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Acupuncture Malpractice Insurance – Are You Ready to Request A PPO Rate Increase?

So is there a way? To request or to get an increase in a PPO rate, because if you think of it, they never do it, but is there an opportunity to do yeah…

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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, my friends. This is Sam Collins, the coding and billing expert for acupuncture and for you, but the profession as a whole. Thank you, American Acupuncture Council, for the opportunity. But let’s get into it. What’s going on, particularly for the first of the year? You’re always thinking business, money, pricing, and many of you have joined these HMO slash PPO plans and may have been in them for years and are noticing them.

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I’m getting paid the same thing, year after year, and at some point that becomes unsustainable. So is there a way? To request or to get an increase in a PPO rate, because if you think of it, they never do it, but is there an opportunity to do yeah, I will certainly say I’ve had offices that have had success in getting rate increases for PPOs, but there’s a way to do it that I think will lend to potentially having more success.

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This is no guarantee, but potentially more success in getting a rate increase. So let’s go to the slides. Let’s talk about that. What things do we need to do? To help ourselves request a rate increase and really get one, it comes down to making sure you create really a value opportunity about your office.

I want you to write a letter to them and request specifically an increase, but by writing a unique value proposition that makes your practice stand out. Maybe where you’re located. Okay, it might be an underserved area. Those types of things are helpful, but more than anything, always go by what’s your status within the plan.

Show your value. I’m sure many of you have heard of the company ASH or one similar, and you can rise in status from Tier 1 to Tier 6. Obviously, the higher tier status you have, The more prestige you have in the plan, and that creates more of a value. They want to keep those higher performing providers, and if you are one of those, that certainly makes it much, much better.

You want to also focus in on your utilization. Bear in mind, we do understand these plans raise your tier by not over utilizing care. That doesn’t mean you shouldn’t do the care that’s necessary, but be mindful, they’re not expecting everyone should get 20, 30 visits. They’re expecting, actually, an average of about 8 visits per patient.

And what that means is, you’re going to have some patients that you might see 20 times. They need it. There should be a balance with maybe seeing some of them two times, so that average comes in. Realize, don’t let one patient plan set it up, but the average over time. And if your numbers are lower, you can show that.

You would point out, heck, my average is six, let’s just say. You want to also highlight, what about the number of providers that might be in the region? Some areas are very underserved. Particularly now with the viability of acupuncture, the VA and all these things, they’re looking for providers. And if it’s an underserved area, that’s going to help.

But even if it’s over served, if you will, there’s a lot of providers. Where do you stand out? Your availability, your location, your hours. Your languages you speak. What if you have multiple languages? I would highly recommend if you have multiple languages spoken in the office, it should be brought up.

Do you speak Spanish? Do you speak Tagalog? I mean think of any type of language. It’s gonna be helpful to create access because that’s very important these PPO plans always creating access. Make sure you also point out their value Compared to other existing contracts. Other plans you’re part of, but I would start with Medicare and Workers Comp.

My goodness, even Medicare for two sets? When you look at the Medicare rate, it allows 70. Workers compensation is usually a percentage of that. Usually anywhere from 120 to as much as 200 percent of Medicare. So therefore, you want to start to use that to say, how is it a PPO thinks they’re sustaining when they don’t even meet the value of Medicare?

And Medicare is the low end. ASH is going to pay many acupuncturists 40 to a visit, which is literally one set, even for Medicare. And if there’s two sets for Medicare, you get 70. So it’s probably unsustainable, and it’s not reasonable, really. Because you have to look at inflation and cost of practice.

Don’t be afraid to bring up about your own specific issues in your practice. What does cost more? Certainly, when you first started practicing, your rates have increased. I’m looking at rates of rent now, which are through the roof. Could that be sustained? Look at gas, the cost of phone and internet, all those things are part of a practice and cost.

So you have to make sure that you’re creating all of that with the window to show your value and unique value to that plan of how you’ve helped people. Don’t be afraid to get a few testimonials from patients of how you’ve helped them. Make sure there are ones too that the patients didn’t have something where they needed hundreds of visits to.

But nonetheless, those types of things are going to be helpful because an insurance company has a vested interest. and making their clients Happy. You want to show that’s what your job is and what you have done. So here’s a way to focus that. This would be the highlights of how to put together some type of proposition or letter to the carrier.

And you can point out, I’ve been a panel provider since say 2015. For some of you, it might even be longer. I support the development of managed care in acupuncture because it helps to standardize documentation, promote evidence based care, and create greater accessibility. We want people to have access to get acupuncture.

We do. But we’ve got to make sure in doing so, we have to have a reasonable amount that’s paid to us to sustain it. You’ll highlight to them there’s been no significant change in reimbursement from your plan, and I’ve been a member for decades maybe. These days, I’ve increased costs. Staff salaries, rent.

Think of the work we have to do now with electronic health records, electronic billing. All the costs that are there. A lot of these plans require you to bill electronically. That doesn’t happen for free. Therefore, that’s got to be brought in. Software contracts and so forth. Not to mention your rent and the other things that go with maintaining your practice.

And frankly, the cost of other things. Cost of gowns. Cost of needles. It’s all increased. You’ll highlight to them, my overhead is nearly four times of what it was when I enrolled with you. My average cost of seeing the patient now is 41 a visit before there’s even a profit. So some of these plans are paying as little as 40.

So you got to think, wait a minute, if my cost is 41 and I’m getting 40, does this make any sense? No. Can you imagine every business just exactly makes what their actual costs are? You can’t stay open. There’s just no way. So this level of reimbursement is not a sustainable model, and while being on the plan to create a greater volume of patients, there’s still a limitation.

Let’s face it, an acupuncture visit is typically 30 to 45 minutes. How in the world can you sustain a practice where you’re getting paid? Less than 80 for an entire hour of work, maybe an hour and a half, and then going to be able to maintain that practice to be open. Think of just what you’re paying per square foot.

In some ways, I would argue we might be better off working at Starbucks or Panda Express, considering some of those places pay 40, 000 to 80, 000 a year. For a full time worker. Come on, as a healthcare professional, they can’t have rates that are at least sustained at that level. So you want to start to point out that hypocrisy by pointing out the rates for your insurance have increased to allow the plan to remain solvent.

I get that. Has insurance companies increased the rates to their insurance every year? I know and I redo my insurance every September. There’s been an increase every year I’ve been in there. However, are providers part of this increase? Isn’t it interesting how insurance companies typically say we’ve had to increase the rates because of the increase in cost.

And I agree, there’s an increase in cost. Where isn’t there an increase in cost? What provider is still getting the same, paid the same amount they have for years? So in reality, the provider costs are flat. Yet, they get all these raises to do what? Now maybe that’s to cover drug costs and all that, but at the end of the day How could they say we’re part of an increased rate when they’ve not paid us any more money?

They’re thinking you just can see more people. How could we see more people if it takes that much time? So it’s unreasonable for providers to bear this cost with no consideration, while the plan has increased their premiums and the adjustments in pay to their workers. If you work for these plans, I bet many of them, if not everyone, get some type of adjustment yearly, 2 to 3 percent.

