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United Health Care Non-covered Services for Acupuncture Providers

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Let’s talk about what is going on with UnitedHealthcare. I’m sure many of you have received or have seen the letter that indicated about what changes you have to make.

Click here to download the transcript.

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

Hey, greetings everyone. It’s Sam Collins, the coding and billing expert. American Acupuncture Council and specifically the American Acupuncture Council network members. And I’m really appealing out to you as well. Not just that we’re not sending it to everyone, but I wanted to keep you updated on what’s new and changing.

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As we always promise, we want to make sure you get the information first, have the right information, can use it. I know a lot of you have probably gotten the UnitedHealthcare information about, we have to build differently and put the GA modifier. I wanted to help attempt to make this simpler, more easy to understand, and kind of.

Boil it down a little bit. So let’s go to the slides. Let’s talk about what is going on with UnitedHealthcare. I’m sure many of you have received or have seen the letter that indicated about what changes you have to make. I want to make it even that much simpler. Here’s what’s happening. Beginning February 1st.

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So starting this month, they want all acupuncture providers must bill UnitedHealthcare for all services they’re providing, even if the services aren’t covered. Now, for the most part, let’s be realistic. Probably you’re billing out mostly acupuncture. There isn’t a lot of services that you’re doing that aren’t covered.

But let’s just say there are services that you’re doing that’s not covered. They’re saying now they want it to be billed. So they want these non covered services to be billed, even if they’re not payable. And this will make an added step from what you normally have been doing. Now, keep in mind, the added step is just you’re going to add it.

The reality is, the No Surprises Act, as a lot of you are familiar with, which has been a couple of years, requires that all providers make patients aware of what their costs are. I think acupuncturists have always done an excellent job of that because that’s the number one question every has is how much is it going to cost?

So what this means is you’re going to make sure not only to do that with patients, make sure what they know, the cost are what’s covered and not covered. But more importantly, what’s not covered. We have to make sure the patient’s aware, like by example, if you’re doing cupping or moxibustion, you want to make sure to let them know, okay, this cupping service is not covered.

And therefore, it’s 25, whatever you charge. So again, think of it now, if it’s a therapy, therapies are for the most part covered, so it’s going to be the services that are not covered. Remember, contract and so forth will come into place. If you’re contracted and it’s bundled, it will be. So again, this is going to be services that they normally do.

Do not cover and the patient will be liable for it’s not going to be very many, but there may be instances where this come up. Realistically, this is should be something you’re already doing. Of course, every patient should be aware of, okay, if your insurance is going to cover, what is it going to cover, but also what is it not going to cover?

So therefore the patient understands what they’re having to pay. That’s again, part of your financial agreement. I hope you’re all already doing that to some extent. Now, what does this mean for non covered services though? I’m going to tell you for the most part, I’m going to look at things that are unusual.

Obviously, massage, manual therapy, exercise, heat, those are all covered. But services that aren’t covered, I’m going to put in cupping and moxibustion as being the most likely. Those are ones we’re going to have to outline. Now, by chance, let’s say the policy doesn’t cover therapies. They’re not bundled, then you would include therapies as well.

But for the most part, I’d say they’re covering therapy. So again, non covered services. And what does this apply? And this is where people are confused because it says commercial plans. So you’re wondering what’s a commercial plan? You know what a commercial plan is one that a person buys or they get through their job for the most part, you know, they get as part of their employment.

The only place that doesn’t apply is ones that are called self insured that are just managed by United healthcare. These would be. big giant employers, you know, large union groups and so forth, which aren’t that typical though. Obviously, if you work with a lot of people in those, you might run and cross it, but it’s going to be generally the commercial plans.

One patient’s purchase themselves, get through their job and Medicare advantage plans, but it doesn’t include if it’s self insured. So it is worth asking when you’re verifying. Is this a self insured plan? Because if it is, then you don’t have to do any of this. Again, I don’t see this as very hard. What do we need to do?

We need, oh, did I hit the wrong button here? I apologize. What we need to do is to make sure a few things. Number one, when verifying UnitedHealthcare, inquire if the plan is a commercial or Medicare Advantage. If it is, we have to do this. Now, again, I’m going to emphasize, this should be something you’re already doing.

You should already be making the patients aware of cost and what services aren’t covered But this is now something they want a little bit more detail for them You’re going to complete a financial understanding with the patient with an estimate of cost which means your cost So let’s say you charge 25 for cupping you would indicate this cupping service is not covered and you would indicate something as simple as It’s not covered because it’s not part of your plan.

Your plan may not consider it medically necessary, but anything like that, the bottom line is make the patient aware it’s not covered and they’re paying out of pocket because in order to hold them liable, the plan now is saying their requirements to do that. It says there identify if any. If any are not covered and include a statement.

So some services are going to be covered. Your acupuncture is covered, but services that are not identified and simply again, state it’s not covered or may not be covered. What you’re doing is making clear. You’re not promising them that it’s going to get paid. It is non covered. Now this brings up, what if you’re doing acupuncture and the acupuncture is not covered, you would do the same for that.

I don’t believe we’re billing too many like that, but just in case, then what you’re going to do is bill for those services. Now in the past. We’re pretty much never required to bill for services. They weren’t going to cover. They’re just liable to the patient now What they’re wanting is that we do bill those services to the insurance What we have to do uniquely though is bill it and then put modifier G a so that’s G as an apple Or excuse me G as in George a as an apple and what you’re doing with that is simply indicating that the patient has signed a waiver meaning that financial agreement where they’ve agreed They’re responsible.

What this is really doing is putting in place that patients are never going to be surprised They know what it’s going to cost in addition the insurance now when you bill in this way They’re going to send the EOB back to the patient indicating what they’ve paid for But that service such as cupping like nine seven zero three nine or one three nine would indicate as patient Responsibility and at the fee you’ve charged and remember that fee is the fee you want to charge It’s up to you.

That’s your cash rate. Whatever your fee is and the patient’s paying. That’s all you’re putting there So is this a little bit of a hassle? Yeah, I think so Um, it’s only a hassle in that we need to bill it. Everything else is the same You still have to inform patients you’re doing a service not covered You start to make sure they understand the cost of it.

Now the only difference is that we also have to put it on the claim and when we do so just put it with the GA. So let’s say it’s a therapy this this plan doesn’t cover a therapy. Okay, we would indicate that therapy with modifier GA. Keep in mind it’s not required for services they pay for. This is only for services they’re not going to be paying for.

So they’ll process it and then they’ll indicate patient responsibility. So let’s kind of get back at synopsis here. Let’s go, what’s going on? UnitedHealthcare commercial policies for acupuncture. You are now to make sure a patient is fully aware of services that they’re going to cover, but also not cover.

That’s not different. We’re to make them aware of the cost of the services, whether they it’s covered or non covered, which is also not different. So therefore that’s all going to be the same. That’s something I think acupuncturists do a good job of. Haven’t you always made sure your patients know the cost?

This is just making sure it’s memorialized, if you will, the patient signing it. And now we’re going to bill it. With a GA, if it’s a non covered service. So just a GA. Now you might be saying, well, what type of form do I have to have? It’s going to be a pretty straightforward, simple financial agreement.

Where you would indicate, these are the services we’re being provided. This is the amounts. And here’s the cost. And also indicate if it’s non covered. Now if you’re a network member with me, AAC Network, just contact me. We do have some samples. If you’re not a member, I apologize, but that’s not available to you.

That’s why we do the service. At least you’re getting the information. But for those that are members. get in contact with. We have a couple of examples. It’s not that complicated, but want a straightforward statement that the patients know it’s not covered. Here’s the point. It protects us. Therefore, a patient can’t come and say, I thought it was gonna pay.

