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.
My friends, it’s Sam Collins, the coding and billing expert for acupuncture for you, the profession, and of course the American Acupuncture Council. And thank you for spending some time with me. This is an important time of year because here’s a riddle for you. When do the 2025 diagnosis begin? Now, the quick answer to that riddle might be Sam, you said 2025, it must be 2025.
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Actually, it’s not. The 2025 diagnosis codes, as they do every year, actually update the October 1st before. The answer to the riddle is, the 2025 diagnosis began October 1st. So make sure that if you’re using one of these codes that I’m going to go through to update your list, to make sure you’re using the most current code for your patient, because if you use an old code, It’s going to be denied.
Now you can see here, or in fact, let’s go to the slides. Let’s go to the slides. Let’s look at it. So the update you’ll see here is the 2025 update is October 1st. You can see there’s 74, 000 diagnosis. Now let’s be realistic. Is an acupuncturist going to ever use anything like 74, 000 diagnosis coords?
Of course not. However, a lot can be covered because acupuncture, of course, for pain and pain management has a lot of ways of being coded, but you’ll know one of the most common things you’re billed for, or paid for, I should say. In fact, that’s the code that made the biggest change for you. But let’s keep in mind how these work.
The date of service determines the code. So let’s say, by example, you’re billing a patient that you saw in September of this year, but you’re sending the bill in December. or January for that matter. It’s being a little late, but you’re still sending. It doesn’t matter when you send the bill. The date of billing does not affect the code.
It’s the date of service. So if the date of service was prior to October 1st, please use the old code. If the date of service is after, Use the new code. Pretty straightforward and simple. However, let’s talk about what if change. The changes are occurring for lumbar and lumbosacral discs. Now, as an acupuncturist, you might say Sam, I’m not sure that’s very important to me.
Certainly could be as a lot of acupuncturists now are working as the referral person for back pain and pain management for medical doctors. You’re often going to get patients that will have these conditions and often they’re not going to put a code for you. It’s just going to say, Dysdegeneration.
Right now the code is M5136, so pretty straightforward, M5136, that’s fine, but here’s what’s changing. The changes now, they’re going to be a little bit more granular or more specific, where it allows you to describe what’s going on with the person. You’ll notice this first code, M51360, is dysdegeneration to the lumbar region.
with back pain or discogenic back pain, meaning back pain. So that’s pretty straightforward that it is back pain, of course. However, could there be more? There is more. M51. 361, other intervertebral disc degeneration in the lumbar region with lower extremity pain only. Now notice there now is a code that is back pain only or one that’s lower extremity pain.
So many times a person will have disc degeneration and go, man, my leg is killing me. And it’s actually from the disc. So now there’s a code to differentiate that, but there’s also one when it’s combined. So if you have a patient with combined back pain and leg pain, there’s now a code M51362. Clearly a person with back pain and leg pain, a little more severe, of course, meaning more care long term.
So this really, I think, sets up to demonstrate the length of care someone is likely going to need based on a diagnosis. Now, we have back pain. Leg pain and a combination of both, but there’s always this one too, and I’m sure you’ve seen this. There are many people that maybe they went in for some upper back issues, but they did an MRI or x rays to other areas and they found, oh, there’s disc degeneration in the lumbar spine, but it’s asymptomatic at the time.
If there’s disc degeneration that’s asymptomatic, there is now a code. Disc degeneration without mention of pain, In the back or lower extremity pain. I like that. That kind of lends to, that doesn’t mean the person is fine, but it does mean that they’re obviously having disc degeneration and we know they’re going to be closer to having a problem.
So what this does is just add a little more specificity. If you were seeing these codes, please make sure to add these new digits to get that specificity for it. Because if you send it in 5136, It’s going to be rejected unless of course it was before October 1st. They’ve done the same thing for lumbosacral discs.
There’s M5137 lumbosacral discs, meaning L5S1. But you’ll see it’s the same protocol with back pain, with lower extremity pain, or a combination of both. So just making sure no longer now is it just one simple code. But there’s going to be three codes demonstrating when it’s hurting, Or one if there’s asymptomatic.
Now you might think Sam, I don’t know if that’s significant to me. I’m an acupuncturist, but if you think of it, how often do you treat people with chronic back pain that often could be disc related, you may not be making that as the primary code, but if it’s on the claim, we better make sure we have the right code to it.
