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Acupuncture Malpractice Insurance – Is Your Clinic on the Right Side of the Tracks?

 

 

Today we’re gonna be talking about tracking for success. So is your practice on track? What stats should you be tracking? Are you tracking or aren’t you?

Click here to download the transcript.

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

Hi, and welcome to another episode of To The Point. I am Dr. Nell Smircina with American Acupuncture Council, and let’s go to the slides. Today we’re gonna be talking about tracking for success. So is your practice on track? What stats should you be tracking? Are you tracking or aren’t you? What’s really interesting about this topic is I would say out of the practitioners and students that I coach when we talk about stats in clinic or stats in their practice, over 90% don’t track anything.

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So the little bit these nuggets that you’re going to get out of the presentation today, you’re already gonna be way ahead of the game just by going over these three top things that you wanna make sure you’re tracking in your business. So really things to think about. Like I said, most of practitioners out there, at least in the acupuncture industry, are unfortunately not tracking things.

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This can be really problematic because not only is it not allowing us to be really intentional with what’s going on in our practice, but how are we comparing how we’re doing? If we’re growing? There are a lot more things than your bottom line revenue that we need to be looking at because it’s one thing to say, Hey, I need to bring in more income every month.

But it’s very different when you then wanna dive into where is that revenue coming from? Is it mostly new patients? Is it returning patients? Is it supplement sales? If you’re not really sure, then that’s gonna be really problematic when you are trying to decide what steps you wanna take next to continue growing your practice.

So the first thing you wanna think about is are you tracking to begin with? If you’re not tracking, why is that? Is it because you’re just not sure what stats you should be tracking? Is it because we get so swept up in the day-to-day, which is entirely possible, especially since most of us start out as solopreneurs.

You are the only one who is working all of the levers in your business. So I wanna help with some of those. . Maybe why not today And give you just some really easy things that you could take away and say, all right, this feels really feasible for me. I can at least get started with these three things.

And if you are tracking, that’s awesome. I just told you the stats on people I talk to, how often people are not tracking in their businesses. But if you are tracking, what are you tracking? Is it again, just that bottom line what comes into your practice? Is it the top line when it comes to sales before you take out all of your expenses?

Because what we’re looking at from patient count perspective and revenue can make a really big difference in the decisions that we make. So I absolutely want you to be looking at your finances. We need to budget, we need to plan accordingly. But when it comes to those first steps to take for what we’re gonna track when it comes

Two patients. Let’s take a look at these three today. So the first one, . I’m new. How many new patients are you bringing in? We wanna talk about you and your practice. So we’re gonna close up by saying how important it’s to talk to colleagues and how important it’s to compare you to you. But if you brought in four new patients last month, we wanna do better than that this month.

If you brought in 40 patients last month, we wanna see how to do better this month. We wanna start tracking these things so we can make informed decisions, not only when it comes . To how well is the practice doing, but we wanna talk about capacity. When is it important to bring on another practitioner?

When do you need to bring on office staff? When do you get to the point where you say, Hey, I’m doing too many patients. I don’t have time to run the back office at this point, and somebody really needs to help me. And the first easy one to do is just tracking the amount of new patients that come into your practice.

And I really like to look at this on a weekly basis. If you’re, just getting started with it and that feels a little overwhelming. Monthly is great as well. But really to have that weekly check-in and say how many new patients this week. What’s also great about tracking things is you start to identify trends.

When I had my practice and that was in la it was very, seasonal. I had a lot of parents in my practice, so people would be going away during the summer, they’d be going away during holiday breaks. And you need to be able to plan for that and start to see trends. But when are your new patients coming in?

How many new patients are coming in? Is the main thing that you wanna start with? The second thing is looking at return patients. Now I’ve seen this tracked a couple of different ways where I think it’s most meaningful for you to take something really tangible out of it and say to myself, wow, I really learned something from this process.

How many of those new patients are coming back? That doesn’t mean, all right, what percentage of my patients are returning patients? I think when you first start tracking metrics in your practice, you wanna look at . It could also be referred to as your conversion rate. So you have a new patient. How many of them are turning into a patient with an active care plan Who’s coming back for that next treatment?

That’s really important to know because if we look at that kind of staying at the same level, I. That that’s not improving. We wanna then be looking at, okay, what are ways that we can improve that conversation around why someone needs to go from that initial consultation and exam into an active care plan?

And so we can’t really start looking at what are the main things that cause that performance to increase if we don’t know what that baseline number is. So we need to know how many new patients are turning into return patients. And again. Get grounded in a weekly cadence of this. You can just look at a few things per week and that will start to give you a few metrics that make it really evident what’s going on in your practice, and you can always go from there.

I. All right, the last one with all these numbers this is one people don’t often think about, but it’s very important when you’re looking at planning your income and predicting out what your scheduling is going to look like. What is the average number of sessions that a new patient. Who then gets into an active care plan?

What does your active care plan session wise generally look like? And depending on your specialization, depending on the amount of days that you practice depending on, if your cash or insurance a lot of these things shouldn’t make a difference in this number, but realistically they do. It’s a little easier to have a conversation with a patient who’s paying with their insurance that they need to come three times a week.

Maybe that’s not as easy when you’re in a cash practice. I will say, and I’ve done shows on this before, I think that management of expectations and that communication is critical. You need to be telling your patients first and foremost what is best for them, what’s best for their health. And you can always come back to, okay, that’s not feasible for you.

Then this is how we can adjust. And then if that’s not going well, you can revisit. This is why I said this is what the frequency should be. But you need to look at what is that average number of sessions that you are prescribing someone as part of a treatment plan. Is it six for an additional an initial round?

Is it 12? Is it 10? So that when you know how many new patients am I bringing in and that what percentage of those patients are coming back and what is the average number of sessions that those returning patients are going to be engaged in? That really allows you to plan things ahead of time. So you start to see those trends in when new patients are typically coming and the activities you’re engaging in around that.

You get to see, all right, this is my conversion rate. This is who I’m bringing in as a new patient who then becomes a returning patient who’s engaged in an active care plan. And then, okay, what does that care plan look like? Now that they’re converted, and I know that . 50% of my people or 80% of my people are going to be engaged in an active care plan if I know that’s generally sessions.

Those three things allow me to plan very well and have a really good baseline for starting to look at my practice and how it’s doing, how it’s growing and when I need to bring on more help. . Again, like I said, the majority of people are not tracking. So if you just start with these things, you’re really going to have an incredible opportunity to be ahead of the game, like ahead of 90%

Of the practitioners that I talk to just by starting these. And you wanna compare you to you. So I think sometimes when we’re at the beginning of practice or when we’ve been stuck at a particular cadence and we’re trying to grow out of that and not be at a plateau, it can feel a little challenging.

We can play that comparison game with other people. It is important to measure growth. Also U to U. So if you were doing four new patients last month and you’re doing eight new patients this month, maybe that is not the same cadence as the acupuncturist down the street who’s been in practice longer.

But that’s a huge increase. That’s a 100% increase. So we should be excited about that and be able to then look at that and say, okay, something’s working. What are those things that are working? And also this can be a very isolating profession. So you wanna ask your colleagues, you wanna see are other people tracking things, what’s been really helpful for them?

People who are able to convert most of those new patients who do consultations or exams into returning patients. What are things that they’re doing? So really trying to leverage the people around us and create that support system is key. I love talking about this stuff. And this is always fun bringing you guys these bite-sized nuggets for your practice.

But if you ever have any more questions, please feel free to reach out to me at aac and don’t forget to tune in next week for another episode of To the Point. . .

 

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Acupuncture Malpractice Insurance – Your 2024 Fee Schedules

 

 

Click here to download the transcript.

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

Greetings, all my colleagues, all my friends. Welcome to 2024. This is our first show for you. This is through the American Acupuncture Council, but I’m from the network. I’m the coding and billing expert, Sam Collins, and one of the big questions I get every year is, Sam, what do I do about fees? What has changed?

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What is updated? Of course. We do a big seminar on all that, but I wanna give you a little thumbnail of what’s going on for 2024. What can we expect for fees? Were there updates? What’s going on with deductibles? Can I raise my rates? Let’s get into all that. Let’s go to the slides. Let’s talk about 20, 24 fee updates.

Now, when I say updates, does that always mean an increase? Let’s face it. For many of you who have been in practice for many years, you’ve probably noticed. Sam, my fees from insurance companies that I’ve been contracted with for years have not gone up. Particularly those that belong to groups like I don’t know, a SH and similar, you’ll find those fees have remained stagnant.

