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Pelvic Floor Introduction – Krystal Couture

 

 

I was also really drawn to treating the pelvis because these clients kept showing up in my practice.

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! Welcome! Welcome! This is an introduction to the pelvic floor. My name is Krystal Lynn Couture and I am the pelvic acu. I want to first take an opportunity to thank the American Acupuncture Council for hosting this webinar. this video, as well as the many other educational video series that they have on their vlog.

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Let’s get started. First off, I want to let you know just a little bit about me. I became a PT in 2006 and later became an acupuncturist. I actually started dry needling in 2009 and very quickly I found that the power of a needle was more than just muscle release. I was immediately drawn to Eastern medicine.

And as doing so, I was also really drawn to treating the pelvis because these clients kept showing up in my practice. They didn’t know that much about it. I didn’t learn about it in school, in PT, in school for acupuncture, just, And it just kept happening that these clients needed help, they trusted me, they were seeing me for something else, and then it was like, hey, by the way, I’ve got this thing going on that I really don’t know who to talk to about it.

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And so at first I just listened, and I educated myself and educated myself. And eventually, I developed a system to bring pelvic care to clients. Through the lens of acupuncture to create successful treatment plans for these clients that address the root of the dysfunction through the physical body, through the emotional body, and of course, through the spirit, which is what we do really well with our medicine as acupuncturists.

Today, we are going to have a very brief introduction to the anatomy of the pelvis and the pelvic floor. First, we’re going to talk about the bony structure of the pelvis, then we’ll start talking about the superficial and deep musculature layers. We’ll talk about the differences between the female and the male pelvis.

We’ll get into the functions of the pelvic floor in relation to organ support, in relation to sexual function and reproductive function, as well as bladder and bowel function. And then finally, we’ll have a quick chat about qi and blood. If we can understand the science and the physiology of the pelvis.

and the organs that are contained within it, as well as the muscles and also the energetics that are contained within the qi and the blood, we can start to produce a really amazing way to treat the pelvis comprehensively. And this is what I love about bringing pelvic care into your acupuncture practice.

So let’s start with anatomy.

All right, I have my amazing pelvis here, and I’m going to use this as a model to serve us. So what can see first in the bony anatomy? We’ve got our iliac crests. Our iliac crests come into the pubic bone and the pubic symphysis. This forms our ischial, there we go, ischial tuberosities, or our sit bones.

And then on the back of the pelvis, We’re going to have our sacrum right here in the center with the sacral foramen, right? And then we’re going to come down to the coccyx. So that’s the basis of our pelvic bony anatomy. Now if we orient ourselves to the pelvis in the position from inferior to superior, we’ve got on each side those ischial tuberosities.

We’ve got our pubic bone, pubic symphysis, and then we’ve got our tailbone, right? So that forms a diamond. That diamond is what supports the hammock like structure of the pelvic floor musculature. Speaking of, let’s talk about the pelvic floor musculature. All right, so this is a very brief lesson today.

We’ve got a female pelvis here, so let’s go ahead and just orient ourselves. So we’re going to have the tip of the coccyx or tailbone. Then we’re going to have the external anal sphincter and the opening of the anus here. We’ve got the perineal body, right? And then we’ve got the vaginal opening. So if we want to talk about the superficial musculature, first off coming off of that perineal body, we’re going to have the transverse perineal muscle.

Okay. Next we’re going to have. Next to the vaginal opening, we’re going to have the bulbospongiosus muscle. And then coming right along the ridge, the underside of the ridge of the pubis, we’re going to have the ischiocavernosus muscle. Now let’s go to the deep layers. So we’ve got the levator anni, which is the magic of the pelvic floor muscles that most people refer to.

So levator anni is going to be these layers here. We start off with the puborectalis muscle. Then next we have the pubococcygeus muscle. And next we have the ischiococcygeus muscle. I hope the anatomy lesson provided you with the start of a foundation for understanding the pelvis and the pelvic floor.

Now let’s talk about the differences between those assigned female at birth and those assigned male at birth when we’re talking about the pelvis. So first up we’re talking about the inlet. Okay. This is the inlet. This oval shape here of the female pelvis is going to be wider and oval shaped. In the male pelvis, we’re going to see a little bit of a narrower opening, as well as a more heart-shaped inlet.

When we talk about the sacrum in the assigned female at birth pelvis, we’re going to see a wider and shorter. sacrum with a greater curve to it. In the male pelvis, we’re going to see a longer and narrower sacrum. But when we talk about the coccyx, what we’re going to see is actually the male coccyx has a little bit more curve to it than the female coccyx.

The female coccyx is going to be a little bit straighter, which allows that opening to be a little bit more open and spacious when we push A baby through the opening. The iliac crest. We know this from palpation and also observation. The iliac crests. on the male pelvis are going to sit a bit higher than they do on the female pelvis.

So there’s actually a little bit of a height differentiation. And then of course we have the pubic arch, which you can see here. This pubic arch is going to be much wider in the assigned female at birth pelvis versus the assigned male at birth pelvis. Finally, the bones of the female pelvis are going to be a bit lighter and thinner than the bones of the assigned male at birth pelvis.

So now we’ll go ahead and look at some graphics. Since my demo pelvis is just a female, we’ll go ahead and look at some graphics to explain these differences. So here we have the illustration of the pelvic inlet shape. On the left we see the male pelvis. We can really see that heart shaped On the right we have the female pelvis and we can really see that we’ve got a more oval and wider shaped inlet.

Next, with the sacrum and the coccyx shape. We can see on the left that male pelvis has that elongated sacrum that’s a bit straighter. Whereas the female pelvis is going to have that wider, shorter, more curved sacrum. On the contrary, we’ve got the Coccyx on the male, which curves forward a bit and the coccyx on the female, which is a little bit straighter.

Chatting about the pelvic height and pelvic angles. This is displayed a really nicely here. We can see that those iliac crests on the male pelvis on the left are a bit higher than those of the female. You can see there’s a little bit more width in the female. pelvis, right? And this makes sense when we just look at body shape, very often the male has that more triangular shape and the female has a little bit more curve shape to it.

So that makes good sense. In this picture, we can also see that pubic arch very well. illustrated. And so the pubic arch is going to be 60 to 70 degrees on the male pelvis and on the female pelvis that’s going to be more like 80 to 90 degrees. So now we want to talk about pelvic floor function.

Okay, so first off, the muscles of the pelvic floor provide that hammock like structure. As you can see, in our model, right? We’ve got that beautiful hammock like structure. What that does for organ support is it keeps the lower abdominal organs in alignment. And this is so important because the pelvic floor is actually activated in conjunction with the abdominal muscles and the muscles of the back, especially when we’re doing activities like lifting and bending and carrying and jumping, right?

What happens when we’re doing these activities is actually the pressure in the abdominal muscles. increases. Now the pelvis, the pelvic floor and the pelvic openings are obviously below when it comes to gravity, the abdomen, right? So what that means is the pelvic floor is particularly important in keeping those lower abdominal organs from being pushed outward.

or prolapsing. So you can start to see the importance of the pelvic floor, right? It keeps everything up and in and also helps to support the pressure between the abdomen, the back, the base of the pelvis, and also that respiratory diaphragm. When we talk about sexual function, and reproductive function.

It’s quite obvious that during pregnancy, the pelvic floor is going to support the pregnancy. It’s also going to relax and stretch during labor and delivery to allow that baby to come out, right? To be delivered. But sexually, what happens? The pelvic floor muscles actually play a key role both in those assigned female at birth and those assigned male at birth in labor.

providing movement of blood flow. So in females, the pelvic floor muscles help to increase blood flow to the genitals, which promotes arousal promotes lubrication, and it allows for ease of penetration and thus orgasm. In men, of course, the pelvic floor muscles help to manage the blood flow to the genitals by compressing the veins to the penis and thus trapping blood in the penis which creates an erection leading to eventual orgasm.

So those pelvic floor muscles have a big impact on our reproductive and our sexual function. Let’s talk quickly about the urinary and bowel function. Now, the pelvic floor is going to house the openings for the urethra from the bladder, the anus from the bowels, and the vagina from the uterus in females.

The pelvic floor is going to help close those openings to prevent leakage and then relax them for emptying. The pelvic floor essentially supports continence in both males and females. So here’s a quick image so that you can just orient yourself to the opening’s anatomy. So we can see on the left we have the male image, on the right we have the female image.

Left to we have the pubic bone to the tailbone. In between the pubic bone and the tailbone, guess what, we’ve got the pelvic floor. And then, in males, we have the bladder, the prostate, and the urethra. Then we have the bowel. So those are our two openings and our two spaces to consider. In females, we have the bladder opening to the urethra.

We have the uterus opening to the vagina, and then we have the bowel opening to the anus. So here’s your example. You can also see this really well from my superior to inferior view. of my pelvis here. So we can see there we go. We can see the rectal opening, we can see the vaginal opening, and then we can see where we’ve got the urethra as well.

Up next, let’s get in to chi and blood. Okay. Chi and blood are that crucial energetic aspect that are going to help us put everything together as we bring a unique lens to treating the pelvic floor as acupuncturists. The Great Void consists of qi, and qi condenses to become the myriad of things. In terms of Chinese medicine, qi is the energetic foundation of the universe, as it is the physical and spiritual substrate of human life.

Life.