You’re gonna point out. No, we said that at the beginning, and so I think it eliminates a lot of that issue. However, there is an extra step. Yes, you’re gonna now have to put everything on the claim. Part of what United Healthcare is stating they want to see the services that are being provided. What my hope is is that they start noticing that, wow, this cupping service is popular, moxibustion, maybe it should be something that we’re covering.

At least that’s what I would think. So, that’s the change. Non covered services, make sure patients are aware they’re not covered, the cost, put them on the bill. Patient still responsible. Nothing crazier than that. Again, if you’re a network member, get in contact with me. If you’re not a network member, the whole reason I’m doing this is to get this out to our network members, though it’s going to everyone contact me, let’s get you started on into the network.

We’ll give you a lot more help. In addition to that, though, we can give you a day to day help as well as forms and other things. We’re here to help. So for all of you, I greet you and say thank you for listening for a few minutes. I hope to see you at a future program as well. Take care.

 

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Engaging the Jueyin Channels with Therapeutic Exercise

 

 

We’re going to look at a club exercise today. It can be used for a patient exercise or maybe for your own practice, but particularly we’re going to look at shoulder girdle mobilization. And ribcage mobilization.

Click here to download the transcript.

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

Hi, I’m Brian Lau and I’d like to thank American Acupuncture Council for having me back. We’re going to look at a club exercise today. It can be used for a patient exercise or maybe for your own practice, but particularly we’re going to look at shoulder girdle mobilization. And ribcage mobilization.

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So we’re going to be working with the Zhui Yin channels, the liver and pericardium channel. Why don’t we start by just a quick review of those channels, particularly the sinew channels. And then we can look a little bit at the anatomy and apply that to the exercise. So I’m going to put the presentation up and we’ll start looking at that information.

So this will be, again, a focus on the Zhui Yin channels. First of all, just quick review of the primary channels. We have on the left, we have the liver channel. Liver channel starts at the inner space between the first and second metatarsal, comes up the medial leg and thigh. This isn’t as much of what we’re going to be looking at today.

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Comes up into the groin and circles the genitals, and then this part will be a little more important as it traverses up the abdomen We’ll look at how it follows the line of the external obliques to liver 13, the motor entry point for the external obliques. So it’s a major innervation site for the external obliques.

It encircles the stomach when it comes internal. We’ll glance at that real briefly. The rest of the external channel goes to liver 14. Also in the external oblique muscle. And then the internal branch kind of connects in through the throat and the head. And we’ll leave that for another time.

Pericardium channel goes on the midline of the anterior part of the arm. Follows the median nerve. But then it comes up into the chest, also links to the side of the chest I guess you could say to the breast for women, but I would really consider it more in the soft tissue like the serratus anterior.

So with that in mind, let’s go to the Sinew channels. Sinew channels for the liver sinew channel really ends at the groin, but I extend it a little bit further. We’ll see this softer color one is really more of an internal portion that goes a little deep into the deeper musculature of the psoas, iliacus, and the quadratus lumborum.

But then they’re also, it also links with those external obliques, which is going to be a major component of rotation, which we’re looking at today. And it connects then with the paired pericardium channel, serratus anterior, also the lower costal fibers of the pec major and down into the arm. But we’ll notice as we look at a better anatomy picture that this, Serratus anterior branch is going to wrap around the back.

This is a way that I extend it and it’ll connect in the back with the rhomboids. It creates a sling with the rhomboids rhomboids in the serratus anterior. So let’s look at that anatomy. First of all, on the far left, we have that liver sinew channel ending at the groin, but it’s on that same myofascial plane.

As the iliacus and the psoas, iliacus then connects with the quadratus lumborum. Quadratus lumborum takes us to the twelfth rib, it’s between the ilium and the twelfth rib, and links with the diaphragm. We’ll see a lot of the movement we’re doing today is going to move the lower rib cage and mobilize that area of the diaphragm and the liver, which sits right under the diaphragm.

So we’ll note that anatomy there internally. But on the outside, we have the serratus anterior from the pericardium channel. interdigitates with the external oblique and creates a sling that wraps from one side all the way to the groin of the other side. If we follow the pericardium channel around, the serratus anterior goes under the scapula, attaches to the medial border of the scapula, but really it links fascially, seamlessly with the rhomboids.

When we do Dissection with the Sports Medicine Acupuncture Program, we look at this rhomboceretis sling. And sometimes you can take some time and actually tease those away from the bone and see that they’re continuous sling of tissue. That’ll link into this spleniosurfaces and capitis on the other side, so the opposite side neck.

So from one side of the neck, in this case, in the image, the left side. It’ll wrap around the right ribcage, link with the liver channel, continue along the right torso to the left groin. So it creates a sling around the body, very similar for those who know anatomy trains to the spiral line that Tom Myers talks about in his book.

If you’re not familiar with that, I wouldn’t worry too much about it. But it’s a very similar anatomy to that, though I take it a little bit slight alteration of how he organizes it. But the important thing to note today is it’s a spiral. It’s a spiral that facilitates rotation. And when we’re working with patients who have rotation type postural issues or discrepancies from the left and right, these channels would be largely involved.

The liver itself has a range of motion. It has a movement in the frontal plane follows if it stabilizes along this ligament, it’s called the triangular ligament, but if it stabilizes along a particular ligament that attaches to the diaphragm, The liver can move up and down more on the right side.

So it has a movement on the frontal plane. It has a movement in the transverse plane, and it has a movement in the sagittal plane. We’ll look at those, maybe I’ll demo those real quickly when we come out of the PowerPoint. Bottom line for now is if we’re going to mobilize this lower ribcage, we’re also going to be moving and massaging the liver and moving the diaphragm.

So diaphragm movement, liver movement, I guess spleen movement on the opposite side, but the liver is our thought for the day. And then the pericardium. Pericardium has attachments to the sternum, to the ribs, to the spine in the back. So we’re going to be moving the shoulder girdle. It’s going to pull on the thoracic spine, move the thoracic spine.

That’ll have some massaging. immobilization for the pericardium organ. So let’s look at that sort of on me. It’s easier to see it on a person than it is on the slides, but at least you have a view of the anatomy. So first of all, I have this club. I’m gonna grab this in a second. I’m just gonna put it down for now.

The liver itself, when we’re doing this movement, we want to be able to move that liver so it can move in the transverse plane, wrapping around with the ribcage, wrapping around with the ribcage, so we’ll notice that motion. We’re not going to have as much of this frontal plane motion.

That’s not going to be as big of a part of the exercise I’m doing today, but we might have a little bit of that sagittal plane motion. But primarily, we’re going to be looking at that transverse plane motion because as I swing the club, it’s going to pull the ribcage open. There’s also going to be a lot of movement in the shoulder girdle, thoracic spine, so that’s going to be moving the pericardium.

So that’s it. We’re going to use a club. It’s a really good way to work with this rotation. We’ll do a little bit of a progression. If you’re doing this yourself, you can start off with the first easier version and then progress up. If you’re working with patients who have shoulder issues, you just have to know when to give them the next level.

I’ll give some thoughts on that. A couple thoughts on the clubs themselves. I do have some variation of clubs here. I have some solid metal ones. 15 pounds, 10 pounds, and 5 pounds, even that little small one on the farthest away from me is a 5 pound, but it’s solid metal. So it looks very similar to this plastic one with metal filling, which is 2 pounds.

2 pounds is probably a really good place to start. These clubs are top heavy, purposely. So they can tip very easily and if people aren’t doing good motion they can wing their shoulder in a position that’s not particularly helpful. I have a three pound for the day’s demo. I usually use a five or a ten pound for these swings depending on what I’m trying to accomplish.

But start light, find the pathway, you don’t want to hurt yourself. So it’s better to start light. It’s a lot more, three pounds is a lot more than it seems when you’re swinging. that club around and throwing it. So if you have a good pathway, it’s an efficient movement, but you don’t want to start too high.