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We’ll talk about how you may be able to. Change that a little bit, but let’s talk about what’s going on for 2024. I think and under understand what our fees should be. We gotta think of how are our services valued? Who determines the worth or value? Who sets these fees? The fees are set really by the community in a way though obviously it’s gonna come back to the payer of the service.

What is the fee allowance for it? How much do we allow? What can we charge? It is interesting in our healthcare system. I’m sure you’ve noticed. Insurance companies can tell doctors what they’re gonna pay. Period. End of story. Take it or leave it. But do you ever notice that’s not the same for pharmaceuticals?

Now, that’s a whole nother topic we’ll get into, but bottom line is there is some mandates to what fees we can charge, particularly if you’re in network. So who sets the fees are gonna be the community standards, of course, for cash patients, what our patients will pay, but for insurance, who sets them? How are they set?

Part of it is gonna be something called a relative value unit. And that is the value of a particular service compared to another. The federal government has done this since the early eighties, and they do a study each year that updates the value of services from one to the other by example. Some fee schedules just use a simple conversion, a number, and then they take the relative value of your service.

Multiply that, and that tells you the fee. You’ll see this very commonly in workers’ comp in many states by example, in Texas, they’re gonna take the relative value multiply by 64, 83 or in Connecticut by 51 50 in let’s say Utah, I believe by $61 in Minnesota, or excuse me, in Michigan, they allow 200% of Medicare.

So it’s based on this relative value, the value of one service to another. I wanna give you a thumbnail of that. So you start to understand what does a service value at? I find most offices I consult often have fees all over the place. One fee, great, but then the other fee in relative terms is not correct.

So I wanna take you through how do I make sure to have relative values work for me to know the value of a service? We’ll keep it simple, but it’s not that hard. Obviously though we also have to deal with contracts. When you belong to an insurance, they set the fee for you. They tell you, Hey, join us.

This is how much we’re gonna pay you. However, it’s not gonna be as much as you’d like, but we’re gonna send you more patients. So you have to determine whether or not does that offset. Make up the difference. Can the volume make it up or is it fair? You’ll see these with preferred provider organizations like your Blue Cross’s, blue Shields, but you also see this with HMOs, particularly bigger, insurance companies like a Kaiser and that type health net, that study specific fee for that one.

But this means also the patient can’t go elsewhere. So the attractiveness is when you belong to these contracts, the patients get a better benefit, meaning less out of pocket, sometimes no out of pocket with these, but they set the fee. So you have to look at . Ooh, what is that fee? Is it fair? By the way, are there some things you can do or should do yearly to see whether or not you can get a fee increase?

’cause if you don’t ask, they’re not going to do it. Of course, you have to deal with fees, but also deductibles. What happens with deductibles? Deductibles start first a year, but keep in mind some deductibles. Based on when the patient visited, the prior year may roll over. So check the plans. Some plans may have, say a thousand dollars deductible, but any services the patient may have received from the last quarter of the year prior may apply to this year’s deductible.

I always thought that was unfair when you think about it. What if you got sick in December? Hadn’t gone to the doctor before you pay your deductible. Then January rolls around, oh, new year, new deductible, where now they’ve have a product where insurance is that often will roll that over.

So that’s certainly something to look at by example, deductibles for many types of plans can remain stagnant. 2 5500 thousands of dollars by example. The Medicare deductible did go up $14 this year. Prior in 2023 it was 2 26. This year it’s two 40. So do check that because of course deductible is the amount the patient has to pay out of pocket.

And then we have to figure out what’s that fee that we’re charging so that the patient is paying their portion? ’cause of course, you have to remember, there’s going to be co-payments and co-insurance, and let’s define that. A little bit better, I hope for you. When it comes to fees, the patient’s to pay their portion, when you belong to an insurance like a PPO or an HMO, we often turn that as a copayment.

It’s a specific set amount of money that is per the contract that says, oh, this patient pays $10 copay, $20 copay. So in other words, no matter what the patient receives, you’re gonna get some type of payment from the carrier and the patient’s gonna pay $10 or 20 a fixed amount. Sometimes it could be a percentage, though it could be 80% of the allowed rate, which means 20% of what was billed or allowed.

But often keep in mind we use the term co-payment to mean you are in network. It’s a set amount, but co-insurance would be a little different. And this is where it gets tricky when you are not in the network. What does the patient owe? That would be the co-insurance. In other words, everything the insurance has not paid.

So by example, if you bill a hundred dollars to the insurance and it pays 50, what would be the co-insurance? 50. So that means that patient would pay 50. Now, here’s where you have to be careful. What if you’re billing three different insurances and they all are being billed a hundred dollars? Same service.

One insurance pays 50, one pays 75 and one pays 90. If you’re out of network with each of those patients correspondingly have to pay you. One of them has to pay $50. One is paying 25 and one is paying 10. In other words, you’re not accepting what insurance pays this payment in full, but it’s a part of it to pay your full amount.

In other words, you’re getting paid a hundred some from the insurance, some from the patient, and this is the variation that when someone chooses to go out of network, they’ve gotta pay that entire difference. I’ve had a lot of acupuncture offices have some issues with that because what you cannot do is bill insurance as a fee, and then just simply write it off.

Unless you’re contracted. Now, when you’re contracted, that’s where the copay comes in. It’s fixed, but if you’re not contracted, it’s the co-insurance. So do be careful when it comes to setting your fees. Should you set your fee off the best paying insurance you have. Let’s face it them, there are some insurance plans that pay acupuncturists, and you’re gonna think, I’m kidding.

For some states, three to $400 a visit, I kid you not for acupuncture. That’s how much it’s valued. That’s great, but what about a plan that doesn’t value it that high? When I bill that high amount, does the patient have to pay the difference? The answer is yes. So you wanna be somewhere in the middle of what you’re gonna afford or what a patient can afford.

And remember, you always have to keep in mind my prices for insurance, if you will. Have to pretty much match my cash. Now, that can vary a little bit if you’re in the state of California. Familiar California has laws that allow you to have kind of that dual fee. But in other states, no. The cash price has to be essentially equal to the insurance price.

Maybe a small time of service discount, five to 15%. So when we’re thinking of how services are valued, it’s how do I value them? What’s their worth? How do I value it? What’s the best way for me to think about it? I think for 2024, what I hope to get more offices to do is begin to realize that if you are not doing something to update your fees, carriers will not.

By example, this year, Medicare has reduced fees, not by a lot, but by a very small percentage. They go, oh, how dare they? Has nothing to do with the doctors. Let’s face it. Is Congress and our government a little bit dysfunctional when it comes to budgeting? So of course, where do they start to cut? Will they cut other standard types or fees for Medicare?

Hence where that came from, has nothing to do with the value. It’s just, Hey, we’re gonna cut this. So realize, be careful if you’re gonna use Medicare rates. Realize Medicare rates went down this year. So this, should that mean, oh, I gotta lower my rates also? No, absolutely not. I would in fact, think, hopefully you’re doing this already.

Should you raise your rates 2%, maybe 4% a year? Absolutely. Because if you do not, how do you make up the difference of cost of living? Think of it. You can go years with the same rate and go I’m not making any more money. How would you when you’re not charging more? Because if you see the same patient volume, it’s gonna be the same and there’s gonna reach a finite point.

How many people can you see in a day? That’s not going to change. If you’re treating a person for 45 minutes, you’re gonna see maybe 10 or 12 maximum. Maybe a little bit more, but give or take, so you reach a point, you have to figure out how does this office continues to sustain when all your other increases, your cost of living prices, your cost of needles, your cost of gowns, all those things that go with your office.

So we gotta start to think of, I’ve gotta start to value and make sure am I setting the right fee? And this is where I hope to help you. Relative value units are the value or a fee comparison. Of medical services and overall, every CPT code, every single one has a relative value. And what this is based upon is the value of the service based on several factors.

The work value, the cost of delivering the service value, the cost of your education. So you’ll see when it comes even to acupuncture, there are variations that are year to year, and it simply just compares. One code to another. So make this very simple. If you have a code that has a relative value, let’s say, of 0.75, and you see another code, even if you don’t know what the code is and that code is worth a 1.0, what that should tell you is the value of the code worth one.

Should be 25% higher than the other, or 25% lower based on which way you’re moving. Because what I often find is acupuncturists in particular not understanding this way, undervalue services such as exams and therapies ’cause not understanding the real cost of them. It’s like owning a house in a neighborhood and not understanding the value of the neighborhood.

Remember when you do or sell a house, you don’t just go I paid X, Y, Z for it 20 years ago. I’m gonna charge this much more. What are you gonna do? You’re gonna look at the cost of the neighborhood. That’s what relative values do for you. So let’s look at what’s happened from 23 to 24, and you’ll notice not much of a difference.