So what does Qi do? Qi is going to promote, it’s going to warm, it’s going to protect, it’s going to hold, and it’s going to transform. Qi promotes the essential functions of the organs and channels in the human body. So when we think of the body as the body kingdom and the organs as officials, And the channels as communication between the officials, we can see how Qi is the director of essential function, warming.

Qi is going to be young in nature, and it’s tasked with warming the body and providing heat. Qi defends us against pathogens or the six evils, which we know in the winter we have colds, In the spring, we have wind. In the summer, we can have summer heat, which is that damp heat, or heat, which is dry heat.

We can also have damp or dry in their own right. Qi is going to hold and contain substances in their respective places and control secretions. We know this when we think about spleen qi deficiency becoming, um, spleen chi sinking, right? Transformation. Chi also metabolizes fluids and substances within the body, which includes our blood and the chi itself.

So when we’re looking at chi as a vital substance and thinking about these functions, we can already start to see how we’ve got all these fluid balances that are occurring in the pelvis. itself within the organs, but we also have that musculature that’s going to require qi and blood as well.

Let’s talk blood. Put simply, blood is going to carry oxygen and nutrients to the cells while carrying away waste. Chinese medicine believes this too and Chinese medicine believes that blood carries the human conscious or consciousness within it. So blood has this very physiological robust nature to it, and by carrying the consciousness within it, it’s got a very robust spirit as well.

Just to review, the spleen is going to make the blood. The heart will govern the blood, and the liver will store blood. When it comes to the uterus will store and release the menstrual blood. Blood functions include nourishment, moistening. Holding the mind or the spirit and determining menstruation.

The blood circulates continuously through our system, providing us with nutrients to our organs on the interior and to the muscles, the tendons, the bones, and the skin on the exterior. The blood of each specific organ ensures that the skin. and the hair and the eyes and the sinew and the tongue are properly moistened.

So the blood has a direct role in moistening. This is really important as we start to think about female cycles. Chinese medicine teaches us that the heart and specifically The blood vessels hold the shen or the spirit. Finally, blood determines menstruation. The quality of blood determines one’s bleeding cycles monthly and also throughout the lifespan.

So how are qi and blood alike and different? First off, blood, of course, is the mother of qi. And qi is the ruler of blood. Talk about that for a mouthful, right? Blood has a yin nature to it, where qi has a yang nature to it. Blood nourishes and sustains the zongfu organs that help produce qi, while qi provides the force and the energy to the zongfu to produce blood.

So we can see that they have a pretty symbiotic relationship. Qi is I’m sorry, blood is essentially a denser form of qi. Blood and qi are inseparable. Qi will move blood. And Q will also hold blood. So once we understand the energies of QI and blood, we can start to understand the source of the function or dysfunction within the pelvis.

We can start to understand how to put the layers together, and then all of a sudden, instead of treating the diagnoses of erectile dysfunction, we’re able to go to the depths of kidney young deficiency, or whatever it might be, whatever pattern we come up with, and also identify emotional patterns, spirit patterns that could be contributing, and get really deep into the source.

And treat the pelvic floor, treat the pelvis, treat the root of the body, and treat the root of the dysfunction to really help our clients to feel better and to improve their quality of life. So once again, this presentation is brought to you by the AAC, American Acupuncture Council, and I hope you loved it.

We are also going to be doing a few more presentations. We’re going to be sharing presentation on the pelvic floor and menstruation, the pelvic floor and fertility, the pelvic floor and pregnancy, The pelvic floor and postpartum, and of course the pelvic floor and menopause. I would love to have you join me for this series.

Once again, my name is Dr. Krystal Couture, and I am the pelvic acu. It has been a pleasure to be with you today, and I can’t wait to see you soon.

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What Language Are These Insurance Companies Speaking?

 

 

so I want to go through some of the terms, what they mean to make sure there’s a clear understanding, because I’m finding often there’s a lot of misunderstanding, and because of that, there’s It creates some problems on collections.

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, my friends. It’s Sam Collins, your coding and billing expert for AcupunctureU, and of course, the American Acupuncture Council, giving you another episode here. And what I want to talk about today is a lot of questions I’ve been getting recently about what are the different meanings of terms and understanding.

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I think this is often affecting our reimbursements. And so I want to go through some of the terms, what they mean to make sure there’s a clear understanding, because I’m finding often there’s a lot of misunderstanding, and because of that, there’s It creates some problems on collections. So let’s go to the slides.

Let’s talk about understanding insurance and the billing language that’s associated with it in the terms. Cause like with everything, the better you can express or understand, the better we like to get paid is I think it’s going to create problems with reimbursements. Let’s talk about first, what the heck is health insurance?

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You know, it’s a contract between. The patient and an insurance company often remember that contract is not between us, meaning the doctor and the patient, but the insurance and the patient. So ultimately with insurance, that’s their contract. If it doesn’t pay, that means the patient owes unless you’re in network.

So understand health insurance is a contract not between the doctor and the insurance company, but the patient and the insurance company. Now we may be part of that if you’re a network to some extent, but ultimately it’s their contract. What I want to hit on though, is it really? Health insurance. I mean, there’s preventative things, screenings, but is it really health insurance, or is it sick insurance?

And I think from an acupuncture standpoint, it’s often important to think of it as a There’s got to be something wrong. There’s got to be something where they’re sick, they’re in pain or the dysfunction, otherwise it’s not going to pay. Now, what type of insurance are we talking about? What are we going to see patients with?

Well, we all know HMOs, Health Maintenance Organization. This is a type of a plan that essentially the patient has to go to an in network provider. Now the benefit here is it’s generally going to be cheaper, but they’re limited to go to just those providers. You must stay in network. If you go out of network, not covering, you’re Maybe in an emergency.

Now, the reason this is chosen by many people, it’s just frankly lower premiums and copays because the insurance company gets to control the doctors where they go. So these are the lowest. This is also the lowest in reimbursement for Accu. Now, You may think, can an acupuncturist really join an HMO? Not directly, frankly, but often you join tangentially through joining groups like American Specialty Health.

That often gives access to things like, uh, HealthNet or Kaiser and so forth. So again, these will get access, but they pay very little, so we’ve got to be careful if you’re in these. Is the reimbursement going to be very high? No. This is going to be a volume thing, not really one that’s a fee for service.

Now, what about a so called PPO Preferred provider. Well, this plan allows access to patients to go to in network providers, but it says preferred. So if you go to the preferred doctor, that’s good. It’s cheaper, but you can also go outside so you can access other doctors. But when they do, Or the patient does it, I should say, they’re going to have more out of pocket.

So by example, if you’re not in network with the plan, can the patient still choose to come to you? Oh, absolutely. But the plan may pay less, may have a higher deductible and so forth. So they’re going to realize lesser out of pocket. If they go in network, out of network, maybe more, but maybe the values there.

So this is why many of us will join a PPO with the idea of getting more patients. And, but do remember when you’re part of it. That means you’re accepting a lesser amount. You may not balance bill your full rate. So patients still have a choice of providers, but it’s going to be cheaper if they go in network, hence why many times we join.

Now, of course, it’s greater choice in the HMO, but a little bit greater cost in premiums. I won’t say often a lot more, but certainly more. Now, here’s one that’s unusual, or I shouldn’t say unusual, but is often misunderstood. An exclusive provider organization. Now, you’re going to think, what is that, exclusive?

It’s really an HMO, but it’s a very small HMO. It’s going to be a group of doctors. Or clinics that all group together, sometimes an independent physician association or IPA, and they don’t offer any network benefits. Now these often can be less expensive, but it really limits where the patient can go generally the only way they’re going to get acupuncture.

On this plan is if they have a direct referral because actually the insurance doesn’t cover it. It has to be paid by the group. So they’re often not pushing out a lot of people. This is not a very common policy, but they’re out there for some companies. We’ll do these because they figure it’s going to give greater access and cheaper for them and more access to their patients.

If there’s enough providers. Now, the one plan I think we all prefer, it’s the most expensive, is a traditional fee for service plan. This is your traditional insurance. It’s not a PPO or an HMO, but one that just simply has a simple deductible, and pays for you. 80 20 or whatever the case may be. This is the most expensive plan.

Patients will have lower deductibles and coinsurance. I, by example, have one of these plans. My company is very good to me. They give me a good rate here. I have no deductible and I have no out of pocket. You’re like, how does that happen? It’s very expensive. These have the highest. In fact, they have a platinum.

Here’s what I’m pointing out. If someone comes to you with a platinum program, even if you’re not thinking you want to take Insurance. This is probably one you do, because these offer the most generous benefits, less out of pocket, so forth, because it’ll simply just pay more. Bigger companies often offer these because they can buy it because they’re buying a little bit bigger in bulk.

These are fantastic. Now, if it’s a platinum, it’s great, but if it’s a bronze policy, uh oh, maybe not as good. So keep in mind, fee for service is not as common because it’s more expensive, but obviously the one preferred from a provider standpoint, because it just pays better. But here’s the terms I want to get into.

When you hear a loud amount, the plan pays 80%. Don’t be fooled because it’s 80 percent of what? This is where you have to be careful. Allowed doesn’t mean what you billed. It means what they allowed. So they’re going to have a maximum that will be paid. So let’s say you bill 100, but the plan only allows 50.

That means they’re going to pay 80 percent of 50. Which means they’re going to pay 40. Now, because you billed a hundred, what will you be looking from the patient? 60. Cause you remember you’re not in their network. So be careful with the allotment because patients will say, Oh, it pays 80%. Yeah, 80 percent of what?

