. Violations can result in big fines and it can damage your reputation. Okay, so here’s what we want to do. We want the dos and the don’ts and responding to reviews. Now the dos, we want to keep our responses generic and professional.

We wanna focus on customer service, not their acupuncture care. Now, the don’ts, we never want to confirm or imply that the reviewer is a patient in our office. We don’t wanna mention any details about their care, including anything regarding about their family members. Like just be very safe about it and just don’t do anything like that.

Alright, so creating a safe response to positive reviews. And here’s an example. Dr. Joe and his team are fantastic. They always make me feel comfortable. Here would be a sample response. Thank you so much for your kind words. We strive to provide a comfortable and welcoming experience for everyone who visits our office.

Now, how do we handle negative reviews? Let me give you an example here. I had a disappointing experience with the wait time at Dr. Sally’s office, and here’s a good response. We always appreciate any feedback. We take concerns like this seriously and would like to learn more. Please contact our office directly so we can address this issue.

So one thing to notice is we’re not referring back to you or any way that can imply that this patient even came to our office. These are very generic responses, but these are the responses that we need to have in order to stay compliant, navigating complex reviews. Here’s an example of a review. The whole family.

Love seeing Dr. Steve. Here’s an example. Response. We love taking care of families. Here’s the key. I didn’t directly say we take care of your family. We love taking care of families as just a generic response as compared to I. We love taking care of your family. So that’s the distinction there. And again, this response is safe.

’cause it doesn’t reveal or directly imply that we’re taking care of their family. We just love taking care of families. So here’s some common mistakes to avoid. Just re going over the skin, acknowledging that the patient or their family members in any way confirms their status in our office, providing any additional information about their care, even if they mention it first.

Don’t, just don’t respond to it in that way at least. And here’s another thing, and I see this often, don’t engage in back and forth discussions that might inadvertently disclose more details. And where I see a lot of providers getting themselves in or potentially hot water, they have this back and forth almost argument about the care or the wait time or whatever it was in the office.

So don’t even go there. Alright, HIPAA compliance and best practices. Always thank the reviewer without confirming any details. Keep your responses focused on general customer service. Encourage offline communications for specific concerns. Where we said, Hey, please contact our office. Don’t go there online and in front of everybody.

Train your team. Also, this is so important. Train your team and how to handle reviews in a compliant MA manner. I would suggest that if you have team members responding, make sure before they respond. They get back with you and you approve that response before it goes out. Handling potential HIPAA violations.

This is what we don’t want to have to deal with, but if we accidentally disclose PHI take that review offline immediately, get rid of the trail. Consult with your compliance officer for guidance. Ask to see what you should do from there. Report the incident to necessary authorities If required, however, ask first.

Don’t just start reporting things to hipaa. If you don’t know for sure if it was a violation, ask someone like myself. Ask someone like Dr. Julie. Find out first before you go reporting things. So here’s some final tips for success. You wanna respond promptly. Thoughtfully and you want to regularly review your HIPAA policies related to online interactions, and this is where I say you need to train the staff.

It’s part of the training, it’s part of the requirements we have for hipaa. We have to train the staff on how to respond to situations like this, for example, and encourage our satisfied patients to leave positive reviews and then bury the bad reviews with good reviews. Remember protecting patient privacy.

It’s not just a legal requirement, it’s commitment to the trust your patient’s place in you. So some next steps here, you can all go to and download this HIPAA compliance checklist. You can go to this, the website here, or you can scan the QR code, check out this list. If you go through this list and you can’t safely mark all those boxes, you’re not in compliance with hipaa and we don’t wanna be there.

You don’t have to be there. It doesn’t have to be complicated, it doesn’t have to be confusing, but it’s a process. So make sure you are, because if you’re not, the consequences are what we don’t wanna talk about. You don’t have to be in that boat. If you want, you can schedule a demo with us. You can go to fearless acupuncture.com.

There’s a demo there. You can scan the QR code. You can go to our website@ww.fearlessacupunctures.com or always feel free to contact me at Dr. perry@betterhipaablueprint.com. And again, thank you so much, the American Council acupuncture Council. It’s a mouthful. A CN. How’s that for allowing us to provide you with this webinar?

And in the meantime, everybody have an amazing day.

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VA Community Care – Send the Money Back! Sam Collins

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Hey, guess who? It’s acupuncture time. It’s Sam Collins, the coding and billing expert for chiro, for acupuncture for you, if you will, the profession as well as the American Acupuncture Council. I’m gonna speak to you directly as a network service today because a lot of you, and this means those of you who are network members with me, have gotten some letters recently that said, Hey.