1.14 is the value of 9 7, 8, 1 0, and 23. It moved up one percentage point in 24, 9 7 8 1 1 was 0.86 now to 0.85. But what I hope you’re seeing here, do you notice that’s a 30% difference? The big takeaway here is. Whatever my price is for my first set of acupuncture, the price corresponding below, it should be about a third or 30% less, give or take.

Now again, that means if my first set price was a hundred, what would be my second set price? About 70. That’s how you wanna think of it. I don’t wanna see you value something too low or too high. By the way, if you could tell me what an insurance pays for one code, I can tell you what it pays for the other, because every code.

Has a relative value by example. Do you know an exam 9 9 2 0 3 is worth three times the value of your acupuncture code? And I bet many of you undervalue that. So that means the price of a 9 9 2 0 3 based on relative value and cost should be three times that price. Where this helps you though, is you wanna start to think of what about the states, like I mentioned, like

Texas that they look at your RVs and give you a set fixated number to multiply 64, 83. By the way, Medicare takes this and goes by about $33. Now that varies a little bit depending on your location and state, but on average. So what I hope you can take from this is when it comes to your fees, when you’re updating this year, think of the fee differences, your difference between each code.

You’ll notice it’s about 25%. When it comes to the electro acupuncture, but you should be in the 25 to 30% range between the codes. By example, if I bill a hundred dollars for a service, but an insurance is willing to pay 120, if I bill 100, how much are they gonna pay me? A hundred, but they would’ve paid me one 20.

Have you ever noticed no one says, oh, by the way, we would pay you more . So you really wanna start to do a fee survey. That’s one of the things I do with our offices. If you do our seminar, of course, our network. I really dig into that and start looking at what’s your area? What are the costs? How do we look at the relative values?

What do other fee schedules tell us? Because you have to start thinking when you’re setting a fee, what is usual and customary for your area. What is it? The average, but also what is fair? You gotta think of, I might have an area where I could charge more, but you might say, no, Sam, I want to value it.

’cause I want to take care of the underserved group and have my practice more based on cash patients, which are per perfectly fine. But then we know that, and that could be why your fees are a little bit lower than the average. Because keep in mind it says here, may I have a dual fee schedule. Not really.

You have a service and a fee. Now I will clarify. Can you have a fee schedule that is for your ? Contracted groups, like a SH $26 $40. Sure. And then your regular insurance price. Because it’s by contract. Technically, yes. But once you’ve set a fee for insurance outside the contract, it’s pretty much the same across the board.

You’re not gonna have a hundred dollars for insurance and $50 for cash for the same service. Way too far off. Remember, you do have to collect, meaning if you’re billing a hundred and you’re not contracted, you’re collecting a hundred. If the insurance pays some portion of it, great, the patient pays out of pocket.

So start to think of for fees. What’s fair? What would I pay and what do I expect my patients to pay the value of my service? Remember, create value. People will purchase. Remember, the cheapest office is not always the most successful. In fact, often not because it’s perceived, it’s not as good a value. Give the patients good care, a fair and reasonable price.

But being cheaper isn’t always the thing. So I’d like you to start thinking of, if I’m gonna raise my rates this year, how and where do I do that? Do I use relative values? Do I look at common fees in the area? Yes, you should do all of that. I would look at your work comp fees. The simple rule might be just looking at the Medicare fee schedule and thinking what percentage above that.

’cause at least that way you’re doing relative values. It’s one of the things we give at our seminars is you get your fee schedule for Medicare and then can start to work off of that. Or even better, we work one-on-one on that, because you gotta start to think, if it’s first year, it’s time to start thinking of that.

How do I raise my fees? Do I have to inform everyone? You just raise your rates. You’re certainly gonna put notice that you’ve increased, but simply you’re just increasing. Be careful. If you’re not increasing, no one will. What? If you’re billing below what they allow, you’re simply gonna get that allowance.

Don’t be afraid to do more. And what if you are a network? Have you ever thought about asking for a raise? What things do you need to do to get that raise? You know what you have to do? Really create a value. To them show, Hey, I’ve been in your program for many years. Here’s the cost of my services. Here’s the value I bring.

I’m a tier six doctor. Let’s say you’re also an underserved. The more you can, I will say, I’ve had a few offices this year. When I say this year, I should say 23, that actually have gotten a 50% increase in their rates from managed care, particularly a SH. It’s something I’m finding is happening more if individuals are requesting it and you’re in good standing.

What I want you to think of though is that it’s first of the year, have costs of living gone up for you, gen generically. How has that gone up in your business? Have you really start to set a precedence if you don’t raise for years and then raise it 10 or 15%? People go, oh wow, but what if you raise just a small percentage every year?

Keeping yourself within range and keeping in mind how to balance whether you want more cash or more insurance. But what I’m careful of is if you’re not mindful of your fees in your store, no one else will be. I’m gonna say patients at the end of the day are gonna be the ones that are gonna dictate what can I charge?

I. What insurance is allowing. That’s not gonna be the end all be all, but it gives me a feeling for it. What about my contracts? How do I make those work? That’s what we do with the network. It’s what we do with our seminars. This just is a thumbnail start to learn how to really make your practice do better.

And it’s not just about insurance, it’s about everything and being successful in enjoying what you do. The American Acupuncture Council is your partner. We want you to be successful because if you’re not, you have no need for our services. We are partners. Good luck and best wishes for the year. . .

 

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Acupuncture Malpractice Insurance – Supporting the Immune System in Winter

 

 

I’m happy to talk about today about supporting the immune system with Chinese medicine during the winter months.

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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 and happy New Year. My name is Moshe Heller from Moshen Herbs and I’m happy to talk about today about supporting the immune system with Chinese medicine during the winter months. So let’s move to the slides so we can start. Discussing. Today I’m going to talk about, as I said, supporting the immune system with Chinese medicine.

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This is a subject that has been on my mind because in my office, I see a lot of patients who are sick. AnD I always have this call saying, oh, I’m feeling under the weather, I think I want to cancel my appointment. And we hear that a lot that people say, oh, it’s just a little bit of a cold, but maybe I’ll wait and see how it’s going.

So I. Make it a really important aspect to, or important point to educate my patients that it is actually very important time to either comfort treatment if acupuncture is possible to to give. But if not, the minimum is to take some herbs because this is the beginning of any pathogenic influence.

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Attack is the time to treat it. Super, super important to teach our patients that it is important to support the body at the beginning of any cold whether it’s a flu or any other illnesses that start with signs of a cold. So I also wanted to remind everybody that we when when I discuss a lot of times the immune system, I tend to point out the importance between our neuro gastro immune relationship.

There’s a triad that is really important to pay attention to. So when we look at the immune system, . We also need to take care of the gastrointestinal system as well as the neurological system because they influence one, one another and they are connected. maKing sure that the, in terms of the digestive system that it, that you’re supporting it with the correct nutrition and correct foods as well as maybe the making sure that the biome is being supported also. And in terms of our neurological system making sure that we are able to sleep well, relax and not be overstressed or

Influenced by, by affecting the creating a sort of a hyperactive neurological system because of environmental issues. iN Chinese medicine, we su we see that neuro gastro immune complex. So clearly when we look at the production of Qi and blood in our in our in the theory about that, that everything comes from the middle burner, the spleen and stomach receive food and digestion.

And they also, then they transform that into what we call Gucci. And the Gucci then connects with our with either the lunchie or the clear chi of the lung and produces the waiti and and the also the yin chi. Then that further connects to the heart. And in the process of making.

Blood. And in that connection with the heart, I think is the connection to our neurological system and our brain, right? The relationship between mind, brain and the heart is very clear. So again, we have this kind of neuro gastro immune connection that we always need to remember when we are addressing issues of the immune system.

So I want to discuss in this the, this idea in two aspects. One is the process of selecting or supporting prevention before we get sick. Before we get sick. whEn we have, when we ha when we are not sick and we want to prevent us from being sick we, we think of formula that a classical formula called ING Fang Sun.

I created a different version of that. And in Moshen herbs, we sell it as a shield. So this formula is based on ying fang San, but added some other aspects, which we’ll see in a bit to support or support the immune system as a preventative for for having for not getting sick.

So I just wanna make sure that it’s clear that. Sometimes we need to take, if we see a patient that has a weak che or a weakness between the che and the yin chi. It is also important that we. Continuously give f or shield for at least three months, a three months period. It’s a it’s a formula that takes a while to sink in.

And it’s even if you get sick in that period of time, I usually combine the shield with other formulas, which we’ll discuss in a second. I also classically Yin Chaan is sometimes used in low dosages as a preventative also for, people with stronger constitution and xo. Huang also is sometimes used as a preventative, especially if some patients who have a weaker immune system, which we are concerned that had in the past a lingering pathogenic factor.