Now, if you’re billing within their range, maybe, but many times you might have a fee that’s much higher. And let’s keep in mind, can you just write off a billed amount when you’re out of network? Technically, no. You’re to collect it. So be careful. Now, what about health savings accounts? These are pretty good.

They’re not as popular as I think they should be. But what these are, a patient can set aside money, pre tax dollars, for medical expenses. And they can use it for qualified medical expenses. These I like. This is something that if your patients have these, this is something to let people know, do you accept HSAs?

I would say you do because when they come in, the patient will pay you. You give them a receipt, they submit it and assuming that they have some type of benefit towards it. They’ll cover it. I’ve seen them cover things that often aren’t covered any place else, such as just simple massage for nothing else.

It’s tax free when they use it, so for a lot of people it’s something that’s a good thing, but it’s one that they have to have enough money to do that. You’ll often see this where people have high deductible policies. It makes sense to do that. There is something else, though, that people will see that’s called an FSA.

And they think, oh, okay, FSA is one through the employer. They call it flexible. I’ll say forced. In other words, the company does it, but you can only use it towards out of pocket expenses. So it only pays for like the deductibles and the co pays. It doesn’t allow them just to choose care. HSA is great. They can come in directly to you.

Now here’s something else that is often misunderstood. What about deductibles? Well, deductible, of course, I’m sure you understand the traditional deductible. It’s 1, 000. In other words, the patient has to pay 1, 000 before. Insurance begins to cover. In other words, they’re going to look at the covered costs and once it adds up to 1, 000, then of course, the insurance begins payment.

Keep in mind, the patient doesn’t have to pay it all at once. They could be paying over time, but they have to meet that amount. Now, here’s the parts where it’s confusing. Some services may not be included. There are going to be times you’re going to bill and you’re going to, your bill may be 500, but maybe the insurance only allows 200.

So even though you’ve billed 500, 200 applies towards deductible, but there’s 300 that’s not covered. How much does the patient owe you? 500. So when you start billing, be careful of what you’re billing. The intention is you’re collecting it. So you can’t just bill a high amount saying, well, we’ll see what’s going to happen.

This is why you want to be careful. Do not set your fees off of your highest based insurance. Okay. But not necessarily your lowest, because you want to be somewhere in the middle, but deductibles can fool you. So keep in mind if you’re billing a thousand, 500 is considered, you know, the covered services.

Great. Will the patient owe you 500? They will, because that’s deductible. But what about the other 500? That other 500 they still owe you because you billed it. This is why often people will choose in network. Because if they go in network, then because you’re limited to the fee, maybe that’s where the 500 comes in.

Now there is something else that you’ll see with these, where you’ll see there’s an individual deductible. That’s what we’re talking about here, just a simple one. But you’ll often see a family deductible. So let’s say there’s a family of four. Each person may have a 1, 000 deductible, but maybe the family deductible is 2, 500.

So if other people in the family have met 2, 500 towards the deductible, That means it covers everyone in the family. So someone coming in who hasn’t been to the doctor, that will be covered. So particularly when you’re seeing a family, that family deductible could be a real important thing to know that the patient has greater access just because they haven’t gone to someone else has.

So that’s an added benefit that you’ll find or see there. Now, what does that actually, when you see the term co payment, This is often confused. What is a copayment? A copayment is a fixed amount for a covered service, generally for an in network provider. When you’re in network, you get exactly that. Like some of you are familiar, when you see an ASH patient or that type, it will say we’re paying 50.

And the patient’s co pay is 10. Well, what that means is the plan is going to pay 40 and you get to collect 10. That’s the co payment. It’s always fixed. It’s a set amount and it’s part of the contract we have with an insurance. So think of a co payment is more of a payment when you are in network.

Because it’s a fixed set amount. Now, it’s confusing, because what about co insurance? It’s like, well, how is that any different, Sam? Well, the difference here, I’d like to make the designation, co insurance means you’re not in network. And it’s the money difference that’s not paid, because there is no co pay, because they can’t demand what you charge.

So, let’s take an example. You bill 500. The patient has a plan that pays 200, okay? Okay. They pay 200. How much does a patient owe you? Well, the insurance didn’t pay for 300 of it, so the coinsurance is that difference. That 300. So this is where you can see why a lot of people choose a network because they can just control how much they know they’re going to pay.

Because of course that co insurance is everything that you built. So again, I’m going to state to you, be conscientious that if you’re not collecting the differences and you’re out of network, You probably should just lower your fees because you’re not collecting it anyway. And why set yourself up for a sense of fraud, meaning you’re billing an amount you have no intention of collecting.

So keep in mind, the difference is, is the coinsurance. In other words, what’s not paid by insurance out of network, and you get to balance bill for the full amount. Now that means of course, you’re no longer limited to their amounts, but now. Do the patients feel enough benefit from you to come in and pay that extra?

And that’s what we call balance billing. This is where you don’t get a surprise. Balance billing is, or it can be a surprise when a patient comes in and they thought, Oh, I thought I was only going to pay 50, but it turns out they owe 250 because balance billing is the amount left over from what the insurance paid.

And that difference again, out of network, please be mindful, make sure the patient’s fully aware of your fees. Let them know our service is 100. Your insurance may pay some part or none of it. And so ultimately, you may owe us 100, but let’s say one patient’s insurance pays 20, that patient owes you 80.

Another patient’s insurance pays 50, they owe you 50. In other words, you’re still getting your 100, just different amounts from the patient depending on their plan. This is why I often will tell people that insurance is an aid. It’s going to help pay for some of the care, not all of it. But if I can come to you and only have to pay 50 out of pocket instead of a hundred, what I’d be more likely to come in is the, is it there?

So that’s balance billing. Balance billing is like coinsurance, if you will, but it’s what’s left over when you are out of network. Now you’re going to see some where you’ll find, they’ll say it’s an out of pocket maximum. This you’ll see maybe towards the end of year. Let’s say you have someone that’s had.

Pretty good sized illness, went to the doctor for something significant. Once they’ve met that out of pocket max for the year, the insurance actually pays 100%. So your bill of 100 will be paid 100. But one thing to keep in mind, this 100 percent is not of what you billed. It’s, again, always what they allow.

So if you’re in network, great. If you’re out of network, it may or may not cover the full amount, but at least they’re no longer going to put it into a place of The patient has extra co pay. Now they may have extra co insurance out of network. So out of pocket max just simply means once they’ve hit that, that plan continues to pay.

These are ones that are good, particularly you might see towards the end of the year. Now here’s an important one. Where’s an assignment of benefits? This is block 13. You’ll see it towards the top here. And it says insured or authorized person signature. I authorize the payment to be made to the provider of service.

This is how you get the money. If you leave that blank, block 13, the money goes to the patient. So make sure your claims are assigned. If you don’t assign the benefits Check goes to the patient. So if the patient’s paid you in full, no problem. Let them get the money. But if they haven’t, please make sure you’ve done the assignment.

Keep in mind, unfortunately, if you are not part of Blue Cross and Blue Shield, often the assignment Won’t apply. Now with other insurers, they have to follow it, but Blue Cross Blue Shield is exempt. So keep in mind if someone has a plan Blue Cross Blue Shield, you’re out of network. Chances are it’s better for them to just pay up front and let them know they’re going to get the check from the insurance.

That way you’re not chasing after it. But assignment means they’re assigning the payment to be made to you. Simply block 13 puts signature on file, meaning they’ve signed an assignment that’s in the file. Now when we hear the term self pay, Well, what does self pay mean? Well, someone could have insurance, but they may not want to use it.

So they’re just a self pay patient. This is a patient that says, I just want to pay cash. But can a person who has insurance be a self pay patient? Actually, yeah, this is the United States. If a patient says, I don’t want to use my insurance, do they have a right to do so? They do. One thing to keep in mind though, if you’re in network, can they make this choice?

Yes, but make sure the patient signs a document in your office where they’ve said it. And agreed that I understand I have insurance and you’re a member, but I do not want my insurance to be billed and I will pay out of pocket, understanding that I will not want my insurance billed by you or by myself.

In other words, they’re saying they want to be a hundred percent cash patient. Nothing wrong with that. You know, one of the reasons people may want to do that, do you know records can always be kept private? No one can get access as long as you pay cash. The only time an insurance company can get records is if they paid for it.

If you will, but if a person has paid cash, they can completely hold them out. But this could be the case where somebody just goes, my plan is terrible. I’d rather pay your cash rate. Well, nothing wrong with that. Now, this brings me to what about offering cash discounts? We’ve done some other programs with that, but you’re going to often see now for acupuncturists, something called a discount health plan.

These are not insurance. I want everyone to bear in mind, but what it does, it kind of creates your own little PPL. The patient joins this discount health plan. You’re also a member. Now you can offer them a different price. In other words, like the insurance offering a discounted rate, you can do the same.

So for those of you who want to offer steeper discounts for cash. Well, you know, you can’t unless you’re in California. But otherwise the best thing to do is maybe get into a discount health plan. The patient joins that. Now it allows you to offer like an insurance. Think of it. How is it that an insurance says you can’t give a cash discount, but yet when you join ASH, they cut your fee to a third.

Well, a discount health plan is your way of kind of doing that. You just have to make sure the patient’s willing to participate and understands it. Realize someone with a discount health plan may come to you and say, do you take it? No, not unless you remember, but this is a way that has been used to help people get care.