I’m looking at least for that. I would think if you haven’t had one in a while, what about a 10 or 20 percent jump for this year? Because to sustain it in this way at some point just cannot be sustained. In my observation, healthcare services are the cornerstone of this business and have been left out.

I’m requesting if you’re getting per diem or even if it’s per service, a certain request over that, which will allow me to continue to welcome these patients to my office in the future. Because without an increase, I will no longer be able to sustain the relationship. Let’s be reasonable. It just won’t.

In fact, I’ve had a lot of offices that realized that it was a sum negative and they’ve dropped out. And this is someone I spoke to last week. This is not an exaggeration. They pointed out that they dropped out of one of these plans and they first were very panicked because they thought, Oh my God. And they go, Oh my God, Sam.

In the first two months, they lost 30 percent of the patients. But here’s what they realized. They lost 30 percent of the patients, but that only equals 6 percent of the revenue. What does that tell you about this plan? How bad it is? All this work and emphasis. Maybe it’s not worth it. And this is something that you have to start to look at as a business decision.

There’s nothing wrong with being part of these plans if they’re at a sustainable rate. But if they’re not, maybe it is time to move on. And this is what we look at. If they can’t sustain it, then let’s move elsewhere. Don’t be afraid to make a move. Don’t be afraid to request. Because at the end of the day, the power is with the providers if we wield it.

And don’t be afraid that ultimate power is your patient. And if that patient is still coming in without the plan and paying a fair rate, why would I push for this thing where I’m getting paid 25, 30? So do be careful, but I’m not saying not to request, not to do it, but at least this way you’ll know where you stand.

And if they’re treating you that poorly, maybe it’s time to move on. Don’t be afraid to break a relationship that relationship does not have mutual parts that are beneficial to both sides. And that rate increase to us, I think is important and without it, maybe we can’t stay there. So don’t be afraid.

I wish you well, as always, the American Acupuncturist and myself are always there to help our service. The network is a place where you can go and work with me one on one to really write up a protocol like this. I really wish you all well, continue a good practice and enjoy what you do.

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Acupuncture Business Insurance: Things to Consider When Choosing an Insurer

As an alternative treatment, acupuncturists stand at a higher risk of exposure to malpractice complaints compared to other types of businesses. Such complaints can come from any of the clients. Thus, a protection that shields an acupuncture business from these complaints should be in place.

Acupuncture business insurance is the answer for every acupuncture clinic’s protection needs – regardless of business size. If you are running one, it should be there in your to-do list. It provides the protection you need to ensure your business (and your professional reputation) is okay should a client file a complaint against you, claiming malpractice.

Now, the question becomes: how to find a reputable/trusted acupuncture business insurance provider. While there’s no definitive set of guidelines, you should consider the following criteria:

Experience. One of the indicators of how reputable an insurance provider is is the number of years they have been providing the acupuncture service. A company with decades of experience (like the American Acupuncture Council) means it has weathered the market’s ever-changing climate; it thrives even when the market is unfavorable. The length of years in the industry has polished the processes of experienced insurers for better services.

Insurance coverage. Of course, the insurance package inclusion is another important factor when deciding which acupuncture business insurance to choose. For acupuncturists, malpractice insurance, professional liability insurance, premises liability, worker’s compensation, and business owner policy are the top coverage areas to consider. See to it that your prospective insurance provider offers these coverage options.

Financial stability. There are several ways to assess whether or not a company is financially stable. For instance, you can look into their assets and ask for a copy of their annual report or financial summary. You can also check on complaints or problems through your state insurance department. And you should also find out how many insurance claims they disbursed money for in one business calendar year.

Reviews. Lastly, do not forget the power of word of mouth. Read what their previous and current clients say about the company. If negative reviews far outweigh the positive ones, you have a compelling reason to cross out that particular insurance provider from your list of prospects.

Are you looking for a reputable acupuncture business insurance provider? Look no further than the American Acupuncture Council. Call us at (800) 838-0383 for inquiries.

Acupuncture Malpractice Insurance – The Concept of Yin Fire in Pediatrics

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Hello. I am, , Moshe Heller. , and I am from Moshen Herbs on one hand and also representing Jingshen Pediatrics, which is a, , , organization that, , teaches, , , classes on. Pediatric treatments in, , in ACU with acupuncture. , and I’d like to thank the American Acupuncture Council for having me today and, , helping me host this.

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, very interesting talk about the concept of yin fire in pediatrics. So, , let’s start, , can we. Turn on the slides. Okay. So, , , I’m gonna be talking about this idea of yin fire. , and before I actually, , would like to discuss that, I wanted to, , bring your attention to the idea. That, , comes from, , pediatric acupuncture.

And, and I’m going to, , talk about, , this for a second before we go into yin fire. And that is, , an , , , , a concept that actually comes from Julian Scott, , from his book of the treatment of, , pediatrics in with acupuncture, , that there are five. Common patterns of disharmony in children. , and the reason I’m pointing, , to this idea is that there’s some, , , correlation or there’s some,

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Similarities between the ideas that he kind of presented, , presents, , in his book and the concept of yin fire. And we’ll see how that correlates in a little bit. But, , I want to remind to kind of discuss these five patterns as, , as, , as sort of like a a, an introduction. So these five patterns include, , a regular spleen G deficiency, , type.

, and that’s the, , , usually, , seen in a deficient type. . , patient, , pediatric patient. , usually they’ll have digestive issues similar to the same concept of having a spleen cheat deficiency in, , your adult, , patients. And that, that I don’t, I. I think I don’t need to, , explain too much. , hopefully everybody knows that.

, the other pattern, the next pattern is a lingering pathogenic factor, and that comes from the idea that children are more susceptible to pathogenic factors and. More so they are more susceptible to having these pathogenic factors linger and continue to influence them, , further than just, than, , the initial invasion.

The other three. The next one is called hyperactive kidney deficiency, hyperactive spleen, G deficiency and accumulation disorders. So these three are the ones I want to kind of point out because there are, , similar in, in that there, there is this kind of. The similar idea of yin fire, where you have a doll, , or a a, a rooted deficiencies condition that creates, , excess like symptoms.

And that’s at the root of yin fire. And that’s why I wanted to point out these, , three, , patterns. Also the hyperactive. Kidney deficiency and the hyperactive spleen deficiency both. At the root, , you will see signs of spleen deficiency are classical signs of spleen deficiency, coupled with a lot of behavioral excess meaning, , difficulty falling asleep.

Being hyperactive in their, in their behavior. , , kids that seem very, , , excessive and sometimes difficult to control. Although, , at the, at the core, they are presenting with a spleen deficiency, signs and symptoms, the accumulation disorder. Is classically according to, , Julian Scott, more of an belongs to an excess type.

But really I’ve seen a lot of accumulation disorder in my office that are deficient. Patients with the accumulation or these, these kind of accumulation of dampness and in particular, , that, , manifests as. , excess signs and symptoms. So I just wanted to, , give that as a, as a introduction, , to the, the idea of, , of yin fire because I think it’s not totally foreign or it’s not completely new, , in that type of thinking.