And we wanna make sure that the sha young level is harmonized and working well. hEre’s the shield. I wanna take a few seconds to talk about the SHIELD formula because it is it is based on y Ping Fang, but I actually combined it with the two emperor herbs of Kuang. And so together these formulas strengthen the exterior, but also harmonize the function between the weighing the Yin Chi.

And if they an encounter with a pathogen happens, the body’s able to resolve it quickly so it doesn’t stop you from being sick completely, but it supports your immune system or your way in chief weighty and yin chief function to resolve the pathogen effectively and quickly. I also added another aspect into this formula.

I wanted to make sure that the chi transformation is complete. So I added the two cured decoction or urchin tongue which is another two. Herbs, Banian, gen P. Those help the transformation of dampness. And and therefore in support the normal functioning of the spleen. I Also added some more support with Chen, which is sometimes called Prince Ginseng.

It’s would allow the formula to be also a chi and supportive or strengthening but really appropriate for children. It’s not as warm as, and it’s more even than having actual wrenching. , I added another another herb for supporting the immune system or or consolidating the exterior and bringing the kidney support to the lung with weight.

w Weights to strengthen that function. And I also, last thing I added is gogan for supporting the mu muscle layer and also the digestion and. Lingers and an AP adapt adaptogenic mushroom to support the immune system. So SHIELD is a, is really a beautiful formula and used for a wide variety of issues surrounding immune imbalances from 10 C to allergies to to weakened immune system and as a preventative.

For the cold and flu season. So again, just to summarize, ying Fean is this combination of Huang Chi Basu and Fang. Then I added Chen to that from Jiang. I added Baha and . GaN and are here to support the muscle layer and urchin tongue. This is, we used cia. And fooling and added these two herbs of Wu and Ling.

wHen we think of point of acupuncture point selection, of course we have stomach 36. whO doesn’t know that? That’s usually co usually for when we’re trying to support the immune system. Better to use with moa. UV 12 is maybe another point that we don’t think so much about, but is really important for prevention.

It is like the backhoe of wind and it’s really helpful as a preventative. Then making sure that the Q is circulating with large intestine four and re lung seven, stomach 36 and re six. This is an overall q ification in support of circulation of weight, qi, and then also . Of course, advising people to avoid phlegm producing food, milk dairy fried food, spicy food in moderation only.

These are really important aspects to support the, or prevent being sick and also balancing your life between rest and activity. These are all important things. But when we have a pathogenic influence, then we need to consider some other points. And it all depends on the signs and symptoms of the patient that’s presenting.

Sometimes if there’s more heat we’ll need to use or points that relieve heat D 14 and large intestine 11 rather than . Four. When we have more cold, we might need to use lung seven and large intestine four to relieve the exterior and gallbladder 20 to help relieve the wind and triple burner.

Five. we Can also consider using cupping and again the same thing for prevention, preventing, avoiding phlegm producing foods and which is milk products. Wheat products and fried foods, spicy food all of that should be reduced or avoided. And of course, drinking warm soups are very helpful for supporting the immune system and from the center.

The formulas that we might consider Yan is for wind heat in the exterior. Ian is also for wind, heat, but when cough is added in Yin Yan, you will have a little bit of sore throat. anG is when there is a little bit of that kind of un imbalance between the ying and the way. So there’ll be cold symptoms, but the disease might seem to be a little more lingering.

GaN Mal Ling is a patent medicine that is made for I think the main in symptom that I usually look for gun ling is, is a sore throat because it has some really herbs that clear heat and toxins and are specific for the throat. And also shouting tongue is when we have cough and a lot of cold phlegm.

So these are example formulas. wHen we have formulas for when we have formulas for a pathogenic influence this is a continuation, we might need to use xang. If it is a penetrated, the more the middle layer or the Shao yang level we sometimes need to support with

Oh. Support the resolution of of phlegm. Just to clarify now, these are form the formulas that I am talking about are formulas that help to recover from a pathogenic influence. So sometimes we have patients that come in and they’re . They had a cold or a flu and they’re still not a hundred percent clear.

This is really important aspect that needs to be addressed because we need to clear the pathogenic influence and sometimes the res, the residual from the pathogenic influence is usually or could be pH flaming dampness, which can linger and we want to help the body kind of support.

Resolving that completely. So these are formulas that we might consider for that. Hai Huang is one of them. When there, the pathogens lingering in the middle level, urchin tongue, if there’s too much or residual phlegm. Cia ang. is When there’s flamin, its really stuck in the throat, right? It’s like the plumet formula.

Ling Baan is the formula when we have dampness in the spleen in the center, and BHO one ian or variation of bowel one when we have residual issues with digestion or with the digestive system. So these are the formulas for recovering. so Thank you for listening. I hope this little short talk helped you understand how to maneuver or look at formulas from different formulas to support the immune system during these winter months.

We have a lot of the patients coming with these kinds of issues.

 

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Acupuncture Malpractice Insurance – Lung Channel Anatomy and Function

 

 

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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, I am Brian Lau. I teach with sports Medicine Acupuncture, and with the Sports Medicine Acupuncture Certification program. I also teach with the three day cadaver dissection labs. And a little bit of the dissection is the impetus for why I’m gonna do the particular presentation I’m talking about today.

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First off, I wanna thank the American Acupuncture Council for having me. And we’ll go a little bit into the lung channel and the anatomy. We’ll look at some movement aspects of the channel also. So I just finished up two back-to-back five day dissections. I do this every year, the first two weeks of December with the University of Tampa with the Physician Assistance Program.

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So I had a lot of opportunity to look internally with the body. We did a lot of external dissection, but we also did evisceration and we went into the abdominal and thoracic cavity. So that’s with physician assistants. I’m not really talking much about channels in there but I’m always thinking about the channels and I’m preparing for when we do dissection for acupuncturists how to communicate some of this anatomy to acupuncturists.

So that’ll filter in a little bit to this presentation today. And then we’ll go into some application with movement. So you can give some patient exercises that will engage the channel in this case, the lung channel fully. So let’s go ahead and go to the presentation and we’ll start jumping into the anatomy.

So let’s get a start. We’re just gonna go right into the internal pathway. So let me get the setup for this. So let’s imagine we’re in a prolonged, like a five day dissection lab. We’ll go briefly layer by layer. So what we have here, . is on the slide on the left is we have skin on at one portion.

We have some subcutaneous fat in this ne netter illustration, but primarily that’s been removed and we’re down to the level of the fascia above the rectus abdominis, the fascial, the rectus sheath, and the external obliques. So we can see the rectus abdominis underneath this rectus sheath. If I were to

Look at it from the back surface. That’s what we’re seeing in the right image. So in this case, we’re looking from the back through the body visceral cavities removed, and we’re seeing the peritoneal cavity from the back but the front surface of it. So here’s the rectus abdominis. You can see a window of it.

But what I wanted to highlight from this image, first of all, you have the falciform ligament, but another interesting structure is a remnant of the . This little ligament, which is the umbilical ligament, which is a remnant from embryological development. And this whole line here is very tied in with the linear alba, which is that thick Foss structure that separates the left and the right side of the rectus abdominus.

So a nice imprint of the Ren channel or the Ren mine. So we’ll come back to that a little bit now, but I just wanted to highlight that. Let’s go to the next slide. And here in this image we have the rectus sheath removed from the rectus abdominus. So this is what we would do in dissection is we would start to come underneath this rectus abdominus, just creating a little separation from the rectus abdominus and the tissue underneath.

And we would start lifting it up. And that’s what we have in this side right here. We have the rectus abdominus starting to be removed, and you can already get a imprint. You can see the peritoneal. Membrane, the serous membrane, and you can see some of the fascia under the rectus abdominus. The reason I’m going to this detail is when you do this dissection, sometimes it’s very adhered, and as you start removing and lifting the rectus abdominus from the pub pubic bone and lifting it off, it starts to tear the peritoneum because of all the adhesions there.

And why would that be so adhered? We have to get into the next layer, which would be the first layer in the visceral cavity in the abdominal cavity. And I’m gonna go right to that here. And this is what we would see as we open slice that very thin peritoneal membrane. We have the greater momentum and we have the stomach hanging off.

The stomach is that greater momentum. And if everything’s moving well on that person before they passed, then you can just easily kinda lift the undersurface of this greater momentum. Lift it up. And what underneath it is the transverse colon. So it’s very adhere, not adhered, excuse me. It’s very tied into, connected to that greater momentum.