Particularly when they have high deductibles or have very bad insurance or no insurance, it can offer it in a way that it makes it affordable and changes it from your regular amount. And when we talk about regular amounts, what are we talking about? Usual, customary, and reasonable, UCR. This is the average amount paid in your area.

I’m going to suggest take a look in your geographic region, take a look at your Medicare rates, take a look at what you see other providers charge, and kind of get a feel for it. Am I way undervaluing or overvaluing? I’m going to suggest go back to our other video that we did on relative values. But my concern is many offices often charge below, not understanding.

If you’re going to sell a house, wouldn’t you look at the neighborhood to see what what are houses selling for? Because what if you’re going to sell your house at half the price it’s worth? Well, you’re going to sell it. But it’s way below market. You’ll sell it in three seconds. So be careful of undervaluing, but also overvaluing.

I want a way for you to look at your fees to make sure they’re fair. That’s what I do for our network members, network members who join. That’s one of the first things we do with a meeting is to go through. Let’s look at your fees. Are they reasonable? I will tell you my experience. Acupuncturists bill eight or nine codes regularly, probably up to eight or nine, six.

I’m going to tell you half of you have fees that make no sense based on your usual customer and reasonable. So what if someone says your fee is too high? If you go through this properly, your fee will never be too high because you’ll know what that fee is going to be. I’m here to help. The American Acupuncture Council is always your advocate, as am I.

We do that one on one service I mentioned. If you really want to get some help to really make your business thrive, come and see me. I look forward to seeing all of you in the future and keep in mind, we’ll be doing something later. Uh, there’s going to be new codes beginning October 1st for diagnosis. We have seminars for that as well.

Talk to you soon, everybody. Best wishes.

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Marketing Using the Four Marketing Quadrants – Michelle Grasek

 

 

I am really looking forward to talking with you about a really simple way to evaluate your own marketing called the Four Quadrants.

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, I am Michelle Grasek, the host of the Acupuncture Marketing School podcast, and today I am really looking forward to talking with you about a really simple way to evaluate your own marketing called the Four Quadrants. And before we dive in, I want to thank the American Acupuncture Council for the opportunity to speak with you today.

I absolutely love marketing, and I really believe that marketing is a great tool to help us. help more people. So it’s always nice to see you here, and thank you again to the AAC, and let’s go to the slides. So as I mentioned, we are going to take a bird’s eye view of your marketing through the lens of the four quadrants.

And this is a really nice, simple way to assess your marketing and make sure that it is balanced, and also hopefully give you some ideas for areas where your marketing might need a little work or where you’re doing well already. So let’s get right into it. The four marketing quadrants that I like to use when I’m working with marketing students and clients are searchability, Referrals and internal and external marketing.

And I originally learned the idea of creating a marketing map like this or having marketing quadrants from a friend of mine, another marketing strategist. Her name is Kate Matheson. She’s super. But the way that I approach it is a little bit different and I find that this works well for us as acupuncturists.

So what do each of these sections mean? So searchability is really about your digital searchability. How easy is it to find your business? How easy is it to connect with you and to make an appointment? And then referrals is pretty straightforward. I find that people need the least help with referrals.

That’s usually where most people’s patients are coming from. And of course, this can be from professional relationships or from current or past patients. And then there’s internal marketing, which is everything that you are doing to nurture and retain the patients that you have, as well as the methods that you’re taking to reactivate previous patients.

And then external marketing is really what most people think about when we talk about marketing. So these are. Action steps that you take to get visible in front of your ideal patients. And you really want to think about this as showing up where your patients spend time. And this could be in the real world or in the digital world.

From a TCM standpoint, a lot of people like to think about external marketing as yang, so it requires energy and activity and action, and you’re, you’re putting yourself out there, you’re trying to get visible, whereas your internal marketing you could think of as yin, It’s internal just yin, right?

It’s very nurturing and it helps you maintain what you have already built. So sometimes that helps people think about these concepts. And what I’m going to ask you to do today is to use this map to do a sort of casual self assessment of where you are putting your marketing energy already. where you think most of your patients are coming from and any quadrants that could maybe use some more energy and attention.

Okay? The goal is to have your efforts be balanced across all four quadrants and that way you can have patients coming in from multiple sources. Let’s take a look at each of these quadrants. The first is searchability, and what I’ve done in each quadrant is I’ve given you some items that you can mentally check off, okay?

And that will give you a, at least a broad idea of, quote, how you’re doing in each quadrant. And some of these activities are ongoing, whereas others might be something that you haven’t. Get established, it’s in place, and you’re happy with it, and it doesn’t need to be changed. For example, your website.

Maybe you have your website, it looks great you could just check it off, right? It doesn’t need to be ongoing with updates or anything like that, okay? So something to think about as we’re going through each quadrant is mentally checking off the different areas to give you an idea of what needs work and what you’re doing well with already.

So searchability, again, is digital searchability. So this really has two parts. One is assessing your brand presence, and the other is assessing how well you rank in a Google search. How high you come up towards the top of a Google search. So if you were to type your name or your business name into Google, probably what would pop up is any listings you have in local directories for your business, your website, of course, your Google business profile, your social media, and any ads that you might be running like Google ads, for example.

And so all of that gives you a snapshot of your brand and what it might look like to someone who is searching for you on Google. And you just want to do a quick assessment about whether you feel like this snapshot of your brand represents your business the way you would like it to. Okay. So that’s one piece of searchability.

And then the other piece is, if you Google acupuncture near me, how close to the top are you in that list? Okay. And I have a couple quick tips for you to improve your searchability. So let me skip forward here. So the first before we get into this, let’s talk about how Google works.

Google’s goal is to provide the most accurate and most relevant answer to any query that is typed in. So when someone asks a question, Google wants to be able to give the best possible answers in response so that people continue using Google. Do you remember Ask Jeeves? That was a long time ago.

With some of the old school search engines, you might type in a question, and the responses that came back might be a little odd. You were like, okay that’s not really what I was asking. Whereas, Google, as a search engine, wants to always be number one. And to do that, it has to always give the person who asks the question, the best possible answers that they find relevant.

And so everything you’re doing in the searchability quadrant is really about helping Google help you, okay? Providing Google with enough information that it knows when you are, your business is a really good answer to a question that’s been asked, okay? And one of the ways you can do that is by making sure all of your listings in the directories are identical.

And that means identical address. Phone, business name, website, and hours. And really the things that tend to, over time, not be identical are address and hours. Because we set up our listings, and then a couple years later we have totally different hours. Maybe we’ve moved. And they just don’t match up anymore.

And Google is actually very specific about your address. You can’t say that you’re in suite two on like yelp. com and then not say suite two in other listings. And I know this is quite nitpicky, but it is very easy to fix. Go into all of your listings, make sure your address and your hours are identical.

And this helps Google to know that your business is active and the consistency helps Google to know that you are active. Your business is a good response to a search query, okay? As opposed to someone whose information is random all across the web, it’s not going to have as much confidence.

returning that business as the answer to a query. Okay. And then the other thing you can do to help your searchability is to completely flesh out your Google business profile. And one section that people often ignore that can be very helpful is the Q& A section. So you can ask and answer questions on your Google business profile as the business owner, but it doesn’t show that you are the person asking and answering, because that would look cheesy, right?

It’s anonymous. I recommend asking and answering all the frequently asked questions that people normally ask or might be thinking of when they are deciding whether or not to come to you as their acupuncturist if they’re trying to decide between a couple people. And some of these questions are basic.

What is parking like? Do you take my insurance? Answer those questions, of course. And then if you have a specialty, make sure to ask a question relevant to the specialty. So if your specialty is working with kids with ADHD, for example, really specific, you could have a question be, do you do acupuncture for kids with ADHD?

And then you would answer it and say, yes, absolutely. I have this extra training. These are some approaches I like to take, etc. Because then if someone puts into Google Acupuncture for children with neurodivergence or ADHD, etc. Google’s going to say, I know the answer. I know the most perfect business.

That is the answer to this question. Okay. And then it’s going to bump you up to the top. Okay. So those two things are pretty simple, but it can be very helpful in terms of your searchability. So referrals, we’re not going to spend too much time here. As I mentioned, most people feel pretty comfortable and confident that most of their new patients are from referrals.

So I want you to think of think of it this way, this quadrant. Can you answer yes to these questions? So do your professional contacts and your patients know that you’re accepting new patients? Is that something you ever Talk about either verbally, is it written anywhere? Have you ever had that conversation with them?

And do you ever ask for referrals? And again, this could be verbally or it could be written somewhere. It could be posted in your office. The thing with marketing is we are often trying to insert an idea into people’s mind to give them a little light bulb moment later on. It’s easy to assume I run a business.

Of course, people know I’m accepting new patients. Maybe they don’t. Honestly, people are probably thinking their own stuff, right? Are they gonna make? tacos for dinner or spaghetti. They’re not thinking about sending you referrals, but if you make it a point to tell them that you’re accepting new patients, you’re looking for referrals, that process is going to be ongoing in their brain for when they have an opportunity to help you.

Okay? So I think it’s helpful to have a basic it’s a two or three sentence script that you can say verbally and the script is really unique to you, right? It’s so that it rolls off your tongue. So for example, if you love treating knee pain and you are You know, you have a patient who you just treated them for knee pain and maybe they’re only going to come back if something’s bothering them.