All right, so first progression. First progression, we’re not going to swing it overhead. We’re just going to go forward, back, forward, back. I want you to notice the ribcage. As I swing back, pulls the ribcage. open. I want to let it pull the ribcage open. So a couple things first, if you’re following along with this, I want to highlight something, is when I swing back, I’m turning my palm out.

So my hand, if it didn’t have the club, would be facing out. I don’t want to go back with my arm internally rotated. That’s going to put my shoulder in not a good position. Particularly if I had shoulder problems, that would be very aggravating. So as it goes along the midline, I want to turn out. In, out, in, out.

Let it pull the ribcage. Pelvis is stabilized. So I’m letting the movement move the shoulders. in the ribcage, massaging the liver, so back and forth, comfortable, just letting that movement mobilize the ribcage. If you’re

working with a patient with shoulder injury, maybe they do a smaller arc. You have to start small and then work towards that full range of motion. And one last hint before we look at the next portion is don’t let the pelvis kind of drag along. I have to stabilize so that I can move ribcage and shoulder girdle.

All right, next part. Overhead, I’m gonna place it just on the spine. I’m gonna let it touch my back for this first part. I’m gonna work with the shoulder mobility, shoulder girdle mobility. I want to let the club drop down like I’m trying to scratch my back low down. Lift the elbow, and make an arc, bring the elbow in, that pulls the shoulder blade around.

Lift the elbow, drop the club, bring the elbow back. Lift the elbow, drop the club, bring the elbow forward. Lift the elbow, drop the club, elbow back. So this works on the flexibility of the shoulder joint and the shoulder girdle.

Up, around, it’s okay at this phase to help yourself. I can push up, or the big range of motion issue people have is to pull the elbow in. Up, let the club drop, elbow out. Up, let the club drop, elbow in. I’m making an arc.

Patients, or if you’re new to this, sometimes when the elbow lifts, especially if the tricep flexibility isn’t there, the club lifts. But I don’t want to do that. I want to lift the elbow. drop the club. So again, you can help yourself with the other hand at this phase and just work, take your time to get that flexibility.

Next part, I’m going to lift the club away from the back and do the same thing, but the club moves. So you notice the club points to my same shoulder corner. The club points to the opposite shoulder. Same shoulder, opposite shoulder. It’s like it makes a pendulum type motion. It swings.

Once that gets comfortable, final phase, throw the club. Swings down, throw. I’m using my ribcage, shoulder.

Same thing, I don’t want the pelvis to go too wild, so I’m stable, letting the ribcage move.

Okay, that’s forward throws for back. I want to come over the same shoulder, I have to turn my torso to the opposite side, over the same shoulder, pendulum along the back, swing out.

Open the ribcage. Open the chest, open the ribcage.

All right, so we’ll do that again on the other side, but I want to highlight a couple things just from working with people on this a lot. That I give this to patients, maybe not the full movement or maybe portions of it. And I progressed them through the whole thing. I also do it in a Zoom Qigong class. I work with a lot of people that way.

We do it in Tai Chi class sometimes and we apply some Tai Chi drills to it. But working with a lot of people with this, there’s some common mistakes. The first one is the club can get horizontal and that kind of loses the trajectory. I don’t do that. When the club swings back, it points back up and then it’s like tucking.

a arrow into a quiver. It swings around in pendulums and out. And again, you see the clubs up and forward. So I don’t want to let the club get horizontal. I don’t want that top heavy portion to throw me around and then I lose control. It’s a very clean pathway. Point up, in, throw. Up, in, throw. Same thing as I go back.

Club points up, in, throw. You can see there’s a moment in time where my elbow’s down, tip of the club is up, and then it comes through.

All right, so we’ll go through those progressions on the other side. So first one, I’m gonna let the shoulder warm up and the ribcage start to mobilize. Palm turns in, palm turns out. In, Out ribcage moves. So maybe more of the spleen being massaged on me now, but it’s still that region of the liver channel in the sinews of the liver channel,

ribcage mobilization, diaphragm mobilizes,

and I’m ready for the next one. I’m going to take the club. Onto the back, elbow up, club drops down, elbow in, elbow up, club drops down, elbow out. I’m making an arc with my elbow. I can help myself if I want to work on the range of motion.

Take the club away from the back, pendulum. So it points towards the side I’m holding the club on, pull points towards the corner. of the opposite side, it makes a pendulum.

And then when I’m ready, I’m going to take that pendulum into a throw. In, throw. In, throw.

Other direction, turn, throw.

So let the whole torso open, pull back, chest opens. out, relax down. So it’s a full core movement.

Okay. Forward again, throw.

All right. So that gives the basics of it. I would start slow, start with getting control of the club and the swinging. Start with the range of motion before you start worrying too much about throwing, but I do want to show it once from the back. So you can see that. pendulum. Because that pendulum is what makes the club a little bit more weightless.

The idea is no matter how much weight you are, you’re controlling the weight, but you’re also using the momentum to throw. So let’s look at that pendulum from the back. I’m going to turn around. So we’ll go with the forward throws. I’ll go slow with this. So it tucks in. You can see that angle.

Swings around, and then through. Swings around, through.

So it’s a pendulum type motion as I pull my elbow to the corner.

Okay, when I go back, same thing. It’s gonna be in the opposite direction. Over the shoulder, pendulum around, throw.

Alright, YouTube channel that goes through it a little bit different, but same idea. That’s Jing Jin movement training, so if you want a little extra resources but you can also watch this video, I would recommend maybe practicing along with the video a few times. To get the angles, again, start with a lower weight, two pounds, one pound if you have a history of shoulder problems, before going up to something like five pounds, or even heavier once you get comfortable with it, ten pounds.

It can be a good way of doing strength training, but you don’t want to injure your shoulder, so you want to start slow and get the pathway. Who would be benefiting from this? Obviously people who want to increase the mobility of their shoulder girdle. So people who have shoulder problems, if they have a painful arc and it’s extremely painful to get the shoulder.

up. Maybe not quite appropriate for those patients, but they could start with using it to help swing and increase that range of motion at a lower capacity. And then as they get a little more comfortable, they can let that arc become a little bigger. But then I would definitely want to start with them once they’re ready here, getting that range of motion a little higher, dropping the club a little bit more before they start throwing weight around, because it is more.

Weight than you would think when it’s away from the body but also working with back pain, especially when there’s thoracolumbar junction type pain that might radiate down to the radi to the sacroiliac joint or the hip. This motion of the torso and that flexibility of the ribcage and diaphragm can be very helpful for that.

Internal problems, liver T stagnation or any TCM patterns that involve the liver, it would be a nice way to massage the liver and create a little more suppleness. And circulation, increase that circulation around the diaphragm and liver region. So it doesn’t have to be musculoskeletal problems, it could be digestive issues, a whole bunch of things where there’s a component of liver disharmonies.

So be creative with it, there’s a lot of things you can do with it, it’s an enjoyable exercise and it’s something patients can do on their own or if it’s something you’re doing for yourself, it’s something you can do on your own. Alright, I think that’ll wrap it up for today, so again, I would like to thank American Acupuncture Council.

Maybe we’ll do a follow up to this and look at some Tai Chi drills with the club, it’s a really great tool.

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Why HIPAA Matters in an Acupuncture Office

 

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

Hi, everybody. Good morning. Good afternoon. My name is Dr. Perry Barnhill, and welcome to the Fearless Acupuncturist. First, I want to thank the AAC Info Network for having us here to discuss with you the importance of HIPAA and how it relates to your office. Slides, please. Why HIPAA matters in the acupuncturist’s office, protecting your practice and protecting your patients.

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Again, my name is Perry Barnhill. I have certifications in coding, certified medical auditing, certified professional compliance, and certified HIPAA privacy and security. Meaning, I can see what the HIPAA auditors are looking for. And this is why we’ve designed HIPAA program for you acupuncturists because we live in a world where we take care of patients as well.