So it’s connected to the stomach and it’s connected to the transverse colon. So that’s a lot of anatomy. But I wanted to highlight this anatomy ’cause it gives us a really a window into the internal pathway of the lung channel. When we look at the lung channel, . We’ll look at it now with different eyes, so we’ll look at that in just a moment.

But I do wanna highlight that on many people when we’re doing dissection on many specimens, there’s a ton of adhesions because one of the things this greater momentum does is it surrounds pathogens. So if you had, perforation, like an ulcer in the colon, it would surround that. And there’s a lot of lymphatic tissue in there.

There’s lymphoid. Cells that are gonna take care of those antigens. Or if there is some kind of entry of of some pathogen into the peritoneal cavity, that greater momentum can migrate around and surround those areas. So people who’ve had a history of peritonitis, it’s gonna be extremely adhered internally so they don’t lift as well, and you can imagine that they wouldn’t be able to move as well.

Also. So one more bit of anatomy and then we’ll look at the lung channel. Is the greater momentum hangs off the stomach. Let’s move up into the thoracic cavity. Oops. Wrong direction. And here is the continuation of the stomach, the esophagus, as it passes through the diaphragm, and as I go a little higher up, I get into the trachea and bronchi and those also are very connected with each other.

You could dissect them away, but it’ll take a lot of work. They almost are one unit. So now we have a lot of anatomy to go and look at that internal pathway of the lung channel. So let’s look at that. Here it is. So we see these, we study these internal pathways but it’s sometimes not always clear what the anatomy is when we learn ’em.

So we can now see that yes, we do have these bronchi break branching off the trachea. We could follow down the esophagus. We’ve learned when we learned the internal pathway that the internal lung path channel pathway connects to the stomach, it loops down and connects to the large intestine.

And that’s exactly what the greater momentum does. So what I’m proposing for this internal pathway is we have the trachea and bronchi, the esophagus, the stomach, the greater momentum linking with the large intestine at the transverse colon. So structures match. It matches the description of the internal pathway, but reminding ourselves again, that greater momentum has an immune function, that it has lymphoid cells in there, cells that migrate and take care of pathogens, also links with the actual function of the lungs because they do have a lot to do with wayI, wayI and the surface of the body.

This is at the surface of the internal . Abdominal cavity, but still taking some account of the immune response or the wayI response. So function and form, both match. I think it’s a really good a really good model for understanding the internal anatomy of that internal portion of the lung channel.

So let’s branch out now to the actual main channel. . But we’re gonna primarily talk about the sinus involved with it, because we’re gonna look at some movement aspects that, that we’re gonna, I’m gonna introduce that can help stretch and open and engage that outer channel, but also engage that inner inner branch of the channel.

So this is what I have as a model and what we teach in sports medicine, acupuncture. For the lung sinu channel, we have the pectoralis minor biceps, brachii, short head and long head. This bicipital a neurosis, which is an extension of that links in with the flexor carpi radialis, and then into the thenar muscles.

That’s the superficial branch. There’s also a deep branch of the sinu channel, which is the flexor lysis, longus, flexes. The big thumb, the brachialis, which lies deep to the biceps a little bit shorter. It doesn’t cross the shoulder joint, just crosses the elbow joint. And then that links up with the anterior deltoids and the clavicular head of the pectoralis major.

So we also have the scalings in there, especially the anterior scalings. I don’t have that listed in my list. But the, there’s that superficial branch all the way up into the thumb, to the pec miner and the deeper branch that lies underneath that. The main channel would follow the course, the little spaces between a lot of these mussel.

So these could be almost like the river banks. With all the river being the communication that happens in those fossils spaces. A lot of the organisms and such in the river. You could study a river, but you need to understand the river banks, the structures that make up that river, that form that river.

And that’s what the sinu channel’s kinda so for the rest of this webinar, I would like to look at a movement, a Qigong exercise that I give to patients. I also teach in Qigong classes. And this will exercise that external portion. It’ll engage those sinews, but I also wanna show how that’s gonna gently mobilize and move and massage the internal portion, the esophagus, the bronchi, the greater momentum, the stomach.

So I think if you wanna fully exercise the lung channel, it needs to have all of those components there. And this exercise does that nicely. There’s plenty of other good exercises, but I like this one particularly. sO this exercise I have on my YouTube channel, I did it a little bit differently when I filmed it originally.

I focused a little bit more on the stretching aspect. I’m gonna put up another video, same exercise, but I’m gonna do it the way I’m showing in this particular webinar. So that should be up soon. But either way you can check out the video on my YouTube channel if you wanna get a reminder of it.

Or this recording will be available afterwards too, if you wanna have a reminder for it. So if you used it yourself, great, you have some nice memory aids, but also if you give it to patients, it’ll be something you can refer back to. All right, so let’s set it up. So this is gonna be the exercise. It’s a very simple exercise.

Anything, anytime we engage these this lung channel, we wanna engage the sinus, of course, but we al engaging the sinus will open and close the chest, but we also wanna mobilize that internal pathway of the channel. We’ll look at that kind of point by pint. This is gonna be engaging the lung channel, but really when you’re engaging channels, you tend to do ’em in networks.

So this will be really the Y Ming and tie-in channels as a whole. So that’ll be the lung and spleen channel, the large intestine and the stomach channels. But the primary focus for this one is the lung channel. So we’ll come back and look at this video afterwards and highlight some features of it.

But let’s move on to the next slide.

So this is the starting position. This video will loop and you can see it as I’m talking about it. So I’m gonna start by bringing the hands up. I’m standing shoulder width stance. My arms are gonna cross in front of the body. The forearms are supinated, which means basically the palms are facing me.

Our palms are facing the chest. The hands are a little ways away from the body, so the shoulder blades are slightly pronated and the elbows are slightly lateral to the body. So that’s our starting position. I did mention in there that you’re standing at shoulder width. This exercise works perfectly well seated.

If you’re working with a patient or yourself and you have mobility issues and aren’t able to stand even somebody in a wheelchair. I, when I work with people seated, I have them slide forward sitting on their sit bones, sitting upright, so they’re away from the seat and, their sit bones basically serve as their feet then so that they’re able to have an upright posture in the same way that I have an upright posture in the standing version.

Okay, so I’m gonna start by opening the chest, which really means that I’m starting to retract the scapula. So the scapula are starting to pull together in the back. You might be able to see that in the mirror that I have behind me. That I’m starting to retract, bring the shoulder blades closer to the spine.

I’m opening the elbows while keeping them down. Pronating the forearms. So the pronation will start to stretch the biceps, and at the end of the opening, I’m gonna push the hands away from the body so the elbows will be extended. Also stretching the biceps. So generally . There’s a problem that I see when I give this exercise to people, and I wanna highlight what I wanna do before I highlight the problem.

You’ll notice as I’m doing this in the looped kind of version here, is that my hands start narrow or start medial to the elbows, but then they get ahead of the elbows. So that’s what I wanna do. I wanna keep the elbows down and I want the hands to go wide to the elbows. There’s a nice midpoint.

That you can notice where the hands line up right there, they line up with the elbows just on the side of the body. I’m gonna put my cursor over it. So right here. So there’s a point in time where the hands, elbows line up, the hands are facing out. This keeps my elbows from going wide. The point is a lot of people are internally rotated in the shoulder.

And if they keep their elbows wide, then the the arms stay and internal rotation. And I want my arms to externally rotate so that the whole structure opens up. So that’s a little landmark you can look for when you’re doing it yourself or when you’re giving it to patients, is that lining up right lateral to the body and then the hands continue out?

So this is the expansive phase. I’m starting to stretch the biceps. I’m opening the chest by retracting the shoulders in the back, which creates more space in my chest. Creates more volume in that whole thoracic cavity. So let’s look at the compressive phase of the movement. So once I’m fully open, I’m gonna start, you’ll see a little gentle contraction in the abdominals, which starts to compress the torso as I fully push out.

And that’ll take me into a further pronation of the forearms and a winding type motion in the forearm. So let’s look at that. So hands push, out turn. So you might be able to see a little better in the mirror is that the torso bows slightly. My abdomen bows my spine bows look at that a couple more times.

So this is where I can start to engage in the front and gently massage that greater momentum. There’s a little bit of shortening along the whole front line during the compressive phase, which then when I continue this movement and go into the expansive phase, I’m stretching, compressing, stretching, compressing.

So as I turn the forearms, then I’m gonna start to reach the arms back. So that’s the compressive phase of the movement, and then it returns back to the same position.

I leading with the fingertips.

So fingers come forward, I cross my hands, return my chest lifts, and that bow that was in the torso, un bow straightened. So I get a nice gentle stretching and mobilization of the inner part of the channel.

All right, I’m gonna go back a couple slides and I wanna look at the full exercise.