You could say it was really great working with you. I love treating knee pain patients. If you have any friends or family in the future who are experiencing the same thing, let me know. Please think of me. I would love to help them. And then give them a card. Okay, so you’re putting the idea in their head.

And then you can also make sure you have a sign in your office and put in your email signature that you’re accepting new patients. I’m sure you’ve seen some signs. They say things like, the getting a referral is like the highest honor from a current patient. Any way you want to phrase that is super, just so it’s very clear.

Okay, internal marketing. And I know I’m going fast. This is a lot of concepts in a short amount of time, but I really think it’s going to be helpful. Internal marketing, again, is everything that you are doing. To retain and nurture the patients you have and to reactivate old patients, because research shows it’s seven to eight times easier to reactivate a previous patient than to get a new patient.

So this is low hanging fruit, right? Keep the people you have and then reactivate the old ones. So one of the ways that you can think about internal marketing is to It’s creating a really great experience for your patients from the moment that they initially contact you all the way through their treatment and then being discharged.

So as a baseline, what I recommend is go through the new patient process yourself and see if anything feels clunky, if anything is duplicated, just try to streamline it. And then this sounds corny, but it’s really helpful if you haven’t done it in a long time. Sit in the places where your patient would sit, right?

Like at checkout, sit in the seat where they are usually. Sit in their spot in the treatment room, give yourself a treatment on the table, right? Just make sure everything’s comfy as a baseline and then ask yourself, How can I elevate this experience in a way that would be valuable or meaningful to my ideal patients?

Because if you think about the last time you were at a business or an event, and it felt really special, you were like, wow, this is great. What did you do? You probably took a picture. You put it on Instagram or you went home and you texted a friend and said, Hey, I went to this place today and it was so great.

I think you’d really like it. Or you’re talking to a family member and saying, I just had the, I went to this awesome place. Let me tell you about it. The point of this is when we say everything is marketing is that a really nice This kind of special experience makes people talk about your business, right?

They’re sharing it on social media. They’re talking about it in real life. They’re more likely to refer to you. Okay. So if this quadrant interests you, I recommend going that route and seeing how you can elevate the experience at your office slightly in ways that would, again, be meaningful to your ideal patients.

And then, just make sure you have a system for reactivating previous patients. This is actually, it doesn’t have to be fancy. The system is just blocking out time on your calendar every, I’ll say, 8 weeks. And then, going back and saying, Okay, are there any patients in the past 8 weeks who dropped off the calendar?

Maybe they got sick, they said they would reschedule, but they didn’t. And then reach out to them in the method that they like to be contacted. So if they always text you or call for an appointment, that’s how you reach out to them because that’s what makes them comfortable and they’re more likely to answer you that way, okay?

And you could be very direct and simply say, I noticed you haven’t been on the calendar in a while, I was wondering if you’d like to get back on the schedule. Or you could offer a little bit of value. And you could say, I recently read this article or this book. It made me think of you, or I thought you’d find it really useful.

Here’s the link. And then that can naturally start a conversation about whether they want to come back in. Okay. So just some things to think about for your internal marketing. And then this last section, unfortunately we don’t have enough time to go through all of these. I’ll highlight a couple, but.

The external marketing, again, is your young marketing. It is the effort that you make to get in front of your ideal patients. So we are thinking about where your ideal patients hang out, both in real life and the digital world. And so there’s many ways that you could get in front of them. And this might, what you choose might depend on your personality and your strengths, what you like doing.

If you’re more extroverted, then networking is a great choice. If you prefer writing, then content creation could be a great choice. So let’s run through these really quickly. Collaborations and educational workshops are wonderful because Hey! All you have to do is email other business owners locally that you would like to work with and just tell them that you’re open to collaboration.

And you don’t have to have an idea for how you might work together right away. Maybe you do, maybe you want to do an acu yoga class at the local yoga studio, right? But maybe there is like a florist or a garden center, and you want to work with them, you can just let them know I’m open for collaboration, I would love to brainstorm how we could work together, and usually people will say yes, because it’s a win, right?

They know that Whatever event you guys host together, you’re both going to be advertising it. So they are going to get in front of your audience, your email subscribers, your social media followers, and then you are going to get exposed to their audience. Okay. So again, it’s a win and I think it’s a really nice way to get in front of an interested local audience, people who might really become your patients.

Okay, and then other options include, as I mentioned, content creation. So this could be blogging, YouTube videos social media counts as content creation, of course, podcasting. Whenever you’re creating content, especially blogging, YouTube, and podcasting, think about it as a You are curating a library of content that showcases your approach to the medicine and potential patients could binge that library and in the process get a really good idea if you are a great fit to be their acupuncturist.

Okay, so that’s one way to think about it. Of course, there’s email newsletters, there’s leaving postcards or brochures at local businesses. I think Most people have the best luck leaving postcards at nonprofits and community organizations areas where people are looking for referrals, right? Like they often need some help and if they can refer someone out, then that relieves a little bit of the burden on them.

It’s it takes a village idea. So they’re usually happy to have your info at their location. And then there’s Classic networking, there’s getting interviewed on local media social media of course, and running ads all allow you to get visible wherever your potential patients spend time.

Think about all of these things and if if you are like mentally checking things off. You might have other marketing that you’re doing that falls under this category that’s not listed, but that’s okay. Just mentally add it and give it a check mark, right? Because there are dozens and dozens of creative ways that you can get visible in front of your ideal patients.

So if you are doing other things, not on this list, give yourself credit for those. Okay, so now you can think about each of the quadrants where what areas need a little more energy and attention. What are you doing well already? And remember that, if marketing ever makes you feel uncomfortable or you worry about coming across as pushy or sleazy, keep in mind that marketing is just a tool that allows you to reach more people and help them.

Okay. It’s, that’s all it is. And I always encourage my marketing students to first of all, know that you don’t have to do marketing that you don’t like. And, try different things until you hit on something you do because marketing requires consistency over time, and it’s pretty hard to do marketing.

consistently if you don’t enjoy it. So focus on what you like so that you can continue and you don’t feel burnt out and you can feel good about your marketing. Okay? So I hope you find this really helpful. Always. If you have questions, I would love to chat with you. I love talking about marketing clearly.

You can send me an email at michelle at michellegrasek. com

 

 

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Microneedling Your Own Face – Michelle Gellis

 

 

And today, I am going to talk about something else that I teach, which is microneedling. So you can go to the first slide. So the microneedling topic that I am going to cover today is microneedling self care.

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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, my name’s Michelle Gellis. I am an acupuncture physician. And I teach cosmetic and facial acupuncture classes. And today, I am going to talk about something else that I teach, which is microneedling. So you can go to the first slide. So the microneedling topic that I am going to cover today is microneedling self care.

Many of you have purchased a microneedling pen, either from AccuLift or from another company, and you’re using the microneedle pen on your patients, but I’ve gotten many questions about how do you microneedle? yourself. How do I microneedle myself? So today I am going to do a live demo of microneedling.

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A little bit about me. As I mentioned, I teach cosmetic and facial acupuncture classes internationally and have been doing that for about 20 years now. Before that, I was on faculty at the Maryland University of Integrative Health. I’m currently on the doctoral faculty at Yosan University. And recently, my book, Treating the Face, which is a comprehensive manual for acupuncturists and allied health professionals, is available for pre sale.

It is a 500 page hardcover book, so you might want to check that out. Information on my classes can be found at FacialAcupunctureClasses. com and information on products in my book can be found at AculiveSkincare. com. dot com. So that is my last slide and I’m just going to jump right into this demo. So most microneedle, let’s say this way, most microneedle pens come in a case and you open the case up and hopefully whatever microneedle pen you purchase comes with instructions.

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I’ll open this in a second. And then inside of the case are batteries and a cord, the pen itself, and then the charger. So I have a pen that, this is a brand new one, I have the pen that I’m gonna use, and the AccuLive pen comes with a really nice set of instructions. And these are just pen usage instructions.

These are not. Microneedling directions. The microneedling directions come in the form of a CEU, a four hour CEU. So you can check all that out. So the first thing you have to do before you microneedle yourself you have the choice. If you would like, you can put numbing cream on, but when I do microneedling on myself, I don’t use numbing cream, but I do make certain that my face is clean.

I use a scrub on my face to make sure it’s nice and clean. And I make sure my hands are nice and clean. Again, it’s optional if you want to use gloves. And then the Microneedle cartridge should, your microneedle cartridges should come in a sealed pouch and then you just peel the pouch open and you are going to take the cartridge and put it into the pen and these particular cartridges have a triple locking mechanism so they lock on nice and tight and don’t forget to take the cap off.

So I’m going to put this down for a second because just to make certain that my face is extra clean, I take a makeup remover wipe and I spray it with some rubbing alcohol. You can use witch hazel if you like. And I’m just going to work on one side of my face so that we can get through this.

rather quickly. And let’s see, I think I’m just going to work on this side of my face. So I’m going to make sure everything’s extra clean. I’m going to do my neck, a little bit of my chest, forehead, and make sure there’s no makeup or anything going on the areas that I am going to microneedle. So I’m going to let that dry.

Use a little alcohol on my hands, get them extra clean. The next thing that What I do is I’m going to look at the pen and I, when I work on myself, I tend to work most of my face at 5. You can see there’s numbers on the pen that go from zero all the way up to 2. 5. For the purposes of this demonstration, I’m going to have it on 0.