So in regards to HIPAA, what is it that most of us think? A lot of us think that it’s talking, not talking about rather patients outside of the office. It’s not leaving patients names or their files or their charts in plain sight. We don’t discuss their diagnoses or their conditions out loud.

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What about sign in sheets? A lot of us think that we don’t have a sign in sheet that’s visible for everybody to see. So maybe we’re good. Or maybe you have a manual. And it’s on the shelf. It’s getting dust all over it. And we’ve never touched it. Some people think that, hey, if we have a manual, if it’s filled out, we’re good to go.

Or sometimes we think, hey, listen, I already have an appointed compliance officer. They’re doing everything they’re supposed to. Actually, you hope where they’re doing everything they’re supposed to. And so that means I’m good. So what does compliance HIPAA compliance specifically mean? What it means is this a compliance program.

It’s a continuous living breathing program. It’s something that has to be implemented upon, meaning we have to act upon it. We can’t just, like I said earlier, have it, fill it out and deal with it once and then just leave it alone. It’s not cookie cutter. It can be customized to each individual office, depending on how you do things.

Again, it must be routinely referenced, and it doesn’t matter, even if you spend a ton of money on it. 3, 000, some people spend money on these things. Even if it was an expensive manual, it still has to be filled out, it has to be acted upon, and we have to make sure we’re doing the things that we’re supposed to be doing.

Is compliance mandatory? This is a question that I get all the time. A lot of providers or acupuncturists are only doing cash. A lot of you don’t participate in any insurance company. A lot of you don’t do any kind of Medicare at all, but it’s still mandatory. HIPAA compliance mandatory, even if you’re full cash, even if you have nothing to do with insurance, and even if you have nothing to do with Medicare.

A lot of times we wonder with the HIPAA audits, what is a HIPAA audit all about? How does it come about as well? They can be random. And guess what? Recently the OCR, you’ll hear me refer to the office of civil rights, the acronym OCR. Those are the police of HIPAA. And they literally just recently announced that they are going to really start ramping up random audits and offices.

So again, this is another reason we’re going to really need to be on our toes and make sure. that we’re doing the things that we’re supposed to be doing because it’s not worth the risk by not doing them, which we will talk about here in just a moment. Another way that we get audited from HIPAA or the OCR is complaints from patients.

Sometimes, if a patient complains, they have to investigate by law and they will. We can have staff members, usually it’s a former staff member, someone who’s not happy with things, calls and complains about something, and here comes the OCR. Other providers, other doctors in the community, it can be a variety of healthcare providers that may call and complain for you, on to you, for whatever reason that may be.

Usually though, most HIPAA audits are the result of breaches and we’ve all heard about cyber attacks. It can be the phishing attacks that we have. You’ve heard about hackers, we’ve heard about ransomware. Ransomware meaning that they steal, these hackers steal all the stuff from your computer, hijack it, and then they ask for large amounts of money for you to regain all that information you had in your computer system.

The PHI, the protected health information. Sometimes providers get themselves in big trouble because of physical thefts, theft. Somebody walks away with a file, you lose a file, something happens. That’s a breach too. That’s something where we would have to by law report. And then again, if we don’t have our ducks in a rope, we don’t have a manual, if it’s not filled out, we’re not doing that ongoing training, we could potentially be in big trouble.

And then we have business associates, these third party vendors that a lot of issues that have access to protected health information like a lot of you may use outside billing people or billing companies. Those folks have to also be HIPAA compliant. And if they’re not, you could potentially be liable too for any mistakes or breaches that they may have.

Years ago, the OCR knew that providers were not doing what they were supposed to be doing. So guess what? They implemented a audit program where they were going to start doing Random audits. And again, it began a long time ago and guess what? Big surprise, right? Covered entities such as yourselves.

Didn’t do so well as with many other providers out there in the healthcare industry. Most of them, in fact, all of them didn’t do that good. The results were not good. So then of course, they did another phase and they got the same and similar results. And ironically, recently within the last month or so, they’ve implemented more random audits as well.

They basically said, Hey, listen, we know people are not doing what they’re supposed to be doing. So we’re going to increase the amount of random audits. Again, another reason you need to make sure you have these things. Going in the right place in the right direction, having your manuals, and it’s not as complicated as it has to be, and I’m going to talk to you about that here in just a second.

Here’s the number one reason for finding penalties, and they’re all the same thing. They’re basically the risk assessments and analysis, the lack of doing them for lack of a better way to explain it. We’re not doing our security risk and assessments. We’re not having these physical safeguards that we’re taking care of and making sure are in place.

technical safeguards, the computer side of things or the administrative safeguards, the things that we have with our staff or what they refer to as the ICER, the information system activity review, basically making sure that all these protections are in place to protect the health information that we have with our patients.

I’m not going to take a long time on this, but I do want you to understand how bad these fines can be if we’re not doing what we should be doing. And they go into tiers tier one. We were unaware that we had a HIPAA violation, but we exercise reasonable due diligence, minimum fines, 141. But they can get up to 35, 000 in a year.

And then we have tier two where there’s reasonable cause and actions and we’re not willfully neglectful, meaning we were doing most of the things we’re supposed to be doing, but still not doing some of the things we should be, but we weren’t totally neglectful, but still you can see here a minimum 1, 400 plus 142, 000 a year.

Now we get into these other tiers, tier three willfully neglectful. But you actually attempted to fix things within 30 days. Now, if you fall into that category, again, you can see this, these fines can be devastating to any kind of practice. Tier four definitely don’t want to be in tier four. You were willfully neglectful, meaning you did not do what you should have been doing.

And here’s what I mean by this. And this is what the government says. To use the excuse that we didn’t know what we were supposed to be doing is not an excuse anymore at the level of your education, they expect you to know these things and they expect that you do these things properly. So number four, tier four, you don’t want to be there.

Meaning you didn’t do what you should have been doing and you didn’t attempt to fix it within 30 days. You can see the fines here are quite devastating, 71, 000. And up to over two million dollars in a year. So this is why these things are very important Here’s some questions. I want you to ask yourself and also to ask your staff You know who is your compliance officer?

And you know what you have to have an appointed compliance officer and it has to be on paper. Our HIPAA program is It’s all in there. We have the policies, we have the procedures, we have the HIPAA appointment compliance officer form. So these things have to be done. When is the last time you updated your privacy and information security policies and procedures?

These things have to be done routinely. Do you have regular training and do you have proof that you have this training? Meaning the OCR, the office civil rights, they think, okay, cool. You have a manual, it’s all filled out. That’s great. But if you can’t prove that you’re doing ongoing training, we provide monthly training, by the way, ongoing training, they say, not me.

They say it’s just as bad as not having a manual at all. Ridiculous. Yes, I agree. But this is what they say. So we do not want to fall into that category because think of all those tiers. That’s where we’ll put ourselves. Potentially. Have you performed vulnerability on tests on your networks? Meaning are you making sure that your computers, your systems, your service, That they’re all secure and do we have documented incident plans if in case there’s a breach And we have to notify patients by the way So if we have breaches by law We have to notify patients and you have to have policies and procedures in place for this A few other things, like I talked about earlier, do you have business associates?

Well, a lot of us have business associates. For example, like I said earlier, third party billers. If we have somebody that is billing for the services that we provide, they have to make sure that they are also doing what they should be in regards to protecting patient health information. Therefore, we have to give them what we refer to as a business associate agreement.

And we have this, it’s the form, you fill it out, you send it to them, and that helps add a Big layer protection in case they’re not doing what they’re supposed to be doing. In fact, if you have a business associate And let’s say they have a breach and something happens and the ocr finds out that you did not have a business associate agreement I’ll file with them.

You’re going to get fined. So we don’t want to be there. Do you have physical safeguards, locks? I know it seems very simplistic but Physical safeguards, locks. There’s other things, administrative safeguards, like passwords, making sure the passwords are certain length and in characters and certain kind of special characters.

