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Greetings, friends and colleagues, and of course network members. The American Acupuncture Council is always looking for your success. And here’s another episode we wanna focus in on. What’s happening for 2026? How do we get prepared? How do we make sure? Because if your practice is not adapting, you’re probably gonna start failing.
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So we wanna make sure that doesn’t happen. Let’s go to the slides. Let’s talk about what is coming in 2026. What do we have to be prepared for? The thing I think we always wanna start with that first year, at least for me, is always money. So as network members, I always wanna make sure at first the year you’re doing a meeting with me on your current fees and codes.
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And I don’t care that we did one this year. We need to update it for the new year because what we wanna make sure that is clear and it’s what every patient wants to know. How much does it cost? What are the fees? And we have to come up with establishing a good, fair fee to many of you way, un way undervalue, or do not understand your services and costs.
So first things first. What we want every patient to know is a good financial understanding. But you know what? That financial understanding needs to be from us as well. What is your cost of practice? What does it cost for you to treat a patient? ’cause that’s how we’re gonna start to set. Fees. We have to make sure the fees actually sustain the practice.
So the financial understanding starts with us, but also the patient. They wanna know what’s the cost. Do you have a difference for cash and insurance? I assume many of you do, but what’s legal for giving discounts? What about prepaid plans? What about do using these discount medical programs, if any of you’re familiar with those?
What I wanna make sure is that we have a clear understanding so that we can pass it on to the patient and let’s not take it, that we can’t make a slight increase every year. Cost have gone up. If you don’t increase cost or if your cost of increasing, you don’t increase what you charge. You better have a very high volume.
And for acupuncture that often can be difficult because let’s face it, many of you are gonna see a patient 30 minutes to an hour, and that just limits how much you can see, so it’s not unlimited. You can hear about a lot of chiropractors treating hundreds of people a day. That’s not happening in acupuncture practice, so we have to value this properly.
So let’s make sure the patients have a good understanding because we wanna make sure there’s no surprise. Make sure in simplest terms, you want a disclosure to the patient of what your costs are with a good estimate of costs. What is the first visit? Follow ups. What services are we doing? What’s covered by insurance?
What’s not? What are they paying out of pocket? This should be in writing, but given to them orally. And when you do this agreement, remember agreement. It can’t be any longer than 12 months. I would recommend every time they come in for a new course of care, reiterated, have them sign something else, because we don’t wanna reach a point where we have to go to collections or do any credit reporting.
In fact, many states don’t allow you to do credit reporting anyway. So to avoid credit reporting, to avoid collections, how do you do that? Collect at the time of service, collect an amount you think the insurance is not gonna cover, and have that paid by the patient. My rule is maybe make it about 30%. If the 30% turns out to be too much, it’s much easier for us to refund back to the patient or credit them than it is to chase after money.
So if you’re not sure at all what the insurance pays, you might even collect 50%. What you wanna make sure is insurance is not something we’re expecting to pay everything but part. And until we know for sure, we’re not gonna give the patient any idea that, oh, it’s gonna cover in full until you learn that and that’s what we need to do.
Have you really looked at the insurances that you’ve billed? What do they pay? What are your expectations? What services? So that way when a patient comes in with that same coverage, you can go, oh, okay, I’ve seen that one before. Here’s the amount you’re gonna pay. That’s when you ever notice, you go to the dentist, they know exactly the copay.
It’s ’cause they’ve billed it before. They know exactly. Based on that coverage. What if you’re all cash pay upfront? Or are we gonna pay over time? Or are you gonna do a prepaid? So we wanna make sure all these things are set up so the patients are comfortable. The barrier to care for most people is always money.
So we want to deal with the money first, get that outta the way, and then get to the true care plan ’cause they’re coming there to get better. Let’s focus on the value of the service, not that it’s necessarily cheap. Because I want you thinking of, have you really looked at your fee structure for a network member with me, please make sure we’ve done this, and if we haven’t, we need to do one right away because for 2026, we need to update it.
This changes every year. It’s not stagnant. So I want you thinking of what are your charges for the common services you do? I just give some examples here of manual acupuncture, a mid-level exam, and massage by example. How would I use this? How do I make sure? Because I want you to see how fees should be structured.
By example, the relative value of acupuncture. First set manual is 1.38. And you may look and go I’m not sure what that means. What I do with that is to help you establish a fee schedule across all codes. Every code has a relative value, and it’s one of the things we emphasize at our first of the year seminars, which are coming up by the way, January 18th and 25th.
But nonetheless, we make sure you understand it to set the fees, because what I have found for most offices. You’re simply just billing below what you can collect based upon lack of knowledge. So by example, the value of 9 7 8 1 0 is 1.38. Let’s say another code has a value of one. What does that tell you?
The difference is the code that has a value of one is 38% less. Simple as that. Every code has a set of value this way. So the way to use this tool is to do this. Take the price you charge, and I’m gonna say start with acupuncture first set, because that’s the thing. I think you probably bill commonly, you know the value, you know what’s being paid.
So take 75, divide by 1.38. It gives me 54, 34. Now what does that mean to me? This 54, 34 is then what I use to multiply any other codes. RVU. To tell me the price. So if I take 54, 34 and multiply by the relative value of 9 7 8 1 1, which is 0.79, it tells me it’s 42 92. So if the first set is 75, second set would be 42 92.