But, . Let’s talk about yin fire and, , just wanted to point out that, , the concept of yin fire was, , , discussed first by, , li Don Yan, , who wrote the book, , the P Lung in 1249. . In there. You know, we all know that, , li Donan was this, , , famous Chinese doctor who, , developed the idea of the spleen and stomach stu , school, meaning that he believed that a lot of, .

, disorders or most disorders were created or stem from this, , spleen, chief acuity. , and, , and , and in his discussions he discussed the idea of yin fire, which is, , again, , this idea of spleen vacuity at the core and then having. Which we’ll discuss, , what that means in a little bit. , and this idea of Li Donan was discussed, , and debated in many, I import by many important Chinese doctors throughout the years.

. And actually has gained more attention in today. I hear a lot of practitioners talking about Ian Fire. , not, , you know, recently and a lot of, , lectures and, and discussions, which is, , very interesting. And, , the reason I think it’s becoming very popular is because it’s actually. Can be an explanation for many chronic diseases, , or disease that are a mixture of a mixed pattern of excess and deficiency, , in combination.

And we’ll see how that works. , well in, in, in a, in a little bit. , but it’s, it’s, it’s actually, , although you see all these. Excess signs in, in the forefront because the, those are more, , clear. , the right treatment principle is a principle of strengthening and resolving the, the, the main, core idea of this deficiency that’s causing the excess like symptoms that are not really excess.

So, , I’m going to, I, I brought this excerpt from, , from the p , which is the opening, , , con, , , paragraph, , sort of defining what Yin fire is, and it’s, , translated by Lorraine Wilcox, , , which, , provides a very. Good translation in this. You can find, , her article about this, , translation very easily.

, , so let me, , read this, , because I think it’s really important to understand what is said here. So, . , and it starts by talking of, , saying this, if eating and drinking becomes irregular or cold and worth, warmth are inappropriate, the spleen and stomach becomes damaged. So the first sentence we see that the causes of this imbalance, the causes of this balance of, of, of, of the damage of spleen and stomach come from.

, diet basically says it’s either diet, , or inappropriate exposures to, , warmth and cold. , and the diet is, is, is really a very important, , aspect of that. And we have to, . , to, , you know, I, I wanna point out, , before moving on, that, that is, , at the core of, , the treatment pri principles.

When I see, when I recognize infire diet is one thing, I have a very long discussion with my patients, with the parents and the, the children, depending who I’m treating. , about regulating diet and not so much. Not as much as, , I put as, as much as emphasis on. The scheduling and how you eat and, , enough, , chewing and not swallowing, , your food, but chewing it and giving it time and having, , and eating in regular schedule, , as part of this kind of healing of the spleen and stomach.

So this is a very important aspect that, , that we need to pay attention to. Then he goes on on saying, or joy, anger, anxiety, and fear can also consume original qi, or it’s called, he names it as Yuan qe. And here we have to be. And , Lorraine also, , . , points out that when he, , when he call what he calls Yuan Chi, we have to be careful not to, , confuse that with what we call yuan kidney Yuan or Yuan Source.

It’s a different, this Yuan Chi is very much associated with what we might call the chin chi or the clear chi that comes out of. Digestion, right. So, , after, , Gucci is derived from the, the, the, the food and drink it is. Trans and it is connected with the, the, the, , the, the chio, the chi of the air. , it becomes this kind of, , yuan qi and it actually, , is associated with the lower Jiao.

So it’s, , it comes, it’s connected also with some, , of the kidney. , . Kidney. So, , it stems from the lower jaw and goes up to the upper. So, . That’s the Yuan Chi that we’re, we’re, we’re talking about in this case. Once spleen and stomach chi has declined and original Q has become insufficient, the only thing that is abundant is the pathological fire in of the heart.

So in a sense, this, , clear q, , allows the balance or allows the, the, the balance between. , that and heart fire. So once they are declining, , the fire in the heart becomes, , pathological. And this is, this heart fire is yin fire, which arises in the lower J and connects with the heart through its system.

So, , this whole system has to do with the relationship of the pericardium and the Tial fire and, , and it is associated with this kind of movement of qi. And so I. Of, of movement, of qi up and down and, , in our body. And therefore, , a lot of this yin fire is associated with stagnation, stagnation of qi.

So we’ll see that also in a little bit. So Minister Fire Min, minister Fire is the fire of the Lower JAO and the bau. There’s a whole discussion what BAU means, , which we won’t go, go into. , . And once that Tal fire is this, it is the thief of original Qi fire cannot coexist with the original qi. One of them will become victorious and the other will be defeated.

So we see this kind of mechanism that’s, , that’s described, which is . Which I want to sort of, , , in the next slide, I’ve sort of created this, , visual, , , presentation of it. , if we have the lower, middle and upper levels here, , this TAL fire should be, , coming down from the heart and placed.

, under the, , under the pot, if you say, of the spleen and stomach. , So the yanchi, , is also arises from here and, , and is in part of the process. But if the menstrual fire, , is misplaced, it creates, , more heat. If you can imagine this kind of menstrual fire as being the fire under the pot, if the fire is sitting aside from the pot, it brings up, , heat that harass, that can harass the heart.

And so, you know, as the spleen and stomach, , supposed to, , raise the spleen is supposed to bring up the chi to the chest and the stomach riping and rotting and, . It is supposed to connect with the lung chi to create Gucci. And then this is sort of the source of our postnatal chi and also the source of having a very strong and balanced ying chi and way chi.

, so as we can see here, this is all, , once this, there’s an imbalance here. It affects our ability to. , have a balanced immune system. It has, , a, a, a a very, it will affect the mechanisms of our own energy so that it will be very imbalanced and, , and, , if we understand this path of mechanism, we can understand and, , and see it in our patients much clearer.

So I want to just, , also point out that throughout these discussions and development, there’s actually a lot of, . Different. So, yin fire is not one thing. It’s actually a concept. And, , and, and in an article in the JCM, the Journal of Chinese Medicine, , called, , an Introduction to Chinese Medicine Concept of Yin Fire by Sean Randen.

, he writes this, , it’s a, it’s a great article and I, , would recommend reading it. , but he talks about this. The concept of Yen Fire has been discussed and debated through the history of Chinese medicine, and he brings this, , modern auth author from 2007, Leo Tu, who classified Yen Fire, according to four different categories.

. One. , the one of them is the, , what we, he calls occlusive exclusively Q deficiency, , yin fire as described by Lee Donan, you know, in his, in his book. That’s. Currently discussed, but he brings three more aspects of that. One is more, , , issue of XY and mostly this kind of XY cold, xin cold that, , actually the cold creating fire.

So he, , talks about the sea and fire created. From kidney cold. So this, again, this, we, you know, we can see this concept of dull , patterns. So a mixed pattern, cold and heat or deficiency, and what seems like excess. Also, , the other one he discussed is called Kidney in Deficiency, creating Fire. That’s a more classical part of that, but as it as this, if this fire is harassing the heart, that’s when we see yin fire in this case.

And the third one has to do with liver, gallbladder cheese stagnation causing depressive. Heat or fire, , also harassing the heart. So again, I just wanna point out in by this, , is that there’s a broader concept of yen fire other than just, , what we’ve just discussed.

So this is the end of part one of, , the concept of yin fire in pediatrics in part two. I’m going to be speaking about how does yin fire manifest in pediatrics more specifically.