There’s all kinds of things there. It’s not complicated. I say this a lot of times too. This is a new language for most of us. But it doesn’t have to be complicated because we walk you through a step by step process so you can understand it, you can appoint one of your staff to help you out with these things, but once you understand the process and once you start thinking about things, you’ll feel a lot better that you’re doing what you’re supposed to be doing so you avoid all those tears.

Here’s some thoughts I want you to leave with, and a lot of us think that, and again, like I said earlier, we don’t understand this, so we ignore it, it’s a language I just don’t get it, and I hope that it doesn’t happen to me, and you know what, I hope it doesn’t happen to you either, I hope it doesn’t happen to any healthcare provider out there, because our main focus as healthcare providers is to take care of our patients, that’s what we went to all the schooling we went to for, and that’s what we’re best at.

What’s what we’re best at doing but the reality is this we have to do these things And we do not want to be that ostrich what we put our head in the sand and hope that it happens to us Because you know what it is gonna happen to some of us And we don’t want to be there. We don’t want to be vulnerable.

It’s usually not if but it’s when here’s the cool thing You can delegate one of your staff members to do this so that you can focus on your patients You can take care of the things as you that you’re really good at It’s simple enough to have a staff member take care of it. It’s a step by step process.

There’s modules. There’s chapters It’s just very user friendly You need someone to help? Here’s some next steps. You can download the HIPAA compliance checklist here. You can click the QR code and this compliance checklist is a list that you go to. Now if you can’t answer yes, if you can’t say that you’re doing all those things, this means you’re not HIPAA compliant and this means that you’re at risk.

This means this is a position that you do not want to be in and you want to make sure you get it corrected and fixed. Couple different ways you can get a hold of me. One, you, everybody, you can schedule a demo, demo if you’d like to. You can scan the QR code here. Let’s take you straight to a demo. You can also go to fearlessacupunctures.

com. You can check that out, or if you want to, you can contact me at Dr. Perry at Better Hippo Blueprint. I am more than willing to talk to you, to discuss with you, because I don’t want you to be in a position where you’re potentially going to be fine. I also don’t want your patient’s information at risk.

Just like we, us, when we go to our providers, our dentists, whoever that may be, we don’t want our information leaked, like our social security, you as being in practice, that all of you are. We don’t want you to have those fines. It’s way too much risk. So in the meantime, I do want to thank again, the AAC info network for having us here and discussing with you the vital importance of HIPAA and HIPAA compliance.

And in the meantime, like I said, if you want to, I’m more than happy to discuss things with you and click on the QR codes, check things out and have an amazing day.

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Is 2025 the Year of Telemedicine Again? Dr. Sam Collins

 

 

I always want to keep you updated first of the year on what’s changing, what’s new, and there’s been things that are changing for this year regarding telemedicine.

Click here to download the transcript.

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

Hi there friends, it’s Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and most importantly, you as a profession and as an individual provider. As always, we want to make sure you have the most current information to make sure your practice is thriving. And actually just making more money, if you will, or continuing to make more money is our hope.

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I always want to keep you updated first of the year on what’s changing, what’s new, and there’s been things that are changing for this year regarding telemedicine. Now, I know you’re thinking, is telemedicine something that we do a lot of? Maybe not, but I want to point out there’s going to be a place for it.

So I think it’s important to know what these new codes are. So let’s go to the slides. Let’s talk about telemedicine for 2025, because there was a whole new brand set of brand new set of codes in the old system. And when I say old system for 2024 earlier, when we built telemedicine, it was always for. E&amp; M codes.

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And then we build with a modifier 25. That has changed. For this year, they’ve updated. But let’s make sure first that we define what telemedicine is. Let’s make a clear definition. Telemedicine means that the provider uses interactive audio video telecommunications between you and the patient, which means literally a live visit.

It’s just audio video. That’s all just live. So in other words, it is a face to face visit. It’s just a face to face visit done online. I think that’s very viable in this day and age. And I think, though, that really started during the pandemic. I think it’s really stuck because we’re going to move that way anyway.

Think of how often with a medical provider, This is going to save a ton of time because how many of us have been to a medical provider? They don’t touch you. They just sit on the other side of the room. Shoot We should have done that audio video better for everyone. That potentially could fit for us as well in certain circumstances But do remember it’s live audio video and here’s probably the bigger Sticking point for many of you because you’re thinking oh good.

I’m gonna do herbal consults across the nation I’m going to, I’ll slow down. You have to have price, proper licensure. And it says here, make sure you are licensed both in the state where you are located, obviously, but also where the patient is located. So by example, if you’re in California and you’re trying to do a telemedicine visit for someone in Texas or New York or someplace else in California.

You not as a licensed acupuncturist. Now, this is irregardless of if you’re billing insurance, frankly, because you cannot practice in a state you’re not licensed. If you’re saying you want to do some type of herbal consult outside of your state, you’re not doing it as an acupuncturist, you’re doing it as an individual, which means you have no protection.

You’re not, you don’t have malpractice, something goes wrong, it’s on you. I’d be very careful of that. The key factor here is, I think if you’re going to do this, do it for patients that are here because Maybe they have difficulty coming in. Maybe your first visit is going to take an hour because there’s so much information you’re going to do a long consult with them.

Telemedicine might bridge that, so that way when they come in the office, you can get right to it. And or, maybe they don’t have that much time. What about a patient that goes I can’t get off work until this time, I can’t be there. Okay, let’s do some of it, telemedicine. So here’s what’s changed for 2025.

We have some brand new codes and you’ll see these codes. It’s 9800 through 98007. And what these are for. is telemedicine, but you’ll notice they are E&amp; M codes. You’ll notice it says, Synchronous audio video visit for the evaluation management of a new patient, which requires a medically appropriate history and examination.

Straightforward in nature. That’s literally the same thing as an E&amp; M code, except it says synchronous. So in other words, think of these just like E&amp; M codes. 9 8 0 0 0 will be a 9 9 2 0 2, the next one a 4, 0 5. And so much the same way, and I think the easiest way to see these is it’s going to be based on time.

A 15 minute audio video visit, 9 8 0 0 0. 30 minutes, the 0 1. 45 minutes, 02, 60 minutes, 03. And I do think you want to caution that it’s not always going to be about medical decision making, though it could be, which exams mostly are. But if you’re doing a telemedicine with a patient and it takes an hour because of all the information, is it appropriate to use 98003?

Absolutely it is. So don’t be afraid to use it, but document it the same way. You’re going to document I spent one hour over audio video. Tell me the system you use. Tell me the date and time, but you don’t record it. You don’t have to save it somewhere. And it’s going to be all the information you take.

And it’s going to be the same stuff you would take down if they were sitting in front of you. Their history. And maybe some of the evaluation. Now when I say history, realize that’s going to include past history, family history, review of systems, all that stuff. But can it include some exam things? I think at least some.

Could you do potentially a tongue evaluation over audio video, get it close enough to the tongue? Probably. I’d be worried about color a little bit, depending on the cameras, but I think we’re okay. Could you certainly do a range of motion? I think so. Now, could you do tongue and pulse and body palpation?

No, but I think this visit often is going to be one based on a lot of counseling, a lot of history and information. So these are new patients. And these are established patients. They work the same way, just about time. I think time is the more likely use. Here’s the difficulty. How much has this happened in your practice in the last year?

If you’re saying none, it’s probably going to happen none this year, because I think we have to promulgate this. I would say, let’s say you have a patient, they’ve had a car accident, they’re coming in from a medical referral, and you talk with them and you say, hey, we’re going to have to block an hour. for this.

And the patient, Oh, I don’t have an hour. I don’t have an hour until I can come two weeks from now. I don’t want to wait two weeks. Let’s do an audio video. Let’s start there. Now you may wonder what is the value of these? They’re much like the value of a regular E. N. M. They’re slightly less. And by the way, next month we’ll do a program.