5 the whole time. You can dial it down a little bit on more sensitive areas or dial it up if you need to on, like your chin, your cheeks, areas that are a little bit thicker. The other thing is, The speed of the pen, when you purchase a microneedle pen, I do recommend you purchase a professional device, not an inexpensive device that you might get on, in a store or at Amazon.

These pens should be professional, which means they go up to 18, 000 RPMs and everything is the cartridges are sterile and proper training is included. So I’m going to set this. You can set it at different speeds and this right now is at five. It can go up to six. But, I’m going to just start around 5 is a good speed.

And,

there we go. Just start. This particular pen has memory, so if it’s on 5 when I turn it off, when I turn it back on, it’s still on 5, so I’m turning it off, putting it down, and I am going to get some serum. I have hyaluronic acid, vitamin C, and collagen serum, and I’m gonna put a little of that, and I’m also gonna mix in another peptide serum.

Let’s see, peptide serum that I have. Everything is reversed in this video. Peptide serum that I have that I really like for my aging skin. And I am just going to put a little bit on my forehead. I’m going to take my glasses off so hopefully I’ll be able to see what I’m doing. And I’m going to go ahead, and what I do is I just start off going left to just like this.

And then I’m going to go up and down, and I’m not pressing very hard at all. I’m letting the needles do all the work. And then if you have any wrinkles, like I have a wrinkle here. I’m just going to work back and forth. If you have a wrinkle here, you can work back and forth there. And the clinical endpoint is some pink.

You want to have some pink. But what I tell my students is you don’t wait until the skin is pink. You don’t keep Needling until the skin is pink. What you do is you do an area and then you move on to the next area. And if this area has not pinked up you can go back to it. But so i’m going to move on.

It’s a little pink here, but i’m just going to move on and if it hasn’t pinked up a little more I can always go back to it. Next area that i’m going to do Is on the outside of my orbital rim and I hit up my eyebrow too, but the outside of my orbital rim and my cheek. So I turn the pen on again and I’m gonna go right around making sure to get my crow’s feet.

And you want to make sure to build up the perimeter of your face. Same thing, back and forth, just like this. Aerating your lawn, up and down. Make sure you get along the perimeter. Just like this, and then any areas where you might have some wrinkles, you just work back and forth just like that.

If there were any dark spots, you just, or if there’s any scars, acne scars, any type of dark spots, Atrophic score, not a hypertrophic score. You can just dot at it, and I’m going to do my forehead a little bit more, because it’s not really getting that pink. So just get in there, and while I’m at it, I’m gonna do my nose.

It’s great for large pores. So I’m gonna do my forehead one more time, just getting in there back and forth, up and down. If you’re worried about missing areas, you can do little circles as well. It’s all good. I’m getting some nice pink there, so I’m going to move on to my nose. I’m going to go like this, and up and down, just like that.

And the next area I’m going to do is around my lips. So I’m just using one or two little squirts of serum in my hand, mixing it up. And the other thing you can use, I just don’t have one with me, is one of those fan brushes. They’re wonderful. And so now I’m going to be working around my mouth and along my jawline.

I’m really going to get those lip wrinkles. And I’m going to work around my entire mouth because I have not microneedled myself in a while. I want to make sure I get those lip wrinkles. So back and forth, up and down, getting in that Cupid’s bow. And if you have really deep lip wrinkles, make sure you spread them.

Otherwise, just back and forth, get underneath your chin, really build up that collagen in there. Up and down, just like that. Work all along your jawline, just like that.

And the next area I’m going to do is, I’m going to work on my neck.

Now the neck tends to be very sensitive, The skin is very thin, so I am going to dial it down just a little, but of course I can’t see. So I’m putting my trusty glasses on. So I’m going from 5 to 25 and now that I’m not working on my face, I can use my glasses. So I’m going up and down. I’m going to go left to right.

Really get underneath the neck

and anywhere where I have those neckless lines, I’m really getting in there, just

like that, getting up in that jawline.

And then, the next area is going to be I’m going to get on my chest. I have a lot of sun damage which is really noticeable on the computer. Hopefully it doesn’t look that bad in real life. But do my chest area.

I’m just going to do my whole chest area.

I’m going to dial it up a little more. I’m going to go so there’s a little marker here that you can see that shows you where you are. So I’m going to Right up to about 0. 5, and I’m just going to work back, forward, all the way down, my chest, all the way down, and then all the areas where I have sun damage.

And I’m going to go up and down. I already went left to so really getting my entire chest area

and then anywhere where I might have like a dark spot, like right here, I’m just going to stab at it. I’m going to dab this a little bit. And sometimes you might have some pinpoint bleeding. But just make sure, you leave it and then you can always clean it with soap and water or alcohol, but it’s nothing to be concerned about.

And then the last thing I like to do is, I do this with my patients and I do this with myself. When I’m all done,

I give it one final pass. unless I’m very red, which looks like I’m just a little pink. So I’m going to give it one final pass and I’m going to make sure that it’s on 0. 5 again.

Make sure to get any spots that I might have missed

all along. Definitely getting those nasolabial folds around the mouth and I need a little more serum. Sometimes. I’ll take the serum, and I will mix it into a little dish, and I will add a little water to it because the hyaluronic acid will attract water, and it prevents it from evaporating so quickly on your face.

Get my eyebrow, get those eyebrows growing, and that’s it. It’s very quick and simple, so you can either start at the top and work down or you could do one side of your face and then the other. When you’re done, take the cartridge and you put this in the sharps container. The very last thing I do is I have some aftercare spray, and this has aloe, arnica, CBD, and a lot of other.

Wonderful ingredients. It’s very cooling because your skin when you’re done is going to feel like you have a little sunburn and it can really cool the skin. I use it on my face, my neck, all over my chest, and this stuff is great to have around. You ever get a little sunburn, anything like that you can just use it.

So that’s it. Again, if you want more information on the class, you can go to facialacupunctureclasses. com and I hope this was useful for you. You can follow me on social. My name’s Michelle Gellis and I have a lot of useful demos on my website as well. Thank you.

 

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Food as Medicine Part 2

 

 

So today we’re going to go over a little bit of the specialness, if you will, of how TCM looks at food.

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, this is Dr. Martha Lucas, and today I am. I’m doing part two of the presentation, Food as Medicine, and I want to thank the American Acupuncture Council for this opportunity. So let’s go to our slides.

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Okay, so last time I mentioned that we, that language can cause experiences, and that a part of what our medicine can do for our patients is give them advice about food. Because food, let’s face it, food is medicine that you can take. three, four, five times a day. Also, Western medicine is looking into it too, but we have a different viewpoint of food.

So today we’re going to go over a little bit of the specialness, if you will, of how TCM looks at food. First of all, we’re going to talk a little bit about the seasons, because in Chinese medicine, food advice can vary with the seasons. Spring is the season of new birth and new growth. And according to Chinese medicine, spring is about the wood element and about liver functioning.

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And we know that some places where we live have a lot of wind in the spring, and the liver is especially susceptible to wind. We know that it regulates chi, regulates emotions, and the liver is a part of our digestive system. If it’s out of balance, then we can say that it’s attacking the digestion. So we don’t only think of spleen and stomach, but also, obviously, liver and gallbladder.

If our patients or us think that If we don’t adapt to the changing climate in spring, we may get susceptible to seasonal health problems like flu, pneumonia, or a relapse of a chronic disease or allergies. How many of our patients only in spring seem to get allergies? And I’ve noticed over the years that sometimes it’s in the more windy spring.

So there we have that relationship between the liver and wind. So we would recommend that they reduce the intake of sour flavors and increase sweet and pungent flavors, because those are the flavors that facilitate the liver to regulate the chi throughout the body. So examples of recommended foods for the spring, there’s a list, would include onions, leeks, leaf mustard, Chinese yam, wheat, dates, cilantro, and you’ll notice that we have a wide variety, like wheat is one of them.

If you have a patient who’s gluten intolerant, we need to have other options for them so that they don’t feel like they are going to have to eat some. In fact, You need to always read the labels of the herbs that you recommend to people because some of them do have weed in them. Fresh and fresh green and leafy vegetables, include those in meals, sprouts and in addition, uncooked, frozen, and frozen vegetables.

Fried foods should only be taken in moderation because, number one, the liver has a harder time digesting fried foods, and of course, cold foods are harder and harder for the spleen and stomach, or your overall digestion, to tolerate. Because remember, You partly don’t get all the nutrition if your digestion is spending all of its time trying to warm up the food.

Also, because previous to spring, sometimes people spend a lot more time indoors during winter. Then they might more quickly develop a heat imbalance in the spring. So some other symptoms people might have in the spring include having a more dry throat, bad breath, constipation, or a thick tongue coating, because those are heat signs, right?

So then we would recommend foods like bananas, pears, water chestnuts, sugarcane, celery, and cucumber to help clear excessive heat. What I do sometimes is suggest that my patients do something like put slices of celery, cucumber, and watermelon rind in water. And that makes a nice hydrating drink. Plus it’s more tasty than just drinking plain water.

So sometimes you have to be a little creative because as I mentioned in part one, We’ll call it attached to their diet plan. They’re very attached to how they eat food. So sometimes they really don’t want us to be playing around with it. In summer, plants grow fast, right? People have more energy. The body’s qi and blood become more vigorous than in other seasons.