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We paid you money for the va, we want it back. This is very similar to what went on last year. So I wanna talk about how we can go to dispute this, ’cause I’m getting several of you with some really big requests for recoupment. So let’s go to the slides and let’s talk about what is going on. And this is coming directly from the va, which is VA Community Care.

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And again, it’s the care for veterans. You have to be enrolled. And remember, if you’re on the East coast, you will be enrolled through Optum Health. If you are in the West Coast, and now when I say West Coast, let me say Texas and west of Texas, you’re gonna be through Tri West. But it’s happening in both areas.

And what it’s relating to is you’re getting letters that are coming to you saying, Hey, we paid you money. We shouldn’t have. We want it back, pay us back. And if you don’t, we’re gonna take it out of future payments. So we wanna talk about how do you really respond to this, what’s gone on and what we need to do.

Part of it I’m gonna say to you is, this is why I hope that many of you are network members with me, because you would’ve avoided this whole thing had you known. Been part of that. We did go through that last year a bit. So many of you’re getting letters similar to this one. Try West. I’ll leave this one small.

But what this does is it’s just saying the purpose of this letter is to inform you that pricing information, allowable reimbursement on claims previously paid you has been adjusted, given the correct payment is lower. We want some money back in this case, $388. Now that’s not very much, but I don’t like paying anything back.

When I do not have to. So let’s talk about what has gone on specifically and what is the issue that’s happening. How do you overpay it? Let’s face it, fees paid for the VA pay at your state, Medicare allowable. So how could to be wrong? I had someone that sent me a letter and said, Hey, Sam. I went through all my pricing and this is what they paid me before.

How could this be possibly overpaid? There could be two issues here. One of them is called the multi procedure payment reduction, and what this refers to is that secondary services on a claim now I’m not talking acupuncture exams, but therapies by example. If you’re billing a therapy, the first therapy is paid at a hundred percent of its normal rate.

But then each subsequent therapy on the same day is reduced what’s called the practice expense ratio. And what this refers to as the practice expense of a service goes this way by example, let’s say I’m gonna do massage for an hour. I have to do a certain amount of setup for that room. That’s the practice expense.

That practice expense doesn’t have to be done. If you think of it, if I set it up for the first 15, do I reset it up for the next? We don’t. So what they’re doing is reducing that portion of it. Now that practice expense comes out to about 15%, 20%. So it’s not a big amount. Let’s say the code is worth 30.

The multi procedure prov reduction would be that it would be paid probably at about 26 or roughly about 15, 20% difference. So not a big difference, but nonetheless a difference. Now, that’s something they should have been doing and they didn’t, so that’s really on them. My pushback is gonna be at least parsing on that.

However, for acupuncture, the biggest issue is not that, because those would be small potatoes. We’re talking three, $4. It is the use of 9 7 0 3 9 and 9 7 1 3 9. So when you get this letter, what you wanna do is verify with them, how are you indicating it’s overpaid? Is it overpaid because of the procedure reduction portion or is it being overpaid because I use 9 7 0 3 9 and 9 7 1 3 9 for cupping.

Please be aware. Since February of last year of 20 24 9 7 0 3 9 and 9 7 1 3 9, were no longer part of the standard episode of Care for Acupuncture, which meant you could no longer use it. I’m hoping some of you go, oh yeah, I remember when that happened, and you were no longer to use that code. Now, of course, if they were allowing it and they were.

Prior to this change 2024, they were allowing you to bill 9 7 0 3 9 for cupping. And frankly, many of you were getting paid 45 to $50 for it. So if someone’s willing to do that, I’m willing to take it. However, let’s keep in mind, let’s think about that logically for a second. Cupping is a much simpler service than acupuncture.

Yet you are getting paid more for cupping than acupuncture. So you can look and go that doesn’t make sense. However, because they allowed it, I’d say, go ahead. Technically, you should have not been using it after last year. Realize here is the newest list of codes I. Allowed for acupuncture with the standard episode of care since February of last year, and you’ll notice immediately none of the 9 7 0 or 9 7 1 3 9 7 0 3 9 or 9 7 1 3 9 is included.

They were removed. Now the pushback that I have, if you’re getting a request for a refund, that was prior to February of 23 for the date of service, the standard episode of care, up to that point. Did include it. Therefore, it would be appropriate for them to pay, and the pushback would be, hey, it was allowed at that point.