Now, one thing to keep in mind though, let’s say you’re coding someone with back pain. Just plain back pain. You cannot use a back pain code with the disc code. So never combine like an m51 series like lumbar disc or lumbosacral disc with a pain code. In my opinion, obviously you’re gonna use the disc code.
It’s more severe. I mean think if you said someone has back pain compared to saying discogenic back pain or disc causing leg pain, I think you’ll see the severity levels a little bit higher. Probably longer term care. Bottom line, I want to make clear those. Don’t combine them. If you say, Sam, I don’t want to use a lumbosacral disc code, I would say why not, if it’s already been coded for you.
But if so, make sure not to combine it with the back pain codes. And let’s keep in mind, back pain codes updated. What is that? Four years ago now, however, I wanna make sure it’s clear. The back pain codes are M 54 50 for unspecified low back pain. We have M 54 51 for vertebral genic, low back pain, and then we have M 54 59 for other low back pain.
You might be thinking Sam, that’s not new. Why are you updating it? ’cause this is a problem. I see. Obviously many acupuncturists now are beginning to access particularly Medicare. Part C plans. These are your Medicare Advantage or private pay insurance plans that many will have direct access for acupuncture, not needing an MD.
When you have a plan like that, do not use M5450. Please make sure you’re using M5451. Or, M5459. If you use M5450 for the Medicare plans, you’re going to reject it. So keep in mind M5451 or 59. My opinion, M5459, best choice. Other means something that you can name or the reason for. It could be pregnancy related for that matter.
Bottom line is, no pain codes with DISC. If you’re coding DISC, here’s what I’ll tell you. The association is it’s already there. Now you can see there is a code that says no pain, but In other words, don’t put pain with it, but one or the other. Now, there’s some other codes that are musculoskeletal related.
You might look and go Sam, I don’t know if I’d ever use this. And I’m going to say these aren’t probably common, but I want to make you aware. Because as you can tell with diagnosis, they’re commonly looking to update and make things more granular, more explained, if you will. Currently we have a code that just says, Sinovitis, tenosinovitis.
Unspecified. And that’s basically your tendonitis codes. Here’s what we have now. Codes that are specific for these conditions that are going to each area. Shoulder, arm, forearm, hand. So everything upper extremity. In addition, lower extremity. So you’ll see here thigh, lower leg, ankle and foot, and so on.
The idea is that coding is always there to try to give us our best way of describing what’s going on. At the same token, don’t be afraid to be simple when it comes to acupuncture. Often a pain code is going to be your best bet. However, when I can have something more granular, I like it. Think of disc degeneration with pain compared to just back pain.
I think we see two different things there. But also know what the carrier requires. So by example, if you were billing Aetna, even though they may have a disc issue, You’re going to code it as pain, because that’s what they accept. Cigna Insurance, Anthem. Others will accept the DistriGeneration, so know which plans you’re dealing with.
As always, the American Acupuncture Council is here for your help. I run our network. The network services, we do seminars, and we do one on one help. That’s really what we do. If you want to make an expert part of your team, take a look at our site. Take a look at what we offer. We give you two CE seminars a year, plus unlimited access to get with me.
So we can go over everything in your practice. What are your fees? Are you building the coach properly? How do you document? How do we make sure we’re getting paid? We always want to make sure you have success because your success is ours. Until next time, my friends.
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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.
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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 there, my name is Michelle Grasek and I am the host of the Acupuncture Marketing School podcast, and today I’m looking forward to talking with you all about effective email strategies to get more patients on your schedule. And before we dive into this, I’d like to take a moment to thank the American Acupuncture Council for the opportunity to be here with you today.
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I absolutely love teaching marketing, so I am thrilled that I can have this opportunity to teach you for free. So let’s get into the slides. Alright I broke this talk into two segments. So the first segment is really about why email marketing is worth your time and your energy. And then the second segment is ideas for making your emails more effective so that they actually work to get new patients on your schedule.
So let’s start by talking about the goals of email marketing and really why does email marketing work? What are we doing that makes it effective in getting people to take an action? So the most important thing, I actually put it third on this list, is that email marketing is a reminder that allows you to stay top of mind.
So every time you send an email, you hope that people who are reading it, sit up and take notice and say to themselves, That’s right. I’ve been meaning to make an appointment with this acupuncturist, right? It’s just a reminder. And I find that’s a really nice way for people to think about it. If they have some reluctance to send emails, if they’re worried they’re going to be annoying their audience, you’re really not annoying them, but I know it’s a common concern.