Now, Chinese medicine can say that physiological changes make the heart over function and that there’s a little too much yang flowing. around and in the body during summer when it’s hotter. According to five elements theory, an over functioning heart restricts lung functioning. It’s advisable to eat more foods with pungent flavors and reduce bitter flavors, because that’ll enhance the lung and maintain normal sweat mechanisms in summer.

Sweat is the fluid of the heart and also the bladder and the lungs, and excess of sweating can scatter hardship and weaken the mind, according to some theories. So the person can have be more annoyed, have a little bit of depression or a lower spirit, and be restless and have sleeping issues. And this would be during summer heat.

Foods with sour and salty flavors help ease these symptoms. Now, summer isn’t the same in every region, right? I am in Denver, the high desert, so our summers our whole year tends to be drier. I might give my patients slightly different advice than Some are somewhere where it’s hot and rainy, or it’s very humid and damp.

We have to realize where we are living and. and create the plan according to that. For example, if you, in Chinese, in ancient Chinese medicine, the suggestion was to eat the food you grow. In Denver, we don’t have a really long growing season. It’s probably three or four months, but in a place like Gunnison, Colorado, I think it’s 31 days.

In some, again, you have to look at where you’re living And create the food plan according to where the patient is living. Now hot humidity, rainy atmospheres can disturb the fluid and electrolyte balance of the body. And there again, lead to lethargy, weakness, fever, thirst, lack of appetite, and even in the extreme, loose spleen.

stools. So again, looking at that’s dampness causing those issues. So foods that will help keep the body cool and balanced include things like watermelon, strawberries, cucumber. Again, you can help your patient just put those in water and create a nice hydrating cooling drink for the body. In general, The daily diet, even Western medicine says, should contain more fruits and vegetables, always, but especially at this time because they’re cooling and they can help provide adequate fluids to the body.

Now warm and cooked foods help the digestion work better because spleen and stomach love warmth. They do not like heat. Ice cold drinks. So with my patients, I like to start their nutritional advice in what I call baby steps. The first baby step is no ice drinks. So well, maybe sometimes the first baby step, to be honest, is no soda.

I recently, I’m working with a woman, one of my weight loss patients was drinking sodas every day. And so for her, the first step was no soda. Again, know your patient, listen carefully to What they usually eat, and so I might say in this case, no iced drinks, and explain to them that in Chinese medicine, and even in Western medicine, your digestion is warm.

It’s not ice cold there inside your body. So if your digestion has to spend all of its time warming up the food, you’re missing out on some nutrients. So even in the winter, sorry, even in the summer, it sounds like lots of people are like, oh, I could never eat soup in the Summer. Your warm and cooked foods help your digestive system work more effectively.

Whereas, greasy, raw, frozen foods can, what we call, damage the digestive system. And then the person might have less of an appetite, or diarrhea, or acid reflux, or some other stomach upset. In, even in Chinese tradition, in summer, making soups, you can add ingredients that help clear heat and reduce dampness and help the person’s digestion keep working well.

In autumn, things begin to fall fall off the trees and fall off stems, and, but mature, right? Remember, it’s always a cycle, right? help support good soil, and then the next year they grow again. In Chinese medicine, autumn correlates with the lung system. We have things that regulate the skin, respiration, body fluids, immunity, and can be res associated with depression.

The lungs hold grief, so if someone has grief or depression you always need to treat the lungs. Like Lung2, the translation of it is something like cloud break or release the clouds, because it’s talking about the cloud of emotion, and it could be some damp also, but the clouds of grief. Now the vigorous summer is over, and things are moving inward to prepare for winter, where we might even be more inward.

Right now, we’re going to adjust our nutritional advice for the changing seasons, because it, the weather can be drier, and again, the person might get things like an itchy throat, or a dry nose, chapped lips and You might see more hair loss in autumn and also allergies again. Now those can be really related to things like a dry nose.

So I have all of my, I ask all my allergy patients, do you do a nasal rinse? Because a lot of lung issues, it turns out, start up in the sinuses. So doing some sort of a nasal rinse, keeping your nose more hydrated can help with, help prevent things like the flu. For one thing it’s less, the flu doesn’t like moist, doesn’t like dry nasal passages, so it’s helpful to do a nasal rinse.

And we’ll need to promote because they’re going to help lubricate the body as the weather is getting drier. So nuts and seeds are appropriate, pear, pumpkin, honey dairy products. But again, remember too much dairy is cloying and damp. I had a patient who had, was growing these little, tiny little clear nodules on his skin.

They were so small, but you could feel them. It turns out he drank, I’m serious, like a gallon of milk every two or three days, ate ice cream every night. The worst thing you can eat according to Chinese medicine, right? Because it’s dairy, which is cloying and damp and it’s frozen. I suggested that for two weeks, he, cut down on his dairy and lo and behold, those little growths went away.

Dairy can be really cloying and then you can eat more food with sour flavors and reduce pungent flavors like onions and ginger and peppers that can lead to a decrease in body fluids. And then in winter things really. Slowed down to save energy, right? This is why root vegetables grow underground.

It’s like how animals hibernate and even humans might conserve energy and build spring, sorry, build strength wanting to move into spring. Now, there are a lot of people who exercise all winter, who go out all winter, but in Chinese medicine, theoretically, it’s when we’re slowing down and we’re trying to save energy.

So we want to enrich our bodies at that time. Maybe we eat a little more protein at that time. Beef, goose, duck, eggs, Chinese yam. There’s a list of ingredients that are common in Chinese dishes during the wintertime and winter corresponds with the kidney system. So it’s, advisable to eat more foods that associate with the kidney.

And the kidney’s flavor are, is salty. Its color is white. So we might choose foods like, for example, I have asparagus on the list, but maybe you would get white asparagus during that time.

Winter is also a good time to boost your natural constitution. At this time we can help. boost the constitution so that in spring the person’s chronic conditions don’t show up again, for example, allergies. We would be working on the person’s allergies during the winter time so that their body is absorbing the nutrients from those foods that we recommend so So that in spring, their allergies don’t come back.

So it’s harmony between food and weather on a more practical experience. As I said, this, some of this advice might seem to contradict what Western medicine says, or again, you’re going to have to be careful in what part of the world patients live in so that you know how to coordinate the food advice with the weather in their area.

Foods become a part of our body after they’re consumed, so we are treating the person’s body with food. Food is one of the eight foundations of traditional Chinese medicine along with other things like herbal medicine, body work, including things like gua sha and twina, and of course acupuncture, which is the most well known therapy in Chinese medicine, but A knowledge of food energetics can deeply supplement your ability to help your patients.

This next section, we’re going to talk a little bit more about how to work successfully with food with certain conditions or procedures that your patients are going to have to go through. Because the stronger our digestion is, the better we are able to tolerate, The food we eat, we’re better, we are better processors of the food.

If we have to have a procedure, for example, a surgery, our immune system is going to be stronger because our digestion is our earth element. It’s the core. Everything surrounds the digestion. So trying to make our patients have good digestion or improve their digestion is going to help everything, including their skin.

And remember, if they’re going to have something like a procedure, they’re likely to start worrying about it or ruminating about it. And we have to help them with that also, because As we know, worry actually makes the digestive pulses go backward and then back toward the kidney, what I call attacking the kidney.

So something like worry and ruminating, we really do need to help our patients with that. So for example, before a surgery, I recently had a patient have surgery for breast cancer, so I always tell my patients you need to come in before your procedure and then after your procedure. Before your procedure, this is what we need to do.

Build up your system, your digestion, build up your immune system, because surgery is really it’s, Even though the person may need it, it’s a quote unquote good thing because they’re having something like a cancer removed. It’s still going to potentially create some negative impact on the body. For example, stagnated chi.

So we want to get their immune system working. We want to help them with some ideas. Don’t mix food and work. In other words, pay attention to eating. Chew well. That’s how you get nutrients out of your food. Stop before you’re full. Let’s cut down on cold foods. No diet, no soda or diet soda I have down there.

It just has too much sugar and chemicals in it. So helping them work with their digestion before their procedure looking at, Are they cold? Do you need to add warm foods to their diet? Do you need to warm them up before their procedure? If they’re yin deficient, now, here’s this woman was She’s in her 60s, so probably yin deficient.

If they’re going through, they’re elderly, going through perimenopause, or they have issues with yang rising like headaches, then you need to add yin strengthening foods to their diet. Like I love sea plants for that. And so keeping them looking at what’s going on, getting their digestion stronger before their procedure.

Chi deficient patient, you’re going to, number one, recommend fresh air and exercise. Those are actually good recipes for your chi deficient patient. Obviously, they might need to start slowly, but that’s okay. Fresh air and exercise are good for them. They can make an oat porridge. You can recommend qigong to them.

You’re blood deficient patient. Now they’re going to be blood deficient after surgery. So this is why they need to come in before and after surgery. So we might have some post op recommendations for them too because they need to build blood again. So foods that are chlorophyll rich Of course, meat has blood in it for your vegetarian.

They can use things eat foods like beans. And then blood is particularly weakened by sugar. So trying to get people to cut down on the amount of sugar in their diet, plus we know too much sugar negatively affects the spleen, right? It’ll start to create dampness. The spleen is, Its flavor is sweet, but it doesn’t like too much sweet.