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Acupuncture Malpractice Insurance – Facial Motor Point Use for Cosmetic Applications Part 2

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Hi, my name is Michelle Gellis and I am an acupuncture physician who teaches facial acupuncture classes internationally. Today, I will be presenting part. Two of a lecture on using facial motor points for facial concerns, and if you would please go to the first slide.

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This is a list of the different classes that I teach. They are all recorded and on my website, and today we will be going over some of the. Topics that I cover in treating neuromuscular facial conditions and some of the advanced techniques from my facial acupuncture class.

Today’s talk focuses on facial motor points. Last time, if you missed part one, I talked about using facial motor points for cosmetic applications. And today we are gonna be talking about so cosmetic applications like, Crow’s feet or frown lines. But today I am going to be talking about using facial motor points for a couple of different types of neuromuscular facial conditions, and the two that I’m going to discuss today are Bell’s Palsy and Ptosis.

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But first I wanna review quickly. What is a motor point? If a muscle. Is not functioning properly. Using an acupuncture needle and putting it into the motor point of the muscle is like a reset switch and it will bring the muscle back into normal functioning. Because on our face, the skin is attached to the muscle.

Using the motor points on the face can help the face to not only look, differently getting rid of tension and wrinkles and lines and folds, but it can also help the face to function properly so that if someone has some sort of a neuromuscular facial condition, using the motor point can help to resolve that.

A motor point is different than a trigger point. A trigger point is like a knot in a muscle, whereas a motor point is, so if this is your peripheral nerve, you have your sensory nerve, and then you have your motor nerve, and the motor point is where the motor. Attaches into the muscle. It is the most electrically excitable part of the muscle where the motor nerve is attached.

The face has two nerve branches that are in charge of the functioning and the sensory of the face. So we have the trigeminal nerve, which is. The fifth facial nerve CN five, and that takes care of sensation. And also mastication, it connects to your massacre, the facial nerve which is CN seven, cranial nerve seven.

Helps the functioning of the face, so your facial expressions and also taste. So you can see the two different nerves. We have the facial nerve and the trigeminal nerve. And the trigeminal nerve has the ophthalmic branch, the maxillary branch, and the mandibular branch, and the facial nerve has five.

Branches, the temporal zygomatic, bcal, the mandibular branch, and then the cervical branches which go down to the platysma.

The first neuromuscular condition we’re going to talk about is Bell’s Palsy and. Be’s palsy is the most common cause of facial paralysis that you will find in your treatment room, that you’ll see in your treatment room typically, and it’s a disruption of the facial nerves, and it can result in facial paralysis, weakness, drooping, inability to keep the eyelid open or closed.

You can patients can get unusual taste sensations, hearing loss, ear pain and normally the symptoms get at their peak within 48 hours and can last for several weeks up through a lifetime.

Palsy is typically in Western medicine. It’s typically thought of as a result of a virus and, mostly it is seen in individuals between the ages of 15 and 60, although I have seen patients as young as two in my treatment room with Bell’s Palsy, and it usually follows some sort of a viral infection.

It is seen. In a very large number of pregnant women and Western medicine treats it with drugs such as Acyclovir. And also usually so the acyclovir is an antiviral, and then frequently they will give some sort of a steroid to help with any inflammation. So the first thing you would do is an exam protocol, and in order to ascertain which of the muscles is not.

Functioning properly. So you would look at, for example, the frontals. The way you would determine if that is working properly is you’d have your patient raise their eyebrows, close their eyes, and you’re going to be looking for any disparity between the two eyes. Have them smile, and this is going to let you know how the zygomaticus major and minor.

Functioning the orbicularis, orus, the lator muscles, and ZOS. Et cetera, et cetera. So you’re gonna go through the exam of the different facial muscles and you’re going to look for any disparity, and then you will know which muscles to treat, and then within that muscle group. Where the different motor points are, and fortunately for us, the motor points on the face, most of them are either on an acupuncture point or they’re right between a couple of acupuncture points.

So it makes it easier for us to find them because the muscle, the face does have a lot of muscles.

So the first motor point that we would use if someone could not pull their eyebrows together and frown would be the motor point for the corrugator muscle, which is just lateral to bladder two.

The next, as I mentioned the frontals that raises the eyebrows and the motor point for that is gallbladder 14. So you would treat the affected side for the orbicularis oculi. This can help with. Closing the eyelids, and that can sometimes be a problem. People with Bell’s Palsy, they have to take their eyelids shut and the motor points.

There’s two for each eye, and one is between Sania 23 and gallbladder one, and then the other is the extra point Q Hoag, which is right on the orbital Ri. It’s between stomach two and gallbladder one. The next is the motor point for the Zygomaticus major, and that is SI 18, and you’re going to needle into the muscle, but not through the muscle.

The Zygomaticus minor helps to elevate the lip and the motor point for that is between stomach two and stomach three. For the levator Labii Superioris, the motor point is between LI 20 and stomach two, and the levator labii Superioris helps to elevate the lip individually as if snarling the Tallis, is on either side of Ren 24 and it is a half soon lateral to Ren 24, and this helps to elevate and protrude the lower lip.

So in addition to ascertaining which muscles you’re going to treat. If you were treating a condition such as Bell’s Palsy, you also would want to do a full body treatment. And so you would do your TCM diagnosis and look for the pattern and treat the underlying pattern. In the case of Bell’s Palsy, it is either blood stagnation, a lung wind invasion, or a spleen chi deficiency.

And then you would do local points and motor points on the face where the person has the deficiency. In addition to any body points, posis is another neuromuscular facial condition that. You will see commonly in your treatment room, and it can affect one eye or both eyes. It’s when the eye lids are not opening fully.

Everyone has a little bit of ptosis, but it can happen as we age. Some people are born that way and for others it can happen after some sort of an injury or even an illness. And this these are different levels of ptosis. This is slight ptosis, very slight ptosis. And this is due to aging. And then this is more severe ptosis.

I already went through all of this. There are many different causes of ptosis again people, sometimes people get ptosis when they have cluster headaches and, some sort of brain injury as I mentioned injury. A brain injury, spinal cord injury can cause ptosis as well. The motor points that you would use ver posis are the orbicularis oi, and also the frontalis can help the major muscle that’s involved.

Is the levator muscle, but there is no motor point for that. There is a way to treat it with cosmetic threading techniques, but I cover that in my cosmetic classes. When you’re looking at posis of the upper eyelid, it’s either a deficiency of spleen. And kidney or and or spleen deficiency with wind phlegm or oh, I’m sorry.

Let me back up a step. The slide is confusing. The it’s either a spleen deficiency with wind phlegm. Or a deficiency of spleen and kidney. And so the, you would do your differential diagnosis based on what the symptoms are, and then you would treat the underlying symptoms accordingly, as well as using the motor points.

This is information on how to find me if you are interested in. More information. You can follow me on Instagram or join my Facebook group, facial Acupuncture and my website for all of my recorded and live classes I do teach internationally is facial acupuncture classes.com.

I wanted to say thank you for today for coming, and thank you to the American Acupuncture Council for giving me this opportunity to spend some time teaching you.