Just remember that email is a simple and easy reminder that you, your business, And your practice exists. Okay. So then the second reason that email is so effective is it’s a really nice medium for teaching people about acupuncture and how it can help their specific symptoms. And it also allows you to talk a little bit about your clinic so that people get to know you and the way that you practice.
And that really leads into the third purpose of email marketing, which is to build your know trust factor. So in marketing, we. We know that people like to buy things from people they know and trust. You’re probably familiar with this concept. And the way that you write an email newsletter, the way that you teach people concepts or share information will allow people to buy things.
understand, what kind of person you are how you approach this medicine, what it might be like to work with you, and that builds trust, right? It’s building up that know trust factor. So we are going to talk about each of these in a little bit more detail. But first let’s talk about why email marketing is worth your time.
The first is that you own your list of email subscribers in a way that you can never own your social media subscribers. Now I have seen a lot of small business owners put an enormous amount of energy into social media and growing their following. And that’s why You know, there’s really nothing wrong with that, especially if you enjoy social media a lot.
I say go for it. It can be a really nice opportunity to get in front of, real life people in your community. But, I think that if you are on the fence about social media, or feel like you don’t have enough time to be consistent with it, email is a really nice alternative. And this is one reason why that’s the case.
So if you think about Instagram, for example, there have been several instances in the past couple of years where Instagram just stopped working. It went down for a day and all of the influencers on Instagram who have built their business model around selling something to their followers. They panicked because they didn’t know if or when Instagram was going to come back up.
They didn’t know what their income dip would be like based on how long Instagram was going to be out for. And at this point we know Instagram came back, obviously, right? It was only a day each time, but it’s it’s not the best business model if you’re only focusing on growing followers because you don’t have that control over these people that you are making such an effort to build with, right?
By contrast, you own your email subscriber list, and you can really control the way that your message is delivered to them. So we know that the social media algorithms change all the time, and you can spend a lot of energy creating Reels, for example, but then have only a very small portion of your followers actually ever see that content.
Whereas at least when you send an email, you know that it landed in the person’s inbox. And of course, there’s a certain small percentage that might end up in spam. That’s normal. But at least 95 percent of the emails you send are going to be they’re going to arrive at their destination. Okay. And I think that is building your email list is a good way to build stability in your marketing in a way that social media is not because social media can be unpredictable.
And again, you don’t get to control the way your message is delivered or whether you will even have followers in the future. Okay. So that’s one thing to think about. The second reason email isn’t a really good choice is that it is so low cost in the marketing world. You almost, you can’t find anything to beat it.
So for example, if you have 250 email subscribers on your list and you’re paying about 20 a month for something like MailChimp or Constant Contact that, and you send one email a month, that is 0. 08 per email, and It’s really hard to find another marketing strategy that only costs eight cents a person.
So your investment is low, right? There’s you just, you don’t have that much to lose. And another reason that email is a great choice is that it’s a very low pressure way to educate people and to get visible. So especially if you are an introvert, or if you don’t love the idea of learning to dance on TikTok, then email is a nice alternative.
I always tell my marketing clients that they get to write their email newsletters at home, in their pajamas, on their with their cats, whatever suits you, right? And especially if you already enjoy writing, email is a great medium for it’s like an opportunity to be visible in front of a lot of people while you actually get to be behind the scenes.
Okay. I hope that makes sense. And that is a much more comfortable way for a lot of people to do marketing. So I always say that if that We’re not consistent with things that we don’t like. It’s really hard to do marketing over the long term if you don’t enjoy it or it’s not a good fit for your personality.
So choose something that is a good fit. And for many people, email marketing fits their strengths. Very well. And then lastly, email is much cheaper or has a higher ROI, forgive me, than social media. So for every dollar that you spend on email marketing, the return on your investment is around 38. So that is 3, 800 percent return on your investment.
That’s outrageous. And that is partly because it’s so low cost to begin with, but also because it is very effective. at the same time compared to social media, which generally if you spend a dollar on social media, your return would be about 2. 80, which is a 20 28 percent ROI. Okay. So for all of these reasons, email is just a really good choice.
for reaching your patients, converting them and getting them on your schedule for a very low cost. So let’s switch gears then and talk about some tips and strategies for effective emails. So I have been teaching marketing in our industry for about a decade and have been doing marketing coaching for almost five years.