The program I do will be on our views. So we’ll go over that. But I’m gonna tell you, it’s roughly 80 percent of what you would build your normal E. N. M. S. There’s no modifier necessary because there’s no treatment. It’s just this visit and what if a visit where the patient’s calling and just goes, you know what?

I need to discuss with you. I’ve got these issues. This visit could be counseling. These could fit. I would just be mindful. Make sure it’s a plan that covers exams. Here’s one of the problems we’re having for acupuncturists. A lot of the plans that you have joined as a provider, you wind up getting into a contract that says we don’t cover exams.

Now, that doesn’t mean you shouldn’t do them. They’re just saying they bundle it and don’t pay it separately. I know a lot of you know what I’m talking about. That’s an upcoming show as well. Anyway, what my point is that be careful. If they’re not covering an E&amp; M code, they’re not going to cover this.

So it’s got to be a plan that covers an E&amp; M, but I do think this is reasonable in some instances. Realistically though, let’s talk about acupuncture. While I love the availability of this service and the potential to use it, I think there’s a place for it. Is that the way we really want to treat someone?

Is that how we’re going to make them better? Let’s face it, in acupuncture, what you do is hands on. You get in the room, you put in needles, because without needles, you can’t talk me into feeling better. Sorry, give me some advice. But the reality is it’s the acupuncture, it’s what you do, but this can be a bridge.

So focus really on the acupuncture part, but this bridge might work for some, I can tell you major carriers, Anthem, Cigna United Healthcare, they will cover this. Just, again, go back to wait a minute, what does my contract say if I’m part of ASH? Maybe not. Now, there’s also new codes for 2025 for telephone calls.

Now, I say telephone calls, actually, what these are called are synchronous audio visits. Now, the reason I say telephone calls is because I’m old. Young people think, no, I don’t need a phone. You can do it through lots of devices. And so realize, though, it does mean just audio only. Now, these work in the same way as the old phone call codes.

And let me be clear. Remember those old codes for phone calls that you had? 99441 and so on? Those are gone. They don’t exist. But let me be conscientious when it comes to a phone call. Phone calls aren’t very typical. Because phone calls are difficult. A phone call that results in a person coming in for a visit or has been seen within the previous 7 days.

is one that they’re not going to cover. And so make sure we understand that. But they are straightforward. 15 minutes, 30 minutes, 45 minutes, or an hour. Okay? That’s a new patient. We have telephone audio visit here for established patients. You know where this probably works though? You have a patient you’ve treated.

It was two weeks ago. They call you and go, oh my god, it’s killing me. And you spend 30 minutes on the phone and they can’t come for the next month because they’re going to go out of town. That could work. Now notice the scenario I gave because if the result of this phone call is a visit is being appointed, then it becomes part of the visit.

So phone calls aren’t going to be well paid because let’s face it, no one’s going to call. You’re going to go, Oh, just do these acupressure points. I’m not saying you won’t do that. Chances are you want to get them in for a visit. So I point this out because it’s important to know, because you’re going to hear people saying there’s codes changed.

And it’s true, but we have to look at what’s the viability of use for us as providers. Is it really viable? And I would say for most of these, in this sense, probably not. It even applies to this new one, which is called a virtual check in. I had someone the other day as acupuncturist, that’s why I decided to do this.

I want to use this code because the patients are sending me emails. A check in is not an email. A check in is when you have an electronic health record system. That’s protected HIPAA compliant, where the patient logs into their account and then checks in with you with some information that maybe you’re communicating back and forth.

You can tell now, that’s probably not viable. One, I don’t know of a system that’s out there for us that does that. Some medical ones do, but the ones for accus, I don’t see that too often. I’m not saying if you have one that does, great. The problem is going to be, notice it says, provided within the previous seven days or procedure within the next 24 hours.

So in other words, if the result of this is again, treatment. Or, was within seven days of a prior visit? Does not count. So being mindful here, when it comes to use of these, do they really match? Because chances are when someone does a check in or a phone call, what is it going to result in? The person coming in for a visit.

So let’s be careful of being overzealous, but focus in on what we do well. What is the reason that people come to you to receive acupuncture if you could talk them into feeling good? You would have done that already or they wouldn’t need to see you It’s the acupuncture where I think this is helpful is to understand that there can be a bridge Particularly the audio video one that helps the phone call thing or you know The audio only is what I think it helps to get them in the office in that few minutes of counseling though You’re not billing for it directly Indirectly, it’s creating that good patient doctor relationship.

They trust you and you’re giving them solid information. The good news is, your practice continues to thrive. Next month when we go over RVUs, I’m not sure you’re aware, do you know your fees for the first set raised 20%? And that’s where I want to make a focus. So as always, we want to be the place where you get the right information.

The American Acupuncture Council has a very vested interest in all of you. Please make sure you continue to practice well, but I also want to make sure you’re profitable. If you’re not already, go to our website for the network. Take a look there. We’ve got a lot of information to always keep you updated because as always, your success is ours.

Until I see you next time, be well, my friends.

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insurance for acupuncturists by American Acupuncture Council

Essential Guide to Insurance for Acupuncturists

Like any other alternative treatment, acupuncture comes with risks, including patient complaints that could escalate into legal disputes. Such a scenario can be damaging not only to a professional reputation but also to your finances. However, purchasing insurance for acupuncturists provides essential protection, safeguards your business, and ensures peace of mind.

Today, many insurance providers offer customized policies that allow acupuncturists to choose the coverage that best suits their practice. Coverage options include:

  • Professional liability insurance – protects the professional reputation of acupuncturists. Acupuncture is still vulnerable to damaging complaints despite making advancements in the alternative treatment industry. Thus, taking preventative action to protect your license and practice is necessary.
  • Business personal property (BPP) – covers the named insured for lost, stolen, or damaged business property, such as equipment. For example, you can cover a treatment table, furniture, or other business property that is not a permanent fixture of the building structure by this insurance policy.
  • Premises liability – commonly called slip or trip and fall insurance. It covers the potential risks of a guest on the premises alleging damage to their personal property or injury in the clinic area, such as slipping from a wet spot on the floor, tripping on a frayed rug, or fainting and falling off the treatment table.

Insurance for Acupuncturists by American Acupuncture CouncilHere at the American Acupuncture Council, we have “Additional Insured” coverage to protect an entity, such as a landlord, corporation, or another person, that requests inclusion in your policy. The purpose of this coverage is to protect the AI entity named in a claim that was a result of your actions (or inactions), the AI entity will be defended by your policy. Your policy will cover any damages awarded against the AI, as specified in the liability limit provision.

Running an acupuncture practice comes with its own set of challenges, including potential patient claims that can result in financial stress and legal complications. With the right acupuncture insurance policy, you can focus on delivering high-quality care, knowing your business is protected.

Choosing a reliable malpractice insurance provider is one of the crucial decisions for acupuncturists today. A trusted provider ensures that you never have to worry about unexpected legal or financial risks, allowing you to focus on what matters most—the growth of your business and the welfare of your patients.

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Are you looking for reliable insurance for acupuncturists? Look no further than the American Acupuncture Council. Call us today at (800) 838-0383.

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Pelvic Floor and Pregnancy – Dr. Krystal Couture

 

 

In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

Click here to download the transcript.

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

Hello everyone, and welcome back. I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’m here for another blog. Brought to you by the American Acupuncture Council. If you haven’t popped over to the American Acupuncture Council website, you absolutely should because they sponsor amazing vlogs throughout the month.

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In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

In order to really understand what’s happening with the body through pregnancy, I want to talk about the energetics of pregnancy and conception, as well as talk about a little bit of the spirit of the Po, evolution, hormones during pregnancy, the Yuan Chi, Teeny bit about pathologies during pregnancy bodily changes and then the restoration and repair process of The body that it goes through during that pregnancy experience so in the simplest terms when we’re talking about conception is going to be the addition of Yin, and yang Right?