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Acupuncture Malpractice Insurance – Pulse Diagnosis: Beyond Slippery and Wiry Part 2

Lovingly call a slippery and wiry school where all the patients we saw in clinic had slippery and wiry pulses, or thin and wiry.

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Hi, I am Dr. Martha Lucas, and I am here with part two of Pulse diagnosis Beyond Slippery and Wiry. I am located, my practices are in Denver and then in Littleton, Colorado. I. Work at a regular internal medicine, modern medicine practice. They asked me to come there many years ago to what they said was help them with their diagnoses, which I thought was pretty cool.

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I also, I. Teach Chinese medicine classes. I’ve been in practice for more than 20 years. The name of the course is, or the name of these webinars in my book is Post-Diagnosis Beyond Slippery and Wiry, because I always say that I went to what I call a slippery. Lovingly call a slippery and wiry school where all the patients we saw in clinic had slippery and wiry pulses, or thin and wiry.

Occasionally we could say thin and wiry, but that was pretty much all we learned, and my school did not have any courses on pulse diagnosis. I was very lucky and. In my very first semester of school, my mentor, Jim Ramal, offered a full semester long course in pulse diagnosis, which I was so excited to be there that I took the class because I had previously been, or still working in Western medicine as a research psychologist, but was very curious about what else is going on besides my patients were cardiovascular.

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Patients who had just had bypass surgery and researchers are curious and I just wanted to know, hey, your engine just got fixed, but what else is working to keep that engine working well? So that’s why I started to study various energy medicines and ended up in Chinese medicine school. Just because I had, as a regular person, taken a color puncture course, but needed to know why certain colors, why on certain points, which I knew nothing about ’cause I was just a regular person, but.

My mentor made me fall in love with his method of pulse diagnosis, and and I never looked back. I continued in school, became a, obviously became a practitioner, and my specialty is the diagnosis. People come to me for. An in-depth diagnosis because guess what? Your treatment is going to be more effective if you actually give a correct diagnosis, and I would like to take that sentence.

I had acupuncture and it didn’t work out of the English language because either the patient didn’t work at it. They expect you to cure their five year long back pain and two treatments or. The diagnosis wasn’t right and then the treatment just didn’t work right? So I want to very much thank the American Acupuncture Council for allowing me this opportunity to go on and on about Pulse diagnosis, because as you can tell, I’m super excited about it.

And you can always look me up@lucasteachings.com or my private practice site is acupuncture women.com, and I am always happy to answer. Any questions that you might have. So let’s go to the slides. As I said, this is part two. So I asked this question, what is this thing called the normal pulse? Because in part one I talked about how even historically, and not only in Chinese medicine, I.

Doctors talked about this thing, taking the pulse during healthy times, and they talked about what a normal pulse is that practitioners need to know how to feel a normal, balanced pulse as well as morbid pulses or imbalance or the pulses of a person who has an illness. And we are going to talk about the normal pulse.

Jin we said it is imperative to know the normal pulse or the pulse in the healthy person before the morbid pulses are to be learned because a morbid pulse is in fact. The abnormal change of a normal pulse? My school never told me what normal was. They talked about I think my school might have been a stomach cheese school that they said, oh, a normal healthy pulse is slightly slippery and somewhat wiry.

Oh my goodness. Could that be more ambiguous? What? What do you mean slightly wiry or slight, somewhat slippery. That’s wrong. That is not what a normal pulse feels like. What a normal pulse is a sine wave yang and yin. So yang rises, yin falls, and then they connect each other. So it’s a series of sign waves, yang and yin yang and yin.

And it’s symmetrical. So the yang isn’t founding up, and the yin is this little tiny thing. It’s symmetrical, it feels smooth, it’s connected. The yang and the yin are mixing, which is what they do, right? They mix with each other to create a wave that they’re each supporting each other. So that’s what normal feels and that’s the goal of every treatment.

The person comes in, you feel they’re outta balance pulse. You determine what you need to do with whatever you’re going to do. Acupuncture gua, una, herbs moa, and then you do your treatment. I recommend a little bit of treatment, refill the pulses to see what happened or what didn’t happen. A little bit of treatment.

Refill the pulses, so it’s a kind of a little puzzle that you’re trying to fix. So any break in symmetry from that normal sine wave yang and yin yang and yin is pathological. If the body isn’t able to self-regulate itself anymore. I. Without help in a perfectly healthy world, the body would self-regulate.

You’d have some outta balance. Let’s say there’s a cold or something and your pulse gets a little bit outta balance, but then your body regulates itself and it goes back into balance. If that. Doesn’t happen. If it can’t return to the normal sine wave, then we need to see people, which is why I recommend what I call maintenance treatments, which is, okay, we got you back into a healthy state.

I’ll see you in a month. And I always tell people, don’t go back to square one. Don’t not go back to square one and call me and say, oh my goodness. Because that would be. Your body is going back into the old pattern of imbalance, instead of staying in a more balanced state.

And believe me, we can retrain a person’s body to learn how to reregulate itself and get more balanced. Are we all ever gonna be perfectly balanced like we were in utero? And sometimes, not even then, frankly, depending on our parents’ health, depending on our parents’ relationship, et cetera. But we can get closer to it.

We can go out of a sickness state into a wellness state more quickly or out of an emotional state, into a calmer state more regularly when we, as the practitioners retrain the person’s body to remember what normal feels like. Because when all of our energies are substantial in communicating with each other, then there is not what we call a pathological pulse.

So we can deal, we can literally watch the health issue go from healthy to unhealthy to back to healthy, as I said, the front of the position. The uprising part is young. That’s the functional aspect of the organ and the back or the downward flow is the yin, which is more the physicality of the organ. So again, using this idea, we can see is this person’s problem more a function or more of a physical?

Problem the large intestine and constipation, we would maybe be able to determine whether the constipation or change in bowel habits is due to a weakness in the large intestine function handling a typical food load, or whether or not it’s over that physical organ is overburdened or both. Other interesting qualities are the co-sign.

So in my way of my system, we have the sine wave, which is normal. We have the co-sign wave, which is the opposite of a sine wave. So it starts more in the yin part and goes up. So that’s, and you, when we, when I teach this in classes and you get to see it like depression is a co-sign in the liver.

Position. Once you see a co-sign, then you are able to recognize it more and more. As I say, it’s often seen in the liver, but it’s seen in other positions as well, and we need to know what level it starts at. If the co-sign starts at the deep level, it’s an older issue with the person, an older emotional issue, or an older.

Physical issue, maybe even they’ve adapted to it. If it starts at the top level, it’s more current, something that they’re dealing with right now. For example, taking that depth idea, sinking or emptiness or you don’t feel anything, it’s empty in the spleen, stomach, the earth position. That can mean early childhood trauma.

It can mean what? What is called the relinquishment wound by psychologists, which means. The person was separated from their mother right at birth. For example, my oldest grandson was a preemie, and so he was, had to be taken out by emergency c-section, and he was taken away from my daughter at that moment.