And I find that most acupuncturists have an email newsletter opt in. on their website, something that says, you know, sign up for our monthly email newsletter or something simple like that. But they very rarely or never send the email newsletter, right? So you’re collecting the emails, but you’re not sending them.
And remember, email is this beautiful opportunity to stay top of mind with people just to remind them they meant to make an appointment, if you’re only sending a quarterly email newsletter, for example, I find that most people send something maybe once every three or four months. If you’re sending a quarterly newsletter, that is a lot of time for people to forget about you and your practice, to forget their intention to make an appointment.
So I recommend sending emails twice a month. That is a sweet spot. Now, don’t panic. Whenever I say this, people’s response is immediately, I don’t have time to write content for one email a month. How am I going to write two emails? So we will talk about that in a moment. I have some really effective, helpful ideas for that.
But they’re also worried about annoying people by sending emails twice a month. So the reality is That twice a month is a polite volume of emails to send. It really is not too often and I find that it’s just enough for potential patients. and regular patients to remember that they meant to make an appointment, right?
You’re staying top of mind just often enough that they’re not forgetting about you completely. And I find that is a number of emails that is actually doable for people if they’re using the tips that I’ll share in just a moment, okay? And think about your favorite clothing brand. When something is on sale, they will email you multiple times a week.
Sometimes they’ll email multiple times a day. So we are not doing that. We are As I said, we are sending a polite number of emails at just twice a month, okay? So don’t worry that you are annoying people. You’re really not. People opted into your email list for a reason. They want to learn from you about Chinese medicine and how it can impact their health.
They want to hear from you. And I have a little note down at the bottom of this slide that I want to point out because this is pretty common experience. If you have not been sending emails and then you start sending, people are going to start unsubscribing. And this is totally normal. You actually want the people who are not a good fit for you to unsubscribe from your list because you don’t want to pay for them to be on your list.
So most email platforms like MailChimp will unsubscribe. It’s like a free monthly subscription until you hit a certain number of email subscribers, whether it’s 300 people or 500. If there are people who read your emails and they say, Oh, I don’t think I’m actually going to see this acupuncturist, and they unsubscribe, that’s fine.
It’s better to just let them go, to not take it personally, because it’s almost always going to happen. Every time you send an email, you’re going to get a couple unsubscribes, but you don’t want to have to pay for them to have this bloated email list filled with people who are not going to become your patients.
So just know that it’s going to happen. It’s totally normal. It doesn’t mean you’re doing anything wrong and it does not mean you’re annoying people. Okay, so let’s talk about two things that allow you to send two emails a month. Like, how can you be that efficient? And the first the first perspective is that you can send very simple email newsletters with only one message in them.
So you only need one reason to send an email in order to hit send. And we’ll talk about that in a little bit. But do you remember? And I don’t know I graduated about 14 years ago, so these kinds of email newsletters were very popular at that time. But it was very common for an email newsletter to have multiple different parts, like three or four different sections, and they usually had a theme like the liver in springtime, something like that.
And they were long, and they were complex, and they took a long time to put that content together. So There’s nothing wrong with that type of email newsletter. It’s very effective, but I don’t think it’s any more effective than just having one section, one message. And what I have found over the years with those long, complex email newsletters is that most people who intend to write them, they never finish writing them.
And then they never hit send. So it really is a barrier to actually doing the thing and sending the email. So when I say you only need one message, I am referring to, you could have one research article that you want to summarize briefly and share with your audience, and then have a call to action.
If the research is about acupuncture and knee pain, At the bottom of your summary of the research, you could say, as your call to action, If you are struggling with knee pain, we would love to help. Click here to schedule now. Okay, so it can be very simple and brief. And then the second concept that will really help you in putting these email newsletters together is the idea of repurposing content.
So I can almost guarantee that you have written or created a lot of content already. over the years for your practice, you do not need to keep writing that content from scratch. So if you’re not familiar with it, repurposing content is when you take something that you created for one platform, for example, Instagram, and then you copy and paste it and you make some edits so that it makes sense for another platform, which in this case would be email, an email newsletter.
And I really believe that repurposing content is the only way to maintain your sanity in digital marketing. If you are trying to create brand new content every week for eternity, it’s just too hard and you just don’t need to. It is totally acceptable to copy and paste and kind of reconfigure content you already wrote so that it makes sense for whatever platform you’re copying and pasting it to.