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Yin is going to serve us as those prenatal qi energies and the postnatal qi energies. So therefore we’re going to have the connection of essence and blood. Yang is going to serve as the minister fire. As we go deeper into conception, the mum is going to provide different things. Then the father is going to provide, right?

And in order for them to provide these in balance and harmony, they have to be balanced and harmonized within each of the individuals prior to conception. This is going to lead to the healthiest form of. pregnancy and for the fetus, right? So we want the mom to have the spleen, the liver and the heart in good communication with each other, and also in the perfect balance, not in excess.

Not in deficiency, and this is so that making, storing, and the governing of blood will be harmonized for the pregnancy and for the fetus. The chong and the ren also need to be in balance, and they need to be open for pregnancy. to occur. The chang is going to be that mover of the blood and the ren is going to provide us with that yin.

So we want to see harmonization there. We also want to see the kidney jing in a state of vitality, right? We need the mom to be vital when she comes into pregnancy in order for her to remain vital throughout the pregnancy and after the pregnancy because that takes so much. energy. I also need her to be vital because she’s going to be providing that energy to the baby as well.

I want the minister fire again to not be in excess and not be in deficiency. We need the perfect amount of fire. We want the postnatal chi and blood to be in harmony. Which of course is determined by so many life factors and how one is choosing to exist within their life along the path of their Tao.

And then finally the spirit of the Po is going to come in. From the dad, we need the liver to be in harmony. We also need that vitality from the kidney Jing and of course the postnatal Qi and blood. All of these in harmony and balance are going to contribute to a better life. Successful and bountiful, abundant pregnancy that serves the fetus to the highest and best.

So let’s talk a little bit about the spirit of the Po here. So the Po, as we know, is the corporeal soul. It is the tangible. It is the spirit of the lungs and it resides within the lungs. It is a physical soul. So it has a yin nature to it. It is going to be transferred from the mom. To the fetus, the PO, as we know, is the soul that comes in with the body at birth and it dies at death.

So it does not extend its spiritual journey. It’s corporeal. Thus, the constitution of the baby is reflective, not only of the kidney energy of the mom and dad, but also the mother’s lung energy, right? Spiritual access. Chapter eight says the corporeal soul is the entering and exiting. of essence. And I really love that quote.

And I really think working with the Po is so helpful in the journey to working with moms in their fertility phases. So let’s look at the Kinney Jing evolution. Okay. So during menstruation versus pregnancy that we’re going to have a different experience here. So during menstruation, we know that the kidney gin, it links to the Tian Gui, right?

The heavenly waters, the minister fire acts upon that. And then we have menstruation, right? During pregnancy, that kidney gin is going to nourish the fetus and it’s going to replenish and recycle. The Tian Gui is going to replenish and recycle to Restore and serve that kidney jing. So we have two different pathways of what’s happening with the kidney jing here.

Now we’re going to have abundant yin, right? We’re going to have an increase in fluids with that tian gui replenishing and nourishing the fetus. We’re also going to have abundant yang because there’s no release of that minister fire. So there’s a significant abundance within the body, within the pregnant body.

Also, we’re going to have the component of the energy that travels up the chong. To the breasts also with the stomach chi as well. That’s going to transform blood to milk on an energetic level So this kidney gene evolution is two different stories two very different stories of what’s happening in the body And I think that’s important for us to understand as well as to be able to share with our clients What’s happening on an energetic level in their body when their monthly bleed?

is no longer. Let’s talk also about hormones during pregnancy. So we’ll see that at the beginning of the pregnancy, HCG is going to spike and then it will drop the rest of our hormones. So progesterone, estrogen, estradiol cortisol, and of course our placental actogen, they’re all going to gradually increase to the birth.

And then they’re going to quickly drop off. This is why there are so many Different emotions, different feelings, different experiences throughout the pregnancy process and after the birth, there is a drastic change in hormones. We’ll also see just at the birth, we’ll also see oxytocin spike.

And then we’ll see oxytocin and prolactin spiking and cycling. So highs and lows. And that is when the fetus will be, the baby will be suckling, right? So there are those increases if the mom is going to be breastfeeding. So there are continuous changes of what is happening through the hormone cycle.

Now, if the mom is breastfeeding, there is a chance that the progesterone and estradiol, and even the cortisol are going to stay low, which is going to lead to more emotions as well, which are important to consider. So now Yuanqi in the fetus. Yuanqi is derived from prenatal Jing from the parents at conception and stored in the kidneys responsible for growth development and maintenance of life.

Now I really like this quote that I found in the Shilin Temple blog which describes kind of Yuanqi and the cellular nature. So cell division requires a fixed liquid base of Yuanqi which allows the cell which compromises the yin or essence of life to divide. Weakness in the yang qi, or yuan qi, or weakness of the yin causes the cells to lose its true identity, its dao, and to create chromosomal changes which cause the fetus not to develop in a way that is consistent with the laws of nature which desire harmony.

So basically what this is saying is that even at The basic, most simplest cellular level, the body, the fetus is seeking harmony. It is seeking homeostasis, and it is seeking that in alignment with the Tao, with the purpose. And there’s so much power in that, there’s so much understanding in that, and there’s so much energy that is required during that phase.

Very briefly, let’s touch on pathologies of pregnancy. The first that we’re going to talk about is going to be a deficiency which could be of blood and yin as well as kidney deficiency. Now this is going to be particularly seen in those who have a tendency toward overwork and thus may have a pre existing kidney deficiency.

Could be kidney yang or kidney yin depending on other factors, right? It’s really important for us to understand our clients that are over workers. If they are coming in with these types of deficiencies that likely, unless they make major lifestyle changes, they aren’t going to change during the pregnancy.

So we want to address that. We want to be aware of that so that they can have a successful fertility into pregnancy journey. Another thing that we’re going to see. is rebellious chi and rebellious chi is, it makes sense, right? Because of the physiological process that’s happening within the abdomen, that there’s going to be this upward rising energy where there’s meant to be a downward rising energy.

Now, this rebellious chi is going to impact the stomach channel as well as the Chiang Mai. And these are particularly related to emotional stress. So while there is that physiological component, emotional stress is going to compound rebellious chi. There’s also, again, with what’s happening in the middle here, that middle jiao can be obstructed and cause some spleen chi deficiency.

And the buildup of phlegm again, sounds obvious during pregnancy, but important for us to be really aware of. This is also going to be something that can create some disharmony between the Ren and the Chong channel, which we want the Ren and the Chong to be strong for fertility and strong throughout the pregnancy and afterwards.

So why are we bringing up pathology in this workshop? Really the key here is because I want you to be aware of the contributing factors. that can impact pregnancy and also that might impact the pelvic floor. So we start to think about kidney deficiency, right? And if this leads to our liver yang rising, or it liver win rising, that kind of thing, or An ultimate a deficiency in that Yuan qi that’s going to be an impact on the pelvic floor because of its connection with the kidneys, right?

And the reproductive system, that rebellious qi, that confusion, proprioceptive confusion of upward versus downward energy is going to be difficult for the pelvic floor. rises and falls as well, right? With contraction and relaxation. And so if there’s proprioceptive congestion or confusion in the energy channels, there’s going to be physiological proprioceptive confusion.

So want to be really aware of these pathologies and to advise our clients that are coming in for fertility in. The manifestation of overwork in the manifestation of over stress, right? And how they can really focus on this fertility time, focus on this pregnancy time to be with themselves and to be nourishing their own bodies and their babies.

Speaking of, let’s talk about the body. I’m really excited for this section. So in ideal circumstances before pregnancy, what we’re going to see is that the internal organs and the pelvic organs of the abdomen all share space. There’s no major distinction or separation between the organs of the pelvis and the organs of the abdomen.