Now, if you are getting requests after February 23rd, now that’s a whole nother issue. That’s one that, oh, shucks, we should have known. Now, network members with me, you should have well known because I sent out a lot of information. This is why I’m sending this all directly to you as well, not to mention just for everyone, let’s make sure you understand.

If you’re billing the va, these are the codes they allow. They do not allow 9 7 0 3 9 if you are wanting to do a service that is not on this list. You must specifically get authorization from the VA to provide it, or it’s automatically non-paid. Now I will have you notice. Notice the last two codes in each one, the 0 5 5 2 T, and S 89, or excuse me, 0 5 5 2 T is the code for laser.

So they do cover laser. Don’t get excited. It doesn’t pay that much, but it is covered. So bottom line is do not use for cupping any further. If you have been. 9 7 0 3 9 or 9 7 1 3 9. Do not use them. They’re gonna be a problem. And if you get paid, you’re thinking I got paid. They’re gonna come back and take it back.

I. We’re gonna push back on that a little bit, but again, after February of last year, it’s gonna be a little bit harder. So for cupping, what should you do? I’m not saying not to bill for cupping, I’m saying for the va, however, it is only under 9 7 0 1 6, and that code, frankly, is worth between 11 and $15, which truthfully makes much more sense to me.

I don’t think cupping should have the same value as acupuncture. Not to say that cupping doesn’t have value, but is it as much as doing the needling? I think not. So therefore, yes, it’s still payable, but just under that code. Now, if you’re getting issues on the price reductions, that’s what I would still push back on, depending on when they’re implementing.

But remember, that’s gonna be a pretty small amount. If it’s a big amount, I’m almost certain it’s going to be cupping. So make sure you’re pushing back. How can I dispute it? The number one dispute I have, and this is the starting point, but I want always there to be two disputes, is just plain statute of limitations.

Let’s face it, we have only 180 days to bill the va. Does that give them infinite time to recoup, years later? No. Under federal statutes it’s 365 days or one year. Therefore, if they’re making a request to recoup money from you, that is over 365 days or one year. That’s the number one pushback. If you’re a network member with me, please contact me.

We have a dispute letter to that fact for you already formatted that you can send. Hopefully this is encouraging. Some of you, oh, this is why that network is so good anyway. If you’re not a network member, you’re just gonna have to go back and say, Hey, that’s statute of limitations. I would also push back though on this issue case law, there’s case law that’s been around since the nineties that says when an insurance pays something improper and the provider has not done anything.

To make that payment improper. The carrier is the one responsible under federal rules. They may push back on that, but if you recall last year, we were able to dispute that, but I’m expecting the same. So my hope is that given in another month or so, we should see some pushback where they’re going to no longer seek these recoupments, at least the ones prior to 23 or over a year.

My concern for you though, is make sure you understand, do not bill. 9 7 0 3 9. I know you’re thinking they paid me. They can recoup it. We wanna push back. Let’s make sure the claims are correct. If you’re not a network member with me, this is a great time to understand what we do. This is something we’re trying to get you ahead of the curve and not chasing after it.

VA patients are still very good patients. Remember, we got about a 20% increase in the Medicare fees for the first set this year, so that’s a good patient. Just understand the rules. Again, no use of cupping. If you’re not a network member, please take a look. If you’re a network member, please contact me.

Let’s go through. We can do a one-on-one zoom if we need to, but let’s make sure we’ve got some fire to push back on this. Until next time, my friends, I wish you the best.

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Acupuncture Malpractice Insurance Policy Quote

You must do your homework if you are running an acupuncture clinic and planning to buy insurance to protect it. The reason is that prior research is necessary when choosing an insurance provider; requesting quotations is part of the selection process. But why is it valuable to request an acupuncture malpractice insurance policy quote from a reliable provider? Here are some insights to consider:

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Each insurance provider offers a different quote, depending on several factors. For instance, more experienced practitioners and those with solid credentials may get better rates. You should also check the coverage limits, claims history, and policy types. Even location can be a factor for rates – rates may vary from one state to another due to differences in legal risks and regulations.

Comparison is Key

It is not enough to ask for an acupuncture malpractice insurance policy quote from one or two prospective providers. Shop around; send requests to at least five prospects and compare them. Using the same criteria, you can determine which among your prospects offers favorable deals. You can start your search by reading online reviews; pay attention to negative reviews as they provide insights into their reputation.

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Acupuncture insurance providers, on several occasions, give discounts to their potential customers, so check out if your prospects are offering the same. For instance, membership to professional associations might provide you tickets to these discounts. There are also discounts given to new practitioners. As you evaluate your prospects, do not forget to check them out for possible discounts and other savings opportunities.

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