So people often ask me, what can I repurpose? The answer is everything. Anything you’ve created in the past can be cleverly repurposed so that you don’t have to write it from scratch again. And I recommend starting with what’s often called evergreen content on your website. It’s sometimes also called core content or pillar content.
You may have heard of that, but this is These are usually the pages of your website that people are reading or skimming when they are making the decision about whether or not to come see you for acupuncture. They’re deciding if you’re a good fit for them. So if you have a specialty, for example, then the page where you describe how acupuncture works for your specialty, like Fertility, Orthopedics, Cosmetic.
That page is going to be core content or evergreen. And it’s called evergreen because this is the kind of information that doesn’t change very much, but it is always relevant. It’s always helping people make a decision about whether you’re the right acupuncturist for them. So repurposing evergreen content is always a good choice.
It’s a nice place to start. If you’re thinking about planning your email newsletter several months in advance. I would begin with evergreen content. And your frequently asked questions section on your website, if you have that, is a type of core content. I also recommend incorporating that into your email newsletter.
Each Q& A, can be its own email. Okay? If you have written blog posts in the past, you can repurpose that content. If you have published Instagram or Facebook posts and they got a lot of good engagement, like your followers ask questions, they were curious, they were sharing a lot, then that could be really great content to repurpose for emails as well.
And you could either You could just copy and paste the caption, for example, from Instagram, or we’ll talk in a second what to do if you have a lot of video or visual content. So a couple examples of repurposing if you are the kind of blogger who writes like 3, 000 word blogs because you like to be really thorough and we know that Chinese medicine is complex.
So we like to explain everything. I’m one of those people. I’m a long form blog writer. You don’t want to copy and paste the whole blog post into an email. That’s a little too much for an email. So I recommend breaking it down into three or four sections or concepts and then send each as an email, right?
And You could send it as a series of related emails where you are teaching your audience something about acupuncture for this particular topic. So that’s one idea. I mentioned copying and pasting an Instagram caption. Of course, you could also do this with Facebook. Again, if you have social media content that people engaged with, that is a good trigger for you to know that this might also make a really good email content.
And then Let’s say that you are less comfortable writing, but you are pretty comfortable on video, or maybe you have a podcast, something like that. You can use free software online to make a transcript of the video or the podcast, and then you can use that text that you just transcribed, make some edits, and then send that as an email, okay?
Because people who often have a really library of Instagram Reels will say, I didn’t write a lot in the caption. How am I supposed to transform this content into an email? You can transcribe it for free. Okay, so that’s one idea. And then again, I really encourage you to take a look at your Frequently Asked Questions page and consider sending each of those questions and answers as an email, because that is really the information that people need to help them decide if they want to make an appointment with you.
And a really good example of this is how many treatments do I need for, and then your specialty, right? So how many treatments do I need for fertility? How many treatments do I need for cosmetic acupuncture? That is really important. Question and answer makes a really beautiful email newsletter. Okay, so just a couple of tips for writing effective emails so you can get better results for your efforts.
In any marketing, you always want to write from the perspective of your potential patient and think about questions they are subconsciously asking, which is, why should I read this? What’s in it for me? Why should I get acupuncture? What’s in it for me? Think about the benefits from their perspective.
And Angle all of your writing towards that, okay? So that’s number one. And then most email newsletters are successful when they focus on content that the audience would find useful in some way. So teaching and educating your audience is really great. Answering questions. I’ve mentioned the FAQs multiple times already, but that’s a great option.
Solving a problem. So a good example of an email that you could consider solving a problem would be, um, how to reduce abdominal bloating with Chinese medicine. That could be your subject line. And then the email talks about avoiding ice and raw foods, maybe avoiding smoothies, those kinds of things, teaching them something about Chinese medicine that they can put into action at home, get good results.
And then of course you have a call to action. If you want more help managing your digestion with acupuncture and the wisdom of Chinese medicine, click here to make an appointment. Okay. So that’s like a solving a problem that the patient has email. You could also think about what might be the doubts or the barriers that prevent people from making an appointment with me right away.
And then answer those doubts in an FAQ format. And then of course you can always share an email. If you have an announcement about your clinic, maybe you hired a massage therapist, you have a new receptionist, maybe you’re hosting an event that you want to invite people to. Maybe you’re just going on vacation and you want people to get on your calendar before you leave.