The organs of the pelvis and the organs of the abdomen, they work in harmony with each other, and there’s enough space. So there’s no crowding within the body kingdom on a physiological level and an energetic level. Now again, this is an ideal situation, right? If we have a client that has endometriosis or has inflammatory bowel disease or something like that, we’re going to see something that looks a little different.

But for our purposes today, this is an ideal situation. At six to seven weeks of pregnancy, things start to grow a little bit. The uterus starts its growth process and the uterus actually within the pelvis starts to put some pressure onto the bladder. This is why we can see the need for increased urination, increased frequency of urination and urgency of urination.

early on in a pregnancy. The placenta is also developing in this six to seven week phase. At 10 weeks, things begin to change. The ligaments of the pelvis actually start to relax just a little bit and the pelvic joints loosen. So this is going to be the sacroiliac joints, the pubic joints, and the hip joints.

And this can actually lead to some of that. early on discomfort within the joints at the very beginning of a pregnancy. So it’s important for us to be aware of. Now, of course, we can also posit that as the ligaments are beginning to change, as they’re relaxing just a little, as the joints have more space, guess what?

The pelvic floor is going to be impacted as well because there’s going to be a little bit of a stretch on the pelvic floor already. So the tension within the pelvic floor is already starting to change at 10 weeks. At 12 weeks of pregnancy, things really begin to move, right? So the uterus is now the size of a grapefruit and it fills the pelvic bowl.

The uterus rises during this 12 week phase. It starts to rise into the abdomen because it’s too big to just stay within the pelvis. the pelvic bowl itself with all the other organs that are there, right? The anterior part of the pelvis sits upon the pubic, I’m sorry, the anterior part of the uterus sits upon the pubic symphysis.

So the bladder here, good news, yay, gets a little bit of relief. But the pubic symphysis is now going to be carrying the load, which progresses over time, right? So we can start to see this shift into pubic symphysis pain at around 12 weeks or a little bit later. Now, between 12 and 36 weeks, the pelvis starts to shift anteriorly.

So it’s neutral position is here and it starts to tilt forward, right? So that starts to begin at 12 weeks of pregnancy. Now there’s an automatic implication to the pelvic floor here, right? Because that pelvic tilt is changing the balance and the position of the ligaments, the tendons, and the muscles within the pelvic floor.

At 20 weeks of pregnancy, things begin to get squished. The rectum, the sigmoid colon, and the small intestine get pushed up and back. The ascending and the descending colon aren’t generally affected during this phase. The uterus continues to move up and push on that lower abdominal And at this point in time, abdominal strength and muscle tautness really impacted the position of the uterus being more anterior posterior.

So someone that has very tight, either fascia or musculature, or has strong abdominal contraction, the. Uterus is going to sit further back, whereas if the abdomen is weak or it’s slack for whatever reason, then the abdomen is going to push forward a bit more. Of course, there is that play with the abdominal muscles and the pelvic floor as well.

They are so deeply connected. I can’t tell you the number of times, not with pregnant clients, but in general with clients postpartum. Or clients unrelated to pregnancy that I work with the abdominal muscles and we can make a shift in the pelvic floor. Such a cool experience. But moving on without getting a ton of tangent at 21, 28 weeks of pregnancy, things really.

get compressed and the weight distribution actually starts to shift at this point. So uterus expands into the mid abdomen. So it keeps expanding upward and it’s pressing now against the stomach. The load is increased upon the pelvic floor and the posture shifts posteriorly. to carry that load.

So the body literally is shifting back into the heels. Now at this point you may actually have clients that are complaining about posterior fascial chain pain. They’re also maybe talking about pelvic floor pain at this point as well because the pelvic floor is really holding a lot of the load here.

At 36 weeks, things really change. The uterus expands to fill the abdomen. It generally meets up to the xiphoid process and there’s pressure upon the diaphragm. That increased load on the aorta, the heart, and the lungs starts to show up at this point. And the abdominal muscles are really supporting the weight.

They’re working really hard to support the weight of the fetus. The vagina. and urethra at this point start to elongate. And then the perineum actually is stretched and enlarged and it begins to protrude outward. So once again, if we’re talking about the perineum, that’s the space between the external anal sphincter and the opening to the vagina in females.

Now, As that starts to expand, we can obviously make the correlation that the pelvic floor muscles are going to be stretched during this time. They’re going to be stretched to uncomfortable limits. At 40 weeks of pregnancy, the body is preparing for birth, and the head of the fetus lowers into that pelvic bowl.

The bladder, again, is compressed, and the colon is compressed. So this leads to all sorts of dysfunction within the excretory phases. If you’ve been pregnant, you know this. If you’ve been married to someone who’s pregnant, you know this. If you work in pregnancy, You know this, right? The round ligament, the utosacral ligament and the broad ligament are stretched.

So now these deep ligaments of the pelvis are beginning to stretch. Ligaments don’t have the same recoil that muscles do or tendons because they don’t have as good of blood flow. So this is important for us to be aware of because this is also going to contribute to what’s happening in the pelvis and the pelvic floor during the recovery process.

Now, postpartum, the body is going to be seeking recovery. The body, generally speaking, is going to be fatigued. It has just worked really hard for ten moons, right? In order to grow. a baby. So it’s going to be fatigued. It is also going to be stretched. The abdomen is going to be stretched. The ligaments are going to be stretched of the pelvis.

The pelvic floor muscles are going to be stretched. The back may actually be tighter from that weight distribution and that anterior pelvic tilt. The uterus, the vagina, the perineum, and the pelvic floor are going to be expanded, stretched, and potentially weakened, right? If we think about it, if a muscle is at its maximum stretch, it’s pretty hard from its maximum stretch to get contraction, right?

Whereas if it’s at a comfortable place in elasticity, getting contraction and relaxation is a lot easier. So there’s going to be some proprioceptive and kinesthetic changes that are occurring as well. Ligaments in the joints are going to be unstable initially. Everything is open and the organs are in a new alignment, which can lead to a lot of body and energy confusion and hormones.

Guess what? They’re all over the place. They are changing frequently and they’re changing differently in different people. So there are a lot of things going on with that body postpartum. In order to restore and repair postpartum, the organs have to return to alignment and function. The uterus size and position all has to return to its, pre pregnancy stage.

The perineum needs to heal. There’s going to be a ligamentous and joint recoil and repositioning that occurs. There’s going to be the fascia, the diaphragms, and the posture are all going to Balance or not balance. If the proper work and attention isn’t done or if the body is in severe depletion beforehand, the muscles of the abdomen, the back and the pelvic floor are all going to change.

The blood and the fluid will level out. And the energy and the meridian flow also hopefully will realign. And then there’s the emotional harmony. All this to say, and we have a whole talk coming up on postpartum, which is really exciting. But all of this to say, the body is going to try to do all of these things on its own.

Why? Because it is always seeking homeostasis. The body wants balance with the body. The Dow, the body wants to be in balance with your purpose here on earth. So it wants to do these things. Now as acupuncturists, we can help clients to intervene in this process and to facilitate the healing in all of these, in all of these phases, right?

There’s more than nine, but I just listed nine out so we can really do an amazing job to support our clients with the. Restoration, the recoil, and the return to their pre pregnancy state. Now, if you’ve been with me and the American Acupuncture Council before, you know that I have previously recorded a pelvic floor intro, a chat on menstruation in the pelvic floor, a chat on fertility in the pelvic floor, and this, of course, is our pregnancy and the pelvic floor chat.

We’ll also be doing a postpartum chat. And a menopause in the pelvic floor chat. So I can’t wait for more time with you. And I really hope you enjoyed our time today. Once again, I want to thank the American acupuncture council for sharing this space and sharing this vlog with acupuncturists around the globe so that we can share these teeny tiny little nuggets of wisdom that hopefully impact you, your practice and your clients.

In a positive way. Here’s some references. Once again, I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’ve thoroughly enjoyed my time with you today.

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