So hands come up, cross slightly away from the body, open the hands, expand the chest, push out slightly, compress hands back. Return back to the starting position.

Hands out, push, compress, hands back, return to the starting position.

All right,

so I’m gonna end the PowerPoint.

Yeah, very simple exercise. I would highly encourage you to practice it. Like I said, I’ll put up a video on my YouTube channel, but this video, I think it has the a little snippet of it so you can get the idea of it. But the goal is to open the chest, create more volume in the lungs, but then as I start to compress everything, bows.

Then I go back to the expansive phase, so there’s movement inside so that I can gently mobilize that greater momentum. I can gently mobilize the stomach, I can gently mobilize the trachea and the esophagus in combination with what I’m doing on the external portion of the lung channel. So the whole channel is active and the whole channel is engaged.

So I use this for a lot of different things. You could use it really for anything where you wanted to improve the health of the lung channel. So that could just be preventative, of course. Respiratory issues would be a key component. Of course, if you’re working with people with respiratory issues, you want ’em to have that full volume in the chest.

shOulder problems is one that I give this exercise to quite frequently. You have to make sure that there’s no pain with doing it. So one component is that turning internal rotation, once I’ve stretched out, is I want that to come as much from the body as opposed to all my arm where I’m cranking my shoulder forward.

That can create a lot of pain for people who have shoulder problems, so I have to be very gentle. I’m starting from the distal portion, winding my arm, compressing my torso slightly. So it should be very comfortable for people. There shouldn’t be any sharp pain with this exercise. But that’s one where I give this to is shoulder issues.

Neck issues of course, because that shoulder girdle health is very tied to neck neck pain. It’s really versatile exercise. It’s pretty simple. Patients can catch onto it very quickly. They tend to like it ’cause they’re sitting so much during the day if they work at a desk or driving, or so many instances where we’re compressed there.

So it feels really nice to be able to open and stretch the chest and stretch that whole fossil. Line throughout the arms, but also you get that nice gentle engagement in the inside. So give it a try see what you think of it. But you can always reference the video and highlight it.

And if I have a YouTube video up on it, you can give some questions and comments if you want further clarification. I think that concludes the information I wanted to give today. It’s short and sweet. I’m gonna put this information together into a longer class that I’ll put on net of knowledge that’ll be available through lasa and a couple other partners overseas.

But that should be coming out fairly soon. I’m gonna put a little self massage in there and some some other details for treatment, maybe some needling also. This was just an introduction. Got the ball rolling for that. I was very happy to. . To be able to introduce this to you, and again, thanks to American Acupuncture Council for having me on.

 

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Acupuncture Malpractice Insurance – Treating Neuromuscular Facial Conditions Part 2

 

So the topics we are going to cover today are facial motor points. Facial cupping and Gua Sha and derma rolling and protocols for treating specific conditions.

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

Hi, my name’s Michelle Gellis. I am an acupuncture physician practicing in sunny Florida, and today I am going to do a presentation. This is part two of a two part. Presentation on an overview of treating neuromuscular facial conditions. I teach a two-day class on this subject, and I am going to be presenting some of the highlights for you today.

So if we can go to the first slide.

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So the topics we are going to cover today are facial motor points. Facial cupping and Gua Sha and derma rolling and protocols for treating specific conditions. In part one, I went through, Scalp, acupuncture and submuscular needling as some techniques that can be used to help with neuromuscular facial conditions such as Bell’s palsy, trigeminal neuralgia, TMJ, stroke, Ms.

Myasthenia Gravis, ptosis, and others. And today I’m going to touch on a couple of other techniques plus, um, some protocol specific conditions. So the first is facial motor points. And facial motor points. I’m sorry, motor points are, places in a muscle where if you needle them, it acts like a reset switch for the muscle.

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So if the muscle is in spasm and it’s lost its ability to function properly, or if the muscle is overly tense or overly relaxed, if you needle into the motor point. It acts like a reset switch and it will bring the muscle back into normal functioning. And motor points are not trigger points or source spots.

And Chinese medicine, we call them Ashi points, but motor point is where the nerve bundle actually enters. Muscle. And fortunately for us, many motor points on the face are actually acupuncture points. So an example of a facial motor point are the. Facial motor points for the mentalis and the mentalis muscles are on either side of, uh, Ren 24.

And what they do are they help to elevate and protrude the up the lower lip like this, and they can also wrinkle the skin of the chin. Like that, and they are a half a soon lateral to Ren 24. And here in the picture you can see I put little diamonds to delineate where they are and where the muscle is.

And you would needle through the skin into the muscle, but not through the muscle itself.

Here is a very short video. I was teaching a cosmetic acupuncture class and in my cosmetic acupuncture class I was doing a demonstration and of cosmetic acupuncture, and my student mentioned that she had Bell’s Palsy many years previously. And as a result, she had lost some of the inability on one side of her face to purse her lips.

And if she, uh, she couldn’t whistle, if she brushed her teeth, uh, she would have trouble spitting ’cause she could only . Do this on one side, drinking through a straw was difficult, and so in addition to doing some of the cosmetic points I put in the motor point for the mentalis and this is what happened.

So you can see as soon as I put the needle in her chin started to twitch, and then once I stimulated it, the muscle really started to fire, which was very interesting. And she reported back to me that after that treatment, some of the issues that she had been having had resolved themselves. So motor points can be very beneficial when in with conditions wherein your patient, it has lost motor function of one of the muscles on the face.

And this is really apparent with the face because. On our face, the skin is directly connected to the muscles, which is why we can move the skin on our face without having to actually move a muscle. I’m sorry. We can move the skin on our face without having to move a joint or a ligament or tendon.

All we have to do is move the muscle and the skin moves.

aNother technique that can be used to help with neuromuscular facial conditions is utilizing facial cupping and guha. Now, facial cupping and guha has many similarities to the cupping and sha that you would use on the body, but you would use specialized tools that are designed for the face.

And you don’t wanna leave any marks on the face or neck when you are practicing. The facial cupping in Gua will bring blood and cheese circulation to the muscles, which will help with muscle movement. Brings qi and blood to the skin, which helps with . Cosmetic conditions and can also help if the fascia is very tight.

If there are fascial adhesions, it can help with that and . Any nerves that have become entrapped in facial tissue or within the fascia, it can help to release them. Facial cupping helps to move out stagnant lymph fluids, toxins. And if your patient has rosacea or any discoloration of the skin, facial cupping can be very beneficial for that.

And lastly, it helps to strengthen the vascular integrity of the face, increasing the blood flow, and helping with both neurological and muscular conditions of the face. So this is what fascia looks like and. Nerves will run through the fascia and they can become entrapped. Within the fascia. So using tiny facial cups and, uh, special oil that’s designed for cupping for the face, you can stimulate

The cup, the facial acupuncture points. You can glide the cups. You can stimulate the points again, and then you can use these xs symbolize a suctioning and releasing down the SCM under the clavicle into the lymphatic system. And this can really help, as I mentioned, with all of these different skin conditions.

And with facial guha, you’re actually taking specialized tools. These are jade, guha stones that are used to break up fas adhesions, stimulate acupuncture points and increase blood flow in the face. So here is a demo. This is a very abbreviated, demo a little facial cupping in Guha. I am a licensed board certified acupuncturist, and today I’m going to be demonstrating how to do facial cupping and guha.

The first step is to do a lymphatic drainage. Just ask your patient to turn the head to the side. And you’re going to start behind the ear and you’re going to work your way down and across underneath the clavicle times. I start right around Triple Energizer 17. Work my way down. right down the SCM. Now, it’s important when you’re doing this to not drag the cup down the neck or up the neck.

You’re gonna be using a suctioning and releasing until you get to the clavicle, and then you go right underneath the clavicle lung. Two area three movements that we’ll do. One is . A kind of a, like a dragging of the cup. So you would suction the cup and then move it and release it. Another one is a suction and release and just on a point.

And the other is would be like here where you’re dragging the cup. So sometimes you drag, sometimes you suction. And drag, and sometimes you just suction depending on where you’re working, like five and six, seven, and get right on up to stomach eight, just like this and up like that. guHa tools that I like to use are

Shaped like thickly, do both sides of the face at once. Whereas with the cupping, I just do the one side and then the other side, I just showed you the one side. With the gua, I do both sides of the face simultaneously, it feels better for the patient sides of the tool, and you’re really gonna sculpt the jawline, massaging acupuncture points along the way.

So stomach four. Stomach five and then coming along just like that. It’s a great way to help with the saggy gels. You can end with a little massage on small intestine 19 and work on the cheeks, and you can sculpt up this way and this way, and then get right into large intestine 20. And into stomach three, out to small intestine right here.