Okay, so all of those are just one single message that you are sharing that is a good enough reason to send the email. And I mentioned call to action several times, so before we end I just want to define that for you. So a call to action is when you tell people what you want them to do and how to do it.
Click here to schedule now. Schedule now is what you want them to do and click here is you telling them how to do it. You could also think of a call to action as letting people know what is the next step they need to take if they’re ready to work with you. Okay? So in email, really in all marketing, it is very important to include calls to action because that is literally the part that makes people take action, right?
It gives them the initiative. It turns a little light bulb on their head like, okay, I am ready. and I’m going to click the link. So I recommend having three repeating the same call to action in your emails three times. So have a button at the top and the bottom of your email that’s very simple that just says, ScheduleNow or call for a free consult, something like that.
And then you can also have a call to action in the text or in the body of your email. So if your email was about knee pain, for example, you could say, If you’re struggling to manage your knee pain by yourself, we are here to help. Click here to schedule now, and then you have the hyperlink. Okay? The idea with The frequent calls to action is that people do not like clicking around on the internet trying to figure things out by themselves.
They get distracted. They end up watching cat videos for 30 minutes and they forget their intention. So we just want to make it super obvious, no matter where they are in the body of the email, we want to make it quick and easy for them to find a link so they can schedule now or do whatever your call to action is.
Okay, so that’s a very important piece for making your emails effective. All right, so if you have any questions with me, you are more than welcome to send me an email. My email is michelle at michelleGrasek. com. You can send questions about your email marketing or just marketing questions in general.
And I’d like to thank the American Acupuncture Council one more time for the opportunity to be here with you teaching marketing. I absolutely love teaching marketing and I genuinely believe that it’s just a tool that allows us to reach more patients. So it’s always a pleasure to be here with you.
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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, and today I am going to do a demonstration of nanoneedling with a microneedle pen, so you can go ahead and go to the first slide.
I teach facial acupuncture classes, and part of that is Micro needling and nano needling and one of the questions I get asked a lot is do I do these things on myself? And the answer is yes, I do. So I’m going to do a little demo today of how I do nanoneedling on myself. But first, a little bit about me.
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I, as I mentioned, teach facial and cosmetic neuromuscular acupuncture classes internationally, and I have for about 20 years now. I’m currently on the doctoral faculty at Yosan University, and prior to that, I was on faculty at the Maryland University of Integrative Health, and I also worked as a clinical supervisor there.
And I’ve just completed my very first book. It is a 500 page hardcover book on treating the face, and the reviews have been great. I’m I’ve opened it up for pre sale and you can get more information about the book at facialacupunctureclasses. com and then the products that I am going to be demonstrating today can be, you can learn more about those at aculiftskincare.com
Okay, I am done with the slides. So let me move these slides out of the way. Okay, so the pen I am using today is made by, everything’s backwards the pen I’m using today is made by AccuLift and it comes in a metal case. And the pen itself when it arrives, everything is wrapped up like this. I’m not going to be using this pen.
This is a brand new pen. But it comes with two batteries, and the If you want to plug it in, it comes with a charging cord and also a plug in adapter, which is on the pen right now. And the pen also comes with a really nice set of very large instructions for those old people like me who have trouble reading instructions from time to time.
These are just instructions on the pen itself. If You want to know how to do microneedling on a patient. The purchase of a pen comes with a four hour continuing education webinar that is included. So let’s just hop into it. So before I record before this webinar, I did microneedling on one side of my face.
So if you see my face is a little red, that’s why. But I am going to be doing nanoneedling on this side of my face, and the difference between microneedling and nanoneedling is a microneedle cartridge has These on this particular one, there’s 16 needles, and what happens is when you do microneedling, the needles go like this, and they make little, teeny, tiny, microscopic puncture wounds into your face, and as you can see, I’ve already done it to my face, and it’s, it shouldn’t cause anything too traumatic but So it builds collagen.
Nano needling, on the other hand, uses these nano needle cartridges, and they look different. They’re more like, if you can see this, they are more like a, almost like sandpaper. It’s a really great way to exfoliate, like the dead skin. And it’s something you can do a couple of times a week, whereas microneedling you can only do once a month, nanoneedling you can do a couple of times a week, and you can also do nanoneedling inside the orbital rim and on your lips.