Now, realistically, I’m probably gonna. Make that go up to 43 or maybe even 45. But you can see here, it’s roughly when you look at this, not 50% less because it’s not raw numbers, but in that range. So it’s gonna be probably about two thirds or a little bit below that for that set. So make sure if your first set, 75, 42, 92.
What about other services though? This is where I find acupuncturists have to start to come to realization of the services. Exams are detailed. Take a lot of time and hence they’re more expensive. Notice the value of 9 9 2 0 3. Okay, mid-level new patient exam. Notice it’s 3.37 with 3.37. You can see here it’s not quite three times the rate, but notice it’s three times the rate.
Quite, but just below. So notice it’s 180 3. What I find often is people will charge exams for 50 or $60. Now, if you said, Hey, Sam, I’m running mostly a cash practice. Maybe you do it to keep it affordable, but understand if you’re billing out to insurance, this is the value. It’s worth quite a bit. Are you undervaluing?
For many of you, you are. What about something simple as massage? A lot of acupuncturists do massage, and you’ll notice the massage value is 0.92. It’s more than the additional set. In this case, 49.99. So simply going through each code now as a network member, if we haven’t, please make sure you set up a Zoom appointment so we can work one-on-one with this to make sure you understand.
Oh, that’s why I would charge this. ’cause we wanna do this with every code and start to look at what you’re being paid to make sure to set a fair value. Because here’s the truth. In states like Michigan, Florida, Indiana, they literally take RVs, which is double the Medicare rates. For personal injury, work comp and so forth in these states or California work comp uses 150%.
So keep in mind, for most of you, what is the cost of a first set in the Medicare rate? It’s roughly about $50. So if you look at this at 50, if you’re doing 150%, it would be 75. So again, just using those rates and realize those will update at first of the year. Now, how do you get those? Get with me Network members, of course.
Or come to a seminar so we can go through them because they will change. We’re expecting a nice change for you this year, by the way, but we wanna make sure you understand relative value. Certain more than that. Look in these states. Arizona just uses a pure qualifier of $69. You can see here if I, in Arizona, I take 69 multiplied by 1.38.
That’s $93 for the first set. That’s the fee schedule for the state. Now, if you’re charging below that’s fine, but can you imagine if you have a work comp patient, why would you turn away $93 for the first set notice In other states though, they just use a conversion notice. Idaho 49, Maryland 51, Texas 70.
Utah 59. So you can see here when you take this and divide, you’re gonna see here even Utah’s higher than a $75 rate. Idaho may be a little bit below, so be careful of undervaluing. If you’ve not really done a real review of your fee schedule, it’s time members. Please set up a zoom. Now keep in mind, we should see an increase this year.
Now you’re gonna see some things come out that say Medicare’s reducing, they are reducing for hospital based or facility base, but not for doctor’s visits. We should see a very slight, 3% increase. So that’s nice. We’ll wait to see at first of the year again, as a member or a seminar attendee, we will update that, but you can expect about a 3%.
So what does that tell you? Should you increase your fees? Probably maybe 3% at least. Yes, in fact, maybe higher because maybe many of you have not raised rates in years. Can you imagine if you said, Hey, I Hoag, I owned my house for 20 years, but I’m gonna charge the same price I did 20 years ago. That would be foolish.
It’s worth more. So make sure you update that and understand the differences. They’re projected to increase payments overall due to the new budget. And they’ve realized they had to increase, or you’re gonna make doctors not wanna stay in the system. Now you’re thinking how does that affect me?
Realize Medicare rates help to set other rates because often they’ll just use a percentage. Now the Medicare deductible will go up. Does that affect us very much? Not really. Unless you’re working with a MD or a nurse practitioner, you’re not treating a Medicare part B anyway. That deductible will go up a little bit.
Remember Medicare Part C patients for acupuncture, you can directly access and realize relative value units will update. For many of you. You remember two years ago, you got a very nice increase in RVs for acupuncture. So with that being said, most of you should have had or should have increased your fees roughly 10% about two years ago.
If you didn’t, you’re simply losing money. Now, you may be hearing me say this and go, oh, Sam, come on. I belong to a SH or other plans. When you join those plans, you’ve accepted a lower rate and they do that because when they get you in contract, they’ll pay you less. So you may wanna rethink, should I join?
Remember we did a program on that? So be careful. I wanna make sure you have relative values that based on real information. Keep in mind, there are gonna be no changes to the codes you use regularly, but here’s what I would implore you to do. Do you really understand them? Do you have the full definition, how to document by example?
For our first of the year seminars, we’re gonna get into, Hey, can you bill for red life therapy? What about some of you wanting to do additional services? Cupping, moa? How do you code for those? How do we define them? We wanna make sure, but there are no new codes when it comes to the physical medicine codes that you do.
But are you doing the ones correctly? By example? What if you’re doing guha? Or deep tissue work. Realize 9 7 1 4 0 is more likely the best code for that, and it’s gonna have an actual two, two and a half percent increase above that other 3% y. They remove what’s called the efficiency adjustment. So the code is simply gonna be worth more.
So we have to make sure you’re up to date and understanding. So I want you to stay tuned. This is just to get you ready to say, okay, let me start looking because these will be published and we’ll definitely have ’em at our seminars on the 18th and 25th. Network members, it’s free for you. Just simply set up to register or give us a call.
If you’re not a member, please do we wanna make sure you’ve got the right information. Your practice depends on your understanding of the business then, and that’s what we do. So please make sure you’re ready for 2026. I’ll see you then.