And bring the tools out, do gallbladder too. So essentially everything you’ve done with the cups, you are reinforcing with the guha tools and it can look like this and like this, and it feels really great. . foR your patients, it helps to break up any fa fascia that might be tense and really just those gels that might be sagging.

All the fat that falls down here, you can really move it back up.

I am. So again, this was just a little I am brief overview. I. I teach individual classes on cupping and guha, cosmetic, acupuncture, neuromuscular and all of these are brought together to help, to nourish the skin, the muscles, the nerves on the face. This is these are the tools that . I was using in my demo.

It’s a cupping and guha kit. It comes with glass cups and these jade guha tools. And there’s instructions, um, on the box and under the box. And there are also video instructions that come with it. And, you can learn about all of this@facialacupunctureclasses.com. Derma Rolling is another really wonderful tool.

So the nice thing about the cupping sets is these can be sold to your patients and you can teach your patients how to do self-care at home. In between. Treatments. So if they come to see you, if they can only come in to see you once a week, this is self-care for your patients. And some of my students have even put together little classes for their patients and their patients come and they learn how to use the tools in a group environment, which is fun for them.

But moving on to derma. Rolling. Derma rolling Is . A very effective tool for reeducating the connection between the skin and the muscles and the nervous system. If people have had long-term neuropathy, any sort of nerve damage. Sometimes you can, do some scalp acupuncture or work with the motor points, but this is another level of stimulating both the channels on the face so you can work right along the stomach channel, small intestine gallbladder, large intestine, any of the.

thE zong has meridians on the face. You can roll the roller to wake, not just the points up, but the entire channel. Plus, you’re stimulating the skin, which works in conjunction with the way the brain works. And these aren’t that much different than those . Barrel channel rollers that we might use on the body, but these have tiny needles and they are medical grade, so

These come in 0.5 millimeter or 1.0 millimeter in length, and they’re, you just roll them very gently on the skin. And I sell these to my patients so that they can self-treat at home once I teach them how to use it. And they all come with directions and video demos also. Okay, so Bell’s Palsy is a.

Probably the most common cause of facial paralysis that you will see in your treatment room. And it is typically a temporary condition and it is a result of a disruption of the function of the facial nerve, which is CN seven. And this prevents the messages from the brain. To the muscle, which causes muscle weakness and paralysis, and there can be a multitude of symptoms, uh, pain, neuropathy, muscle weakness.

Hearing loss taste sensations changing, um, changes in smell, vision, eyelids drooping, um, discomfort or pain in the jaw. And, uh, lots and lots of issues. And, but very much on a cosmetic level and typically. People will get this between age 15 and 60, but certainly I’ve seen patients as young as two and as old as 70, um, in my treatment space and the Western medical treatment is acyclovir.

Or an antiviral drug and then a steroid. And it is believed in western medicine that it is from a virus. And in Chinese medicine, we believe usually it is from a wind condition, wind, heat, usually, which affects the face. . the protocol for the exam is you would ask your patient to raise their eyebrows, close their eyes, tightly smile, puff out their cheeks.

If the orbicularis Aus has been affected, or the rosaro, if they try to puff out their cheeks when they close their lips, only one side will puff out and the other side arrow will come out. And smiling frowning. Show your lower teeth. Show your upper teeth. These are going to help you to isolate which muscles have been affected and then you would treat accordingly.

As I had mentioned wind, a wind condition, also blood stagnation or spleen sheet con deficiency. These are, uh, three different . Conditions from a TCM perspective that can, um, cause Bell’s Palsy. And for body treatments on everyone, I’m going to do LI four and stomach 36, and then I will treat the underlying.

dEficiency or stagnation or excess, whatever’s going on. And then I would do local. Points on the face, depending on what has been affected. aS I talked about last time, you can use scalp, acupuncture, ear chen, men, and point for the face. You can do motor points based on which muscles have been affected.

Facial cupping and Gu Shaw definitely to help bring energy into the muscles. Derma rolling . and you want to see the patient. I tell my students at least twice a week three times as ideal, but the more the better when you’re talking about treating a Bell’s Palsy patient. So this was a patient of mine and she had come in right after she was afflicted with Bell’s Palsy and I did an exam on her.

Closed her eyes. Okay. And as you can see, she could not close her right eye at all, and there is no movement in the right side of her face. And I actually misspoke. She had Bell’s Palsy for a while. She was past the point where the doctor said she would get any better and and so I treated her close for about six weeks and we were just starting to get some movement going.

Dry brow, close, dry. So you can see now she’s able to close her eye. nOt a lot of movement on the right side of her face yet the lower part, but she was able to close her lips a little bit. . It really requires patience and and time, but. iT’s just some information about my classes that I teach.

I do have an advanced certificate course, which is comprehensive. All of my classes carry CEUs. They’re all self-paced, recorded. And then you would, um, or can come for a two-day hands-on class. It’s included, but it is not required. And I do monthly live mentor sessions. That is the end of my presentation.

Here’s information about my social media. You wanna follow me on social, and I would like to say thank you to the American Acupuncture Council for this opportunity to present today. I. .

 

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Acupuncture Malpractice Insurance – Are Your Exams Being Denied and Not Paid?

Well, today I’m gonna spend some time talking about valuation and management services or E and M codes or exam codes.

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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 everyone. This is Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council. And of course you, let’s make sure your claims are getting paid, and I don’t care whether you’re doing cash insurance or otherwise. We always wanna make sure you’re doing well, we have a vested interest in you.

Well, today I’m gonna spend some time talking about Valuation and management services or e and m codes or exam codes. And I’ve recently had a lot of offices with issues of Sam, my exams are being denied or they’re not paid and they’re giving me excuses that don’t appear. Right? So let’s talk about that a little bit.

Does a patient require an exam? Of course they do. Well, let’s get into that. Let’s go to the slides. Let’s talk about what’s going on and getting paid for your e and m services. How do I get paid for my exams? And I use the term exams because. Often people will say e and m, and then they say, office visit.

And I want you to keep in mind an office visit is anything that you do when a patient comes in, they’re visiting your office. So keep in mind, office visit from your standpoint should just be the visit overall. It depends on what you do. So by example, on days you do an exam. That would be an e and m service, and you may do treatment the same as well, so be careful.

The term offices, it will often get you confused. What I’m speaking about for exams of course, are evaluation management or e and m codes. If you’ve all learned, and you’ll notice we have two types. The new patient, the established patient, you know, two oh twos to 2 0 5 for new 2, 1, 1 to 2, 1 5 for establishing.

What are these for, for the indication when the patient required an examination by you. To determine their diagnosis, their need for care, and so forth. And so we’re broken down into four codes for new patients, five for established, and they’re pretty straightforward. They just indicate how much time or how much medical decision making did you spend doing an exam.

You should be familiar with that. That’s not the hard part. Where we run into problems often is, I’ll get off the saying, Sam, I billed for an exam code. And I didn’t get paid. The insurance said it’s not a covered benefit or it’s included in something else. So what is it that’s required to do or get paid for an exam?

Well, let’s think of it. An exam is something that’s absolute required. If an insurance says that you shouldn’t do an exam or it’s not within scope, I can’t believe that not to be true. I mean, obviously when a patient comes in, what’s the first thing you have to do? In order to know whether you can help them, you have to evaluate them.

It’s required to determine the condition and their need for care, what’s wrong with them. And then of course, I would argue it is a ethical and legal requirement. Can you imagine the liability if you said, Hey, I don’t care. What’s wrong with you? Just shut up and lie on the table and start needling in you and go, well, we’ll see what’s happening.

I don’t care what’s wrong. Well, of course not. It is an absolute requirement that you make some level of evaluation, determine the need and necessity for care. So I’m gonna say it is an absolute requirement to do an exam, however, where the confusion comes in is how do you bill for it and how do you document it?

Well, let’s realize the one thing that’s probably the most common issue for acupuncturists being denied for exams. Is the failure to understand that every time you bill an exam code an e and m code with treatment, you have to put a special modifier on it in order to determine and to demonstrate it is separate.

From the exam associated with the treatment. So notice here it talks about the acupuncture services or procedures includes an e and m assessment. So in simplest ways, think of it this way, if you saw someone for the very first time, you are clearly gonna ask them lots of information about who they are, what’s their symptoms, what’s going on, what makes it worse, what makes it better.

In other words, you’re gonna do a pretty detailed history. You’re likely gonna do some physical exam things. Maybe it’s tongue and pulse, maybe palpation, range of motion, you name it, the many things an acupuncturist might provide. And then based on that, you’re going to determine a diagnosis and then begin some treatment.