All right? So he would have a tendency to have what is called the relinquishment wound, and sure enough, because. Spleen, stomach, lung, large intestine, rr immune system. What did he have as an early young one? Immune system issues. What did he have as an early, young one? Skin issues. So these were predictable according to his, preemie experience leading to immune problems may be seen. And he recently got diagnosed with asthma. So all of that, and he’s, thank God, and I also thank Chinese medicine. He is what I would call a very healthy 17-year-old, despite the fact that he went through some early life problems with strider and with rashes, and now has asthma.

But he’s a track runner in cross country. So Chinese medicine, I. Really as you if you couldn’t tell. Really love it. And then other interesting qualities are nodding. This movement is a three dimensional movement, so it comes up in the pulse. You can feel it, touch your finger, and it stays there. You probably heard about it in school as called the spinning bean pulse.

What you would feel in the beginning as you’re learning how to feel an knotted pulse is just it hitting your finger and no flow. It’s not going anywhere. That’s what a tumor feels like. That’s what a cyst feels like. That’s what a fibroid feels like, because what is that diagnosis? It is stagnation.

Stagnation in one spot, right? That cyst is in one spot. That fibroid is in the uterus, the nodding movement is eventually you’ll, if it’s growing, especially, you can feel the spinning at the top. You can feel the movement at the top, but that knotted movement is you feeling a localized stagnation.

Sometimes you feel it after people have a surgery because they just had localized. Trauma, localized damage in their body. You might feel it in the lung pulse because the person has some sort of mucus blocks in there. So that’s what nodding is. And it might seem like a pause because it’s not flowing.

It seems like a pause because it’s rising up. And you feel it before you feel the movement on. Some people think of this as an intermittent pulse, but sometimes you need to be a little more discerning to see whether it’s an actual or not, and. I’m talking to my patients while I’m taking their pulses because when I feel something, as I just said, it can be more than one thing.

So to asking the patient, how’s this, how’s that? Have you ever had this? Is this happening? Is that happening? Then we, I. Are getting down to the nitty gritty of what’s going on. Like the person says, oh yes, I’ve just been diagnosed with colon cancer. That’s why I’m here to see you. Then we might feel that in the right distal position because that’s the lung large intestine.

But we also might feel it in the proximal position because we are feeling the physical organ, the pulses can be a model for the whole body. What’s deep inside and what’s more on the surface, and where it is not only located in what we learned as the traditional pulse positions, but also where is that organ in the actual body.

So we are doing a lot of observation along with what we might call clinical findings, what their doctor has told them they have. So we we might think we’re looking at energetic qualities, but actually we are looking at impulse diagnosis at the physical body, the emotional bodies, and the spiritual bodies.

For example, we don’t ever wanna see a scattered pulse, right? That’s someone who’s living in fear, right? And fear and anxiety are almost the same thing. Fear is a little more dramatic than anxiety, but this person is in constant vigilance. Their kidneys get overloaded, get what we call scattered.

We don’t ever wanna feel, scattered kidney position. And then everything gets more tight after that because the kidneys aren’t flowing, they’re scattered. The sympathetic nervous system is showing up in the pulses because their muscles are getting tight. They’re. Central nervous system is overloaded, so it feels scattered little points of light under your finger instead of a nice kind of flow.

So this patient might think of everything as threatening, and that’s because they’re not centered, right? Their pulse. Can’t moderate itself back to calming the nervous system down and regulating and centering them anymore, they’ve become in that pattern of fear, anxiety, nervousness, and what we do is help that get regulated back to normal, back to balance, back to flowing back to the kidneys, being not scattered and supporting all the other organ systems.

So we talk a little bit about the pulses in cancer development, since we’re talking about nodding in tumors. In a healthy person, we know about the microcosmic orbit, right? Think about it. It’s a sine wave, and what happens when you do a sine wave? The other wave. So sine wave. Sine wave, which is how we communicate left and right, is the infinity symbol, right?

Sine wave this way, sine wave that way. And so we want to support the lower Dante N. We want to facilitate that connection. Some people call it the Tai G connection between yang and Yin and. There’s this story about how monks used to click their teeth actually pumping the salivary glands to catch and contain the fire element Ming Mu, to generate the saliva and swallow it, guiding it down.

The Ren Ma, back to the Dante. And so this idea of preserving your Ming Man fire has been around for a long time. And there are various ways that people in the past have done it. Now a blockage in the diaphragm, what we would call a dmai block, may prevent that saliva from getting down to the Dante.

And it’s the same way energetically, if the dmai is blocked, the vertical flowing channels are not communicating with each other anymore. So if you are, for example, treating a fertility patient and men and women, and you’re. Tonifying, the lower, their reproductive system in the lower J and also trying to help their digestion, but their dimmi is blocked and you don’t know it, you’re not helping them because where’s that energy gonna go?

How are, how is digestion going to communicate with the reproductive area? How is the middle or the upper going to connect with the lower? It’s not because those organ systems are dissociated when there’s a DI block, we need, that’s an example, a simple example of something that we need to be able to feel in the pulses so that we can reorganize those systems so that they’re flowing into each other.

So I recommend taking the pulses with your non-dominant hand for one thing with your right hand, I mean with your dominant hand. It happens to be my right hand. I might take, be taking notes. I might be writing down something that the patient says, and I’m also going deep to superficial. So feeling the Ming man feeling the kidneys.

Feeling what’s going on in their core and then moving up to what’s more current. And for example, a short kidney pulse that can be a blocked dite. Usually a blocked dite feels a little stronger than just a weak kidney. But if the, if there’s a short kidney pulse, a short proximal position, pulse, the kidneys aren’t flowing, that’s the bottom line.

If it’s short, they’re not flowing. They’re not supporting the other organ systems. A short heart pulse. Liver attacking the heart, maybe liver attacking the heart, and the heart is. Stopping that because it’s trying to protect the spirit. Is it old trauma that’s causing that? It could be. These are all things it could mean, and this is partly why we need to communicate with the patient.

I said in part one that like the great sociologist, Andrew Greeley said people will say anything and he was talking about surveys, how you can’t believe surveys. Because people will say anything. Same thing with po with the person’s body. They, I’ve had so many patients that I have felt some sort of old unresolved emotional issue or trauma.

I don’t use the word trauma in the first treatment, of course. And they’ll, I’ll ask them, oh, do you have anything unresolved? Something from the, and they’ll say no, I don’t think so. And then the second or third visit, they’ll say, I was thinking about what you said, and you’re right, I had blah, blah, blah.

So it’s. I just helped that patient know themselves better. I just helped that patient understand the cause of their fibromyalgia or their stomach, their digestive issues. So we are helping the patient know themselves better and understand why. Understand why they are having this particular illness or symptom.

Knotted left kidney pulse in the system I’m using in teach, the left kidney position can be the uterus and the prostate. So if it’s knotted in there, maybe it’s uterine fibroid, maybe there’s some prostate inflammation. A knot at the top of the stomach and or large intestine position is thyroid. In Chinese medicine, we don’t have a thyroid organ, right?

We don’t talk about it. We don’t have, certainly don’t have a thyroid channel per se, but where is the thyroid? It’s near some channels where it’s blockage it’s having little nodules or it’s inability to function well, can be felt in the pulses, and then the gallbladder and San Jal positions, especially at the sensory level.