What you need to do, and you don’t need any numbing cream for nano needling. What you need to do is make sure your hands and your face are clean. I like to do a little pre exfoliation before I start. And then just to make sure my face is extra clean, I take a makeup remover wipe and I spray it with rubbing alcohol and I rub I’ll go ahead and even though I just did it, I’ll do it again.
But I spray it with rubbing alcohol and then just make sure if there’s any makeup or anything on your face that. If you don’t have any issues with that, yeah, I’m gonna, everything done.
Once you’ve done that if you don’t like the alcohol, you can also use witch hazel, which is good for cleansing the skin as well. And then with nano needling, I like to grab one of my serums. I brought a couple with me. I have a superb serum, which is Vitamin C, hyaluronic acid, and collagen. I also have my peptide serum and you can use one or the other or you can mix them together.
And since my hands are clean, I’m just going to put a little of the nourish right in the palm of my hand and I’m just going to work on half of my face. So I’m going to work on this half since I micro needled the other half. We’re ready. Put a little serum on. The nanoneedle cartridges come in a sealed pouch like this and then you just tear it open.
You put the nanoneedle right on the pen, this particular pen, and there are a lot of great pens out there. And this one’s made by AccuLift and it has a triple locking mechanism. You take the, Little cap off. Don’t forget to do that. And then the way you determine the proper length for the nanoneedles on this pen is you turn it on and then you are going to dial it up just until you can just see the top of those nanoneedles coming out.
And once you can see them coming out, then you can do your nano needling, and you don’t have to press very hard, the nano needles will do all the work. And this is just a really great way to give your skin a nice refresh when I’m working around my eye area. I actually use my eye cream. Because you’re not needling anything into your skin, you’re just working on the stratum corneum layer.
You can put your eye cream on and just work right inside the orbital rim. Just make sure you’re pointing the pen towards the orbital rim and you’re gentle. You’re not pointing towards your eyeball. And it looks just like this, just like that. And then right inside, just like that. Gentle. And this is great for Those little lines we get under our eyes from smiling and it’s a great way to just stimulate blood flow and real nice healthy qi in that area.
Moving along to the cheeks,
you can do your nose, your cheeks, you just want to go right in there, left to right,
all the way down
and then you’re going to go up and down.
And right around your lips. Again, I’m only doing half of my face. And make sure you do along the jawline. Get your chin.
Oh, and I forgot to say this in my other video, but make sure you pull your hair back. That’s why my hair is back. You don’t want to get your hair tangled up in your device. So a headband or a ponytail, whatever you need. If you have hair that hangs in your face. Now I’m going to do my neck. and my chest area.
And even though I’ve done microneedling across my neck and down my chest, it’s okay to do the microneedling, the nanoneedling. I was pretty gentle when I did the microneedling. You can see I’m just a little red in this area, so I’m good for the So you’re going to go underneath your chin.
And up and down on the neck. Actually feels really nice. It’s not painful at all. And then you’re going to go down on your chest
and back and forth.
So I’m not recommending that you do nano needling over the microneedling. I’m just saying if you did for some reason it cause any harm. It might be a little painful for you. You or your patient, but for the purpose of this demo, that’s what I did. If you want, if you would like, when you’re all done doing your nano needling, you can you can go ahead and put on whatever creams or lotions you would be using.
I happen to have some of my calm aftercare, and I’m just going to use that. And I realize I forgot to do my lips, so I’m going to go back and do that. So for my lips, I usually use some serum, and if you have any kind of serum for nano needling is fine.
And you can just nano needle the whole red part of your lip. It really helps to exfoliate them and plump them up. You don’t want to nano needle, you don’t want to micro needle the red part of your lips, but you can nano needle them
and you can see, makes them look really nice afterwards. Helps to bring that blood flow out and helps with the pleating, lip pleating. That is an entire nanoneedling session for half of my face. And you can see it’s quick and it’s easy. And if you are interested in learning more, you can go to my website, aculipskincare.
com. You don’t have to buy a pen. You can just There’s plenty of demos on there, and the four hour CEU training is on there as well. And my 20 I’m not supposed to say dates anyway. My teaching schedule is on the website as well. And you can also find me on social under my name or facialacupunctureclasses.com. And that’s it. Thank you for joining me.
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hello, everyone, and welcome! 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.
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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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.
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?
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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