Well, those things actually are somewhat included in the acupuncture service, but here’s where we have to be unique. Realize the acupuncture service does include . A small exam. Now, the first visit, the one I just described, is clearly different, above and beyond. But let’s talk about that first visit is one thing, but what about when the patient comes the second time?

Maybe I come to you two days later and you say, Hey, Sam, how are you feeling? Is that a little better or worse than last time? How much time did the pain resolve for you? In other words, you’re gonna do a little short exam that includes a little history, maybe some findings such as, you know, uh, tongue and pulse again.

And then begin treatment. So there’s what we call a pre intra and post-service evaluation associated with treatment. So here is the number one reason most acupuncturists are denied for exams. You forgot to tell them this exam is above and beyond what I normally do as part of the visit. It’s a true examination and we have to put modifier 25.

So if you’ve been denied for an exam and you’re not familiar with 25, that’s probably the number one reason that modifier is necessary to indicate to the carrier that this examination was separate and distinct. Therefore payable, no modifier, no money. Now, why is that? Because you’ll see here, there is a pre-service associated with treatment.

When they come in the second time, you’re gonna do a little review of their record, a little record review, face-to-face time with them, do some evaluation things, get them set up for care, perform the care, and even after the care, you’re gonna evaluate, Hey, how are they doing? Give them some recommendations for at home.

And this is why it says specifically in the CPT Manual. It says what you see at the bottom here, it says, additional evaluation and management services may be reported separately if and only if the patient’s condition requires a significantly separate identifiable e and m service above and beyond the usual pre and post service work associated with care.

So in other words, we’re saying, no, no, no. This is not the one that we do day to day, but this is the one above and beyond. So to come full circle with that, when is that necessary? Well, clearly the first visit. There’s no doubt a first visit should be separately paid for an exam and we put a 25 ’cause that’s clearly above and beyond what you would do on a follow-up.

Now, when would it become necessary again? Now, some of you say, well, Sam, I do an exam every day. That’s exactly what we’re pointing out here. You do and we understand that, and a little bit of that is associated with the treatment. Keep in mind, that’s not only true for you as an acupuncturist, that’s true for medical doctors, chiropractors, physical therapists, anyone that’s doing this type of care.

Would have the same provision. So they have to put the modifiers as well to show that it’s separate. So we have to make sure it’s above and beyond. So it says here if and only if it requires a significant one. So the day-to-day one, you do for, you know, several visits after, not really, but when would it be appropriate?

Certainly every 30 days. Now why every 30 days? It’s the standard. It’s the one set up through Medicare that all insurances have adopted. So an exam on the very first visit. When every 30 days absolutely reasonable should be payable. Just remember, assuming there’s treatment, put a 25. Well, what if you say, what if I don’t put a 25?

You won’t get paid. Now, you don’t need a 25 on the day-to-day one, but on the one that’s exam, so the first visit. And then about every 30 days. Now, some of you say, I like to do it every six visits. No, it’s every 30 days. Whether you do 12 visits in 30 days or six, keep in mind it’s about 30 days. Now, there could be instances.

What if the patient says, Hey, last night I fell down and I hurt my back. Would that be appropriate to do a separate exam from what you were seeing them before? Let’s say it were headaches. Well, of course, because there’s something new or significant that’s above and beyond, so make sure it has to stand out.

In other words, make sure the exam clearly shows that this is not the routine exam, and that’s probably the number one reasons things get denied. So simply put, when you’re billing, put a 25, notice this example here. You’ll see 9 9 2 0 3, that mid-level exam. But because there’s acupuncture performed the same day.

We put the 25 modifier on it. The 25 modifier does not change the price. It’s still gonna be paid the same. It just indicates that it’s payable. There is no reduction in doing that. In fact, in many ways. I wonder maybe should that have been the second thing you’ve learned in acupuncture school? I mean, the first thing, of course, how wonderful the profession is, all the things you can do.

But can you imagine how many of you finished school? Never learn this one simple thing. And then of course you get out and you’re frustrated like, how come I don’t get paid for exams? Well, because you didn’t put the proper modifier. Now let’s keep in mind, I’ve had some offices though, that are saying, well, Sam, I know that I’ve been doing that and these insurances still won’t pay.

So what I’ve done here is I’ve taken a page. From the CPT book, I just took a picture of it. Put it up here, and here’s what it says. Notice it says, evaluation and management services may be reported in addition to acupuncture procedures when performed by physician or other healthcare professionals who may report them, which means you.

Now we move down a little bit here and we’ll get into this section here and it says it may be reported separately using modifier 25 so long as it’s above and beyond. So I wanna make sure if you ever get a carrier that’s saying . You shouldn’t be able to. I wanna point out the CPT manual clearly says it.

This is not unique to you. It says it the same for chiros, the same for medical doctors and so forth. So it is absolutely appropriate. However, there are some plans that come back and say, no, we’re still not gonna pay. So let’s talk about how to deal with if it’s denied, was it billed properly? Would be the number one thing.

Did I put modifier 25? That’s probably the simple one, but sometimes you’re gonna say to me, Sam. I did put the modifier 25. It still came back and it stated the exam was included in another service. What you’re gonna do is push back and say, excuse me, this was done on the first visitor every 30 days, and there was clearly a separate and distinct service, an exam that was above the routine day-to-day visit.

So you’re gonna push back on that and basically point out to them it was separate. That’s why we put the 25. But here’s the bigger problem sometimes. It’s because you have a contract. It’s why I will warn you. In fact, how many of you have worked with me directly? one-on-One to know whether or not it’s worth it to join some plans.

I’m not gonna say never, ever, but you wanna make some better choices. ’cause sometimes when you join these plans, you join ’em and think, great, I’m gonna get more patients. Do you know many of your contracts say we don’t cover exams? So the reason it may not be covered, it’s part of your PPO reduction.

It’s basically saying, we’re gonna send you a lot more patients, but we’re not gonna pay for the exam. You have to make it a business decision. Is that worth it to me to get less money, but maybe more patience in some instances? Maybe, but for me, mostly, probably not. So what if the issue is part of your contract?

Is there a way to dispute that? No. That’s the contract you signed up for. Now, maybe you might decide not to be part of it. This is why. Think of it. If you’re just a cash office, isn’t your first visit more expensive than a second visit? Think of that for a moment. Why is that? The first visit has an exam, but here’s the issue we’ve been running into, and I know a lot of you on the East Coast, I’ve done seminars there up and down the East Coast from New York, down to Florida, that the plan says an acupuncture provider is not paid or may not even do an exam.

We’re running into this into New York quite a bit, and my answer to that is, excuse me, you’re saying an acupuncturist cannot perform an exam. Would that not be against. The rules of just engagement of a patient. Can you imagine the liability if a doctor said, oh, I didn’t examine them. I don’t care what’s wrong with them, I just treated them well, how could you treat someone without evaluating what is wrong and knowing what to do?

So there’s a lot of pushback on that. If that’s what you’re running into, please get part of your state association. Join us in fighting to say, excuse me. Of course it is part of your scope. In fact, what I’ll tell you is look at your scope of practice. Does your scope of practice indicate an evaluation?

I’m gonna guarantee it does, at least at some level, so therefore should be payable, so be careful. I think what’s happening is some payers are finding, hey, acupuncturists will just go away if we tell them no, we’ll just pay for treatment. We don’t wanna pay for an exam. My goodness. No. If you’re doing an exam.

It’s necessary. Of course, that’s payable why it takes time. It takes effort to do it, so make sure that you’re always pushing back. However, please be sure if you are billing for an exam, and I don’t care whether it’s cash or insurance. By the way, is there clearly more information and more details that would show this visit had a distinctive exam?

Keep in mind if you’re billing for an exam, there needs to be an exam above and beyond, just kind of like acupuncture, and we’ll talk more about this coming up in the first of the year, but how are you documenting it? How to make sure you’re avoiding anyone coming back, saying the services weren’t properly described.

Not hard, but there’s things you have to do. Have you ever had help with that? Have you ever understood it? Maybe not. That’s what we do with the network. It’s not just about practice and making more money, but making sure we’re compliant. All those factors, I want to help you with that. That’s what we do with the network.

We do the education. Come to a seminar first of the year, you know what’s happening. There’s updates to these e and m codes. Nothing major but enough that you want to be aware of. To know which code to properly choose, and there’s some additional codes that are updating as well. We always want you to be in the know.

The American Acupuncture Council is your partner. I’m your partner. Your success is ours, and I wish you well. We’re always gonna be there as a resource. Take a look at our website, there’s our phone number, come to our seminars. We’re here to help everyone go out and do well, and I wish you a really good New Year and prosperous new year.

Thank you.

 

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