Can show brain or central nervous system activity. In fact, gall bladder and Sanja channels are very good channels to treat the brain. So let’s talk for a minute about a couple of case studies. So a large gel pulse, right proximal. Remember, we’re gonna look at the positions in some unique ways. This can be, as I said, something going on with the brain.

Or. Something going on physically, right? A patient who has IBS, you might see that big movement in either the middle or the lower gel, but sometimes it’s nervous tension going to the brain. It might have some heat and dampness in it. So we’re looking at things in a unique, more detailed way. A young woman after a C-section, and she has a very stiff and painful neck.

All the tests come back normal, right? She doesn’t have any spine issues. If her pulse in the small intestine position is. Empty. Okay. Of course, her neck is full of muscle tension and knots and inflamed trigger points because there’s no oxygen and blood flow in the small intestine channel. So you know, you might be thinking, oh, wait a minute.

I should be feeling a choppy pulse. No. Remember, sometimes back problems, neck problems, muscle problems are hidden. Because it’s severely depleted, cheat, in her case from childbirth. It’s the hardest thing a woman’s body is ever going to do. Build. Then deliver another human being. So we, this is what I’m saying, we need to be open to what’s going on in all of the channels near where the person’s symptom is.

Or they may have a short wry movement going from the stomach backward. That’s what worry feels like. And we never wanna have worry in the pulses because not only is it not going forward to. Help the lung, large intestine and the immune system be strong, but it’s going backward and attacking the kidneys.

So case study examples, block dite, like I said, fertility example. The person has fallen, they’ve been rear-ended. They’ve been in some sort of accident. And by the way, falls include things like ski falls and sports falls where the person falls and gets right back up. They look down, nothing’s broken, they’re not bleeding.

The Dai still gets blocked. So again, it’s important to know what the person’s history is, what their activities are, if we’re feeling the Dai block, because our treatment is not going to be as effective as we want it to be. If there’s a Dai block. I mentioned a little bit about earth and metal connection.

That’s the immune system, right? So the spleen, stomach, lung, large intestine, they all need to be flowing with each other. So that would mean the kidney position, earth position, metal position, all Y and yin yang and yin. So we can have a strong immune system. Let’s say the person comes in with acne, maybe that is liver stress shooting out.

To the skin, especially on the forehead. Stress, acne especially shows up on the forehead. So again, with acne, we can’t just look at hormones, we can’t just look at heat. We have to look at other possibilities. Of what’s causing this person’s acne. And then the separation of yin and yang, they call that the end of life, right?

That looks like you. What it looks like in the pulses is you only feel yang. And when you go down into the deep portion, it’s pretty, pretty empty. That’s ’cause the organ systems are getting weaker. They’re not able to hold energy anymore. And so what happens? There’s no root. So the pulses just go up y yang, young.

So you know, that’s I treat internal medicine, that’s my specialty. So I always say practitioners who only treat pain are fairly lucky ’cause they’re probably never gonna have to go through the death of a patient. But I went through the death of a patient my very first year out of school. I just had one pass away last year.

It’s when you treat internal medicine, you are going to eventually, as your patients get older and older. Feel that separation of yin and yang, and I don’t like it, but I, it’s a hint of what I need to do. Try to get some of that connection back so they have more of a flow in their pulses. And I’m always optimistic.

I am really, no matter what the person comes with, I at least. I am optimistic that I’m going to be able to maybe slow down the progression of the disease, slow, slow down their symptoms, take their symptoms away, make them feel better quality of life. Always super, super because I get a smile out of the pulses every day.

I. I’m one of those people who’s really lucky that as a woman of a certain age, as I like to say, I still love my work. It still makes me smile every day. It makes my patients smile every day. They’re always interested when they’re like, oh, you’re feeling something, aren’t you? I appreciate your listening to this part two of Pulse diagnosis beyond Slippery and wiry, and I will hopefully see you for part three.

Again, I want to thank the American Acupuncture Council for allowing me to express my excitement to you about Pulse diagnosis, and hopefully I’ll see you next time.

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Acupuncture Malpractice Insurance – Getting Paid with Timed Series Documentation

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Hi everyone. It’s Sam Collins, the coding and billing expert for acupuncture and the American Acupuncture Council. We’re here for you and we wanna make sure your practice continues to thrive. Let’s get into it. Let’s talk about what’s happening with documentation of acupuncture services, specifically time services.

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This is continuously a problem and I want to help you solve that and make sure you understand it with some ease to make sure your claims are paid. Make sure you’re getting paid what you’re supposed to be paid. So let’s go to the slides, everyone. Let’s talk about documenting and recording time specifically for acupuncture.

Where we’ve run into a ton of trouble is to realize that acupuncturists probably never really learn this correctly and don’t understand the value of their time. I think acupuncturists probably more than any other provider, spend more time. With their patients one on one and any their provider, and I’ve been to lots of different types, but my acupuncturist is the one I spend the most time with.

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All I’m saying to you is that’s true. Let’s make sure to document it. So acupuncture highlights specifically time and I underline it here. Notice each of the codes indicate initial 15 minutes of personal one-on-one. Contact the additional one each additional 15 minutes with personal. One-on-one contact.

So it means acupuncture requires that you spend time one-on-one with the patient, and of course, inserting needles. Now I just highlighted the manual acupuncture, but it’s the same is true for electro acupuncture. Whether or not it’s electro or manual, please document the time. It’s the one area that so frustrates me ’cause I have so many good acupuncturists who are doing really well in getting paid hundreds of dollars per visit On some insurances, I kid you not, but we run into problems where their claims are denied and I want to see what’s occurring.

Here’s one for United Healthcare, and you’ll see here this is for 9 7 8 1 1 N one three and it says, not supported. It says the add-on type of code requires a primary code. It cannot be accurately seen. Therefore the validity of the accuracy of the bill services cannot be verified. So in other words, there’s no time you think no, it doesn’t say that.

Let’s see. 9 7, 8 1 3. The initial one says the submitted medical records do not support. 9 7 8 1 3 was performed. The documentation submitted does not indicate the time. Was personal one-on-one contact. Now notice it’s telling you the time didn’t indicate as personal one-on-one. It is not sufficient to just say time, because time could be the time the patient is resting on needles.

We wanna know the one-on-one time. Now here’s an interesting one. Notice some of the claims and initially for the followup set says not supported. Notice the initial set is, so what did they do differently on the first? They didn’t do on the second. You’ve got to get in the habit of saying, I spent one on one time.

So by example, what is this one-on-one time, and I think many acupuncturists forget what this really includes. So let’s get into this 15 minute code. The 15 minute code is personal. one-on-One contact. Literally that means on an acupuncture visit day, not with exam, just treatment. As soon as you walk in the room with a patient.

The time starts. So what I’d like you to do is look at your watch and go, oh, start at 10 0 5, or whatever the case may be. Give me specifically the start time, or at least start a timer because this means, and you’ll see here, the acupuncturist is in the room with the patient and actively performing a medically necessary act component of acupuncture.

Now, realize, what is that gonna include? When you first walk in the room, you might review their note and say, Hey, last time you said such and such. That’s included. It’s going to be review of the history, asking them how they’re feeling. Notice none of this is even yet putting needles anywhere, but just asking the patient what’s going on.