And then looking for people who have phlegm, right? Now they might have acne, right? Acne is absolutely can be a damp issue. It can be a heat issue. That’s why we not only need to treat it topically, but we also need to treat it internally. So you might have them reduce things like dairy products if you know that they have too much damp in their bodies.

Foods that can resolve dampness are adzuki beans, barley, celery, radishes, seaweed, and garlic. And remember, some of these foods have more than one property. Most of them do. Looking at that helps. If a patient’s going to surgery, they’ve had surgery, they’re going to have chemotherapy, they’ve had chemotherapy, food is a great way to help treat them.

Boost their immune system for chemotherapy, you always need, also need to make sure that you’re helping reduce the toxic heat that’s affecting the kidneys. And then, boost their immune system, get their, reduce mucus, if they’ve had chemo chemotherapy. Analgesia, which they have for surgery.

You want to help the liver process all that. So there’s a lot to do post surgery. Boost their immune system with cruciferous vegetables. Garlic has antibiotic activities and inhibits viruses. So that might be helpful for them after their surgery. Deep water fish are rich sources of omega 3 fatty acids.

And seaweeds, of course, for overall. Immunity boosting. Almonds have a lot of amino acids and essential fatty acids. Ginseng and chicken is a great combination for people recovering from surgery, childbirth, or prolonged illness. And then improving the digestion, you can use things like ginseng licorice tea.

And ginger is, of course, great for the digestion. Oats strengthen digestion and build qi. Omega 3 fatty acids are important for immune function, brain development, and treating malnutrition. And then also another source of omega 3s is alpha linolenic acid. And this is in vegetable oils, flax seed, pumpkin seed.

A lot of things we can do for our patients. after and before surgery. Have them add dark green vegetables. The western diet really doesn’t include enough omega 3s, so anything we can do to help people get those into their bodies is important. As I said, sugar, they need to cut down on that. Especially processed sugar.

Natural sugar takes longer to digest in the body, just like whole grains, but we need to have them reduce their sugar because it can actually damage the digestion and the immune system. Also, too much processed sugar contributes to herpes outbreaks, PMS, nervousness, and irritability. So the best source of sweetness for our patients are foods like sweet potatoes, natural sweeteners, instead of allowing them or giving them good advice on why not to eat too much processed sugar.

And then the post surgery diet can include a lot of things I’ve said, grains, vegetables, seaweeds supplementation with fish for essential fatty acids and then a little more So we can get the toxins out of their body. And finally, to treat arthritic or rheumatic conditions, avoid excess meat or protein, alcohol, tobacco, coffee.

Again, refined sugar, all of those can lead to having a little more pain. And Some say nightshade vegetables can increase pain, and then I have down eat fresh goat milk because it’s a more digestible fat and has a broader mineralization, but barley and wheatgrass, anything that’s anti inflammatory and detoxes, for example, I have that.

arthritis and rheumatic conditions can be treated well with the post op diet that I just mentioned. So there you have advice about using food as medicine. It is one of the basic standard traditional Chinese medicine therapies that we can help our patients with. And again, this is Dr. Martha Lucas, and I want to thank the American Acupuncture Council for allowing me to share this information with you.

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VA Community Recoupment

 

 

In fact, I’m sure a number of you have heard about what was going on with the VA community care and doing recoupment for some billing that you’ve done for cupping.

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

Greetings friends and colleagues, welcome to another episode where we’re going to give you help to get paid to make sure you’re not paying anything back. In fact, I’m sure a number of you have heard about what was going on with the VA community care and doing recoupment for some billing that you’ve done for cupping.

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So let’s go and go to the slides. Let’s talk about this. What’s going on and what’s happening. I’ve got a lot of good news and I’m really happy to share that with you. So obviously a lot of you are treating and billing for VA patients. They are great patients. They need a lot of help and it’s the one insurance that does cover cupping.

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So you can bill with cupping and we have been billing with the unlisted code having no problems. However, something came up. I had an office that came to me and said, Hey, Sam, I’ve got a problem. I received a request for recoupment for billing 97039 for cupping and the indicated dates all the way back to 2022.

And I thought, Hmm, okay, interesting. But I thought, how much are they asking for? And I kid you not. This particular office was a heavy, heavy VA office and they’re wanting close to a hundred thousand dollars back. Now you’re thinking, how can that be possible? Well, let me tell you, they treat a lot of VA patients and they paid pretty well for cupping.

That’s what they were coming back for. So there was obviously a lot of panic. Wait a minute. How can they come back? And ask for something they’ve already paid for. That was really part of what we were doing. So in the VA, they have something called the standard episode of care specific to acupuncture. And what these are, are a listing of the services that you may provide an acupuncture patient.

Without any additional authorization, this includes E& M codes, lots of therapy codes, it even includes laser now, but it also includes codes for cupping, and before was codes that listed unlisted. So this is a very current one. You’ll notice this one is dated April 9th of this year, and you’ll notice I’ve highlighted in red the codes that they are allowing, and you’ll see here the first one that’s for laser, But it’s got dry needling.

It’s got 97016. By the way, that is the code you should be using for cupping, 97016. And you notice you just go along manual therapy. And of course, all the acupuncture codes, what you’ll notice is missing. is the code for 97039, the so called unlisted code. It’s an unlisted modality, and many people had used it for cupping, and I certainly recommended it.

It paid well. It just allowed you to describe it as cupping, and we were paid for it. Now, again, you’ll notice this is the most current acupuncture authorizations. You’ll notice, again, conspicuously, there is no 97039. or even the 97139 which is again unlisted codes. Well that’s what they’re coming back for and you notice for each of them whether it’s going to be the initial care plan or the follow ups for chronic care even you’ll notice it’s missing.

However once I received this I said hold on a minute This cannot actually be correct. And the American Acupuncture Council, because of course, a lot of you are insured through them, we began to work in the background to say, this is improper. So we got the attorneys involved, myself as the coder, and we said, wait a minute.

We went back and researched and specifically the standard episodes of care that they’ve published through the, uh, VA from 2021, 2022, and 2023. did indeed list the code 97039. So being it’s part of the standard episode of care and it was allowed during all phases, whether initial continuation of care or chronic care, it was there.

So now they’re coming back saying, well, we know we published a code, but we’re saying we shouldn’t have had it and we want the money back. Well, that certainly doesn’t seem to be proper. So what we did, the American Acupuncture Council and myself is to start to have our providers respond back to them with this letter.

It says, I received a refund request for 97039. And it dated all the way back to dates of service from 2022 as being overpaid. And we’ve researched it. The schedule, the standard episode of care specifically shows from 10 18, they all allowed this code. Now I will keep in mind that they did eliminate it.

And I think this is where the problem began. Because it was eliminated in February, they said, Hey, we’re going to go back and look prior. Well, you can’t. Obviously, if you build 97039 after February 23rd, technically that would be improper. And they could recoup it, but any dates prior, it was part of the standard episode.

So, per the published guidelines of the VA, it says, repayment appears improper because the code was in the SEOC, we identified it as cupping, and per the guidelines, when there’s no specific code, Because even the code I’m recommending, 97016, doesn’t actually indicate cupping. It says vasonomatic device, which would technically be correct.

But you could use either, and they were paying it. So we’re pushing back, saying, well, there was no overpayment because the code was properly identified as an unlisted service and the dates of service for the code should have been paid. We, in fact, even went further and talked about recoupment in that when an insurance pays you for something that they later determined was paid improperly, Even if they shouldn’t have, case law says that they can’t go back for it.

And so really we pushed back in a lot of ways. So everyone panicked. I said, hold on, let’s see what’s going to happen. Well, about a week ago, actually a little over a week ago, this was Optum’s response. It says Optum’s claims department worked on a special project intended to remediate historical claims logic concerns, which impacted unlisted procedure codes.

Although our analysis of the Unlisted Procedure Codes is ongoing, the current recruitments are in the process of being voided. So all those ones they sent letters, now being voided. If they haven’t, go ahead and push back. We sincerely apologize for this inconvenience this has caused and appreciate your patience as we work to void these previous specific recruitments regarding the Unlisted Procedure Codes.

Additional communications will be coming. So in other words Oops, we made a mistake. That’s why often be careful. And that’s really why we do the network is to be there to help with this type of issue. When someone joins the network, not only do you get seminars, but you get this type of help. Quite frankly, this doctors, this office that had this issue.

Literally paid for a hundred years of the network based on what we charged, based on what was there. And realize though, network members, we’re going to get it to you first, but always know that we’re going to be here to support. If you had went to our website, which is the AAC Info Network under News, on July 25th we posted this.

So I want everyone to kind of calm down and say, wait a minute. The unlisted code should have been paid because it was part of the standard episode. From this point forward, do not use 97039. From February of this year, cannot. Now, for those of you that attended my VA seminar earlier this year, you heard this information.

You knew it was changed, but again, they can’t go back and recoup. As always, we want to be your advocate because Your success is ours. The American Acupuncture Council is really your partner. We’re always here to help. And that’s why we do the network where you can work one on one with me because members, I gave them this letter directly.

So if you’re a member. of our AAC Info Network. Now not insured, insured is your malpractice, but members of the network, if you’re still running into this issue, just reach out to me and I’ll send a letter to you. But I’m going to highlight this is going to be for members only. For others, you may have to go back and read it, but it falls in the same category.

Our goal, keep you going, keep you doing what you do well is to help people. And when people want to come after you, we’re going to be your line of protection. Until next time, everyone, this is Sam Collins.

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