It’s then going to include your day-to-Day evaluation could be tongue and pulse, range of motion. You name it. Any of those things you might do realize includes washing your hands, sanitizing. Choosing the points, cleaning the points, getting the needles open, inserting the needles, manipulating the needles if you have to.

And of course it actually includes removal so you know how you’re in the room with a patient. You might leave them rest on needles. I. Maybe you come back 10 minutes later, as soon as you walk in the room, time starts again because the time to take the needles out and dispose actually counts and notice this component as well as completion of chart notes while the patient is present.

So that means, you finish it up when the patient’s there, that actually counts. Now what wouldn’t count is if you do it later sitting in your office, but if it’s while the patient is there, it all counts. So you know you’re asking those few questions at the end. Just gimme the total time. I love that we’d have a program somehow.

Maybe there’s a mat. When you walk in the room, the mat turns on a timer, and when you walk out of the room, the night timer goes off. Because if you’re in the room, it’s a component of acupuncture. You’re doing something towards it. Unless it’s another therapy. Now, where a lot of people get fooled on this though, because they said Sam it’s 15 minutes.

Do I actually have to spend 15 minutes? Technically, no. It’s what we call the eight minute rule, and this eight minute rule is true. For all codes that are 15 minutes when it comes to CPT, including physical therapy and physical medicine, but actually acupuncture. So I’ve given you a simple breakdown of it.

Notice one unit is at least eight minutes. So do you have to spend 15 minutes to do acupuncture? No. If I spend eight minutes and insert a needle. I can remove it and they’re out of there. That actually could be enough time. Now, I don’t think anyone’s doing an eight minute visit, but I think you get the premise here is that we’re just looking in increments that if you’re doing more than 50% of the time, meaning eight minutes, you qualify.

I don’t think anyone has any problem doing the first eight minutes. Of course, where things get a little trickier though is how do we do an additional set? That requires additional time and additional insertions, but it doesn’t require. 15 minutes. The answer is no. It requires an additional eight.

Now here’s where it’s confusing though. What if I do eight minutes on the first and go, I did eight minutes on the second. What’s the total time for eight plus eight 16? Is that enough? No. ’cause there has to be at least 23. So realize the second unit of time, that eight minutes begins after 15 minutes and it’s plus eight.

So that’s why you’ll see one unit is as little as eight, but two units or two sets is 23. Three sets would be 38. So you have to make sure that time matches. So by example, if you did eight minutes on one and eight minutes on the other, that wouldn’t be enough. It would’ve to be 15 plus eight. Or how about this?

What if you sp you spent 12 minutes on the first one and 11 minutes on the second one, would that be adequate? It would, because there’s 23 minutes, so please make sure that you’re just simply documenting the time. Notice it wasn’t saying, the time wasn’t documented, they were indicating the time wasn’t clearly indicated as face-to-face.

So get in the habit of saying face-to-face time with the patient. Because what if there’s time where the patient’s resting on needles? I know when I go to my acupuncturist, she will put in needles. Then she usually leaves the room about 10 minutes or so. Great. It gives me time to relax. Realize though that time simply doesn’t count towards the coating, but then when she comes back, it does.

So it has to be actively part of it. So if you come back in the room and stimulate needles, it would be if you come back in and insert more, that would be an additional set. So please note here it says yes. Do you have to do insertion of needles? Yeah, reinsertion. Bad term of course, but additional insertion.

So keep in mind, just retaining needles for an extended period of time does not give two sets. Stimulating needles does not. There must be an insertion. So keep that in mind and realize I’m showing. This is from Regents Blue Cross Blue Shield from their acupuncture part. Notice it says here, eight minute rule, eight to 22, 20 23 to 37, so you can see clearly.

This is not just a SAM rule. I’m not trying to just say I’m the know it all. No, I’m giving you the rule based on the guidelines. Notice it says if you do seven minutes or less, doesn’t count. As soon as you do. Eight minutes. Yep. So right in there you can do it. So realize that UnitedHealthcare is the one I just showed you that had a problem, and it says, for any time-based code, the duration of service must be clearly documented.

And the time service is not clearly and properly documented, then the service is not supported. And it needs to be because we have to indicate face-to-face time, acupuncture. Often patient patients will rest on needles. And so the reason that we’re seeing some of this is ’cause I think we’re combining that and not separating it out or.

Just not making it clear. Just make it clear. Notice a couple of things here because it tells you how you document, so you might wonder, how do I’m supposed to document this, Sam? It’s unacceptable Documentation of time-based services. What’s unacceptable? Documenting in terms of units. You can’t just say, I did two sets of acupuncture.

You can say that, but I need you to tell me set number one, how many minutes did you spend face to face and where’d you put needles? We cannot use a range of time. You can’t say, I spent between 20 and 25. It should be, I spent 20 or 21 or 22. You also wanna make sure that you’re not specifying a measurement or increment used, meaning that I did from this time to this time.

That range part, or just not mentioning time at all. I think the easiest way to see this though, and for those of you that have been to a seminar with me and or have our accu code, you’ve seen this is a sample of a soap note. What I wanna do is just blow up. Where the area is, that time is documented.

Take a look here where it talks about acupuncture and it says Set one, two, and three. Now realize this form. If you wanted to add a force set, you just add another column, but nonetheless, notice set one. The points that were inserted or reinserted could be either one. We list the points and then we indicate face to face time five 20 to 5 45.

That’s 25 minutes notice, there’s retention time. There is a rest period, but notice set number one is 25. Notice set number 2, 5 55 to 6 0 5. That’s only 10 minutes, but does that meet the eight minute rule? Yeah, it’s more than eight plus. The first one being 25, that’s 33. We’re easily above. And then notice the third set is six 10 to six 30.

Now, may wonder how come the middle set was so much shorter? Doesn’t take that much time to add more probably. And the last set was also 20 minutes. Why was that last set longer? Think of all the things you do at the end of the visit, counseling the patient, removing the needles, and disposing. Just give me the time.

None of that is hard. Acupuncturist by, right? Always brag about how much time they spend with someone. I talked to someone this morning that goes, Sam, I spend God between 40 and 50 minutes with every patient, and I believe that to be pretty true. For most of you. You know what I want from you. Document it.

You’ll never have an issue. Now you may think I only do cash. Great. You still have to document the services. So realize this has nothing to do with insurance. This is just to do with you properly documenting what services were provided. Tell me how much time you spent, what points you did. We’re good.

It will also equal you get paid. I’m not sure you’d notice, and I’m not gonna go back to it. Did you see the prices on some of that United Healthcare? So if you wanna rewatch this later, you’re gonna go, oh my gosh. Now, I’m not saying we wanna bill that much, but if you’re in certain areas, why wouldn’t you bill what it’s actually worth?

Acupuncture is a great service. You’re at a great time to be an acupuncturist. Take advantage of the advancements of your field in getting access. Please document the time. It’ll never be an issue. I wanna say thanks, but realize we’re always here to help our network service and our seminars are where you can go for one-on-one help.

We can do zooms together and deal with you specifically, not just a general question. Please go out and do well because we’re dependent on you, the American Acupuncture Council and myself. We count on you. Your success is ours. Until next time, my friends.