Tag Archives: Acupuncture malpractice Insurance

AACHeller04192023HD Thumb

Treating Infertility with Herbs – Moshe Heller


And I’m going to be speaking about treating infertility with Chinese herbs, with Moshen herbs with different, we’re gonna talk about one formula and how we can adjust it.

Click here to download the transcript.  Click here to download the slides.

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. I’d like to first of all thank the American Acupuncture Council for having me today. And I’m going to be speaking about treating infertility with Chinese herbs, with Moshen herbs with different, we’re gonna talk about one formula and how we can adjust it. And and I also wanted to let you know that I have another I will be having another talk about another two formulas, which are very Very applicable to this season, which is spring season.

One is called React and is used for allergies. And the other one is called g shield. And it is used for improving the immune system. So those are very relevant to the spring which is in its might. AC activity right now, and I you might be feeling it a little bit itchy eyes, nose, throat, and all the pollen is everywhere.

So happy spring and let’s start talking about the subject of today. As I mentioned, I am going to be talking about actually one formula, but two different variations of it that supports fertility in both genders. So the first formula, I named it Sprout and it’s the motion herbs formula for supporting uterine fertility.

And the other one is called Seed which is the motion herbs formula that supports sperm fertility. These are, this is going to be what we’re going to be talking about today, but I also wanted to start by talking generally. How do I approach treating fertility in Chinese medicine in general?

The first concept I wanted to discuss is yin and yang. This is something we all know and really is really an important aspect of regulating the body and preparing in, especially in preparation for conception. And of course yin and yang has to be balanced. The reason I wanted to mention it today is because I’ve been noticing in my office in the years that I have been in practice that I need to focus a little more on yin than young when I treat patients with fertility, and I my assumption is that this is due to the fact that.

our lives are in this modern society is very active and fast and moving, and we have too much too much, too fast and not enough downtime and not enough yin in our life. It’s becoming much more young and there’s much more young expectations from us. We need to perform, we need to support, we need to do all the things that kind of weigh on our young, but in order to create more young, we definitely need more yin.

So I find that a lot of times what I see is that there’s I need to focus on creating yin, not only in. Treatment, the treatment itself but also in supporting the patient in the process of getting ready to conceive. That means talking about foods that support in it means talking about activity and rest and so on and so forth.

So one of the basic things that I recommend for women and men who are trying to conceive in the process of getting pregnant One of the main kind of yin foods that I recommend is bone broth, and that’s just an example. So for all my fertility patients, I usually recommend to u to to use bone broth, almost like a supplement.

So they’ll have at least a cup of bone broth every day to support that yin. . And then we also discuss the idea of making sure that sleep and rest is part of the the general lifestyle and that there’s a lot of focus on that. And that leads me to the idea that we really always, or frequently, I find that I really need to work on strengthening the gene.

And what does that mean? In general that we are looking at Jing strengthening as we all know Jing is a really important aspect of. Of fertility especially in the idea of chi. In Chinese medicine we know that Jing is really if Jing is deficient, our ability to conceive or to produce sperm or to produce eggs is reduced.

And A lot of times because nowadays conception comes much later in life than the jing as we age is reduced. And therefore there’s always need a need to support or evaluate how much we need to support Jing in both genders. We will discuss the herbs that really work on strengthening jing, but also, as I said, lifestyle is a huge con aspect of preserving.

even supporting or strengthening the gene. And again, that is looking at diet, looking at activity and rest and and also making sure that you are using some kind of a an exercise that is not only cardiovascular, but also meditative, I would call it like yoga or chigong or anything that the patient feels comfortable with in that aspect.

So when we are supporting the uterine health, of course we are not only looking at Jing and yin and yang, but also at the health of the blood. And the health of the blood is really pretty important as we might assume. In, in, in conception. And a lot of times that is a really important thing to evaluate in a patient, to understand how to treat them.

On top of checking, what’s the. What how, what, how strong is the jing? How strong, how balance is the yin young. We also need to regulate or check the blood health and also the liver. Liver liver. Health, I would say meaning is there a liver cheese stagnation as part of the diagnosis?

Is there or is there a liver blood deficiency as part of the diagnosis? So we need to understand that in order to best support the uterine health of a female patient where When we are supporting the sperm health, we not only need to look at the things that we that I mentioned before, but instead of blood, a lot of times I evaluate the relationship between the heart and the kidney.

as I really think that the concept is that the one the heart fire is in relationship with the kidney Jing to allow for the production of healthy sperm. So I look at the kidney fire or kidney heart balance when I’m evaluating. The sperm health as part of the diagnostic process. So these are all really important things and we as we will talk more specifically as we go through the formulas to understand what kind of herbs you might be thinking of in each of those cases.

So let’s start with the formula sprout. Which is the uterine fertility support and it’s was created based on the Formula One shall down and it’s a one shall down. Is really Important formula. I think for for supporting fertility, it’s, as a base formula for supporting fertility.

The translation of that is rejuvenation, special pill. What it means basically is that this formula is made to. Revive the jing in a sense. So it’s a Jing Tonified formula and when I created it for the use of sprout for female fertility, I added herbs that support chin blood. As I mentioned before it is really important that we look at the blood as well as the function of the kidney.

Balancing kidney ian and young as, and as well as regulating the liver making sure liver blood is really full. And also that liver chi is flowing harmoniously. So this is all taking care all part of the creation of, or the formulation of the, this formula. So I’ve looked at many herbs and how do I Ma adjust the formula to support the natural potential of the body to, and how do I strengthen the kidney energy and support the jing and really regulate and strengthen the liver?

And so I have used different, I added different herbs like Xianchen which. A really important herb, I think in the, in supporting both the spleen energy and the fluids and the yin of the body. So this is American jining, as you may know which really helps to not only nourish chi and young, but also supports kidney.

Yin. Therefore, I think it has an effect on supporting Jing. I also added Zu as a way to consolidate the kidney energy and help with. With holding on to the Jing that has been created as well as to support Liberty Tea flow and also calming the she and spirit. So I also in both Sprout and in seed, I added Herbs outside of our Chinese herb preparations or varieties.

I added in sprout two Ayurvedic herbs. One is called, one is Ashwaganda, which is. Pretty much the Indian Jining or sometimes referred to as the Indian Jining. It is a real balance and it’s like parallel to the the American jining in its ability to. Both give support the young, but also in a calming way and not overstimulating, and also added chat, which is asparagus root for its calming, nourishing, and yin building aspects.

To support the formula’s yin building ability. So if we look at Sprout the on the left, you will see here the main, the herbs that I, that originate from Huang, Shadan. I’ve reduced some of them, eliminated some of them, and and substituted with others. On the right side of the four of the list, as you can see here the interesting thing, one of the main herbs in Huang Shaan is Shaya which is basic chi tonic but also, Generates fluids and really helps support the transformation of fluids and and nourishing the, in nourishing the yin.

. The other herbs that are included is and are the two young produ young strengthening form herbs. . So these young strengthening herbs especially barian, have a very moish nature. Therefore they really support both kidney young, but also kidney jing and and they’re very balanced in that way as well.

We, I also added two herbs two herbs in the formula that is . Both support yin and blood and and Jing also in, for that matter. So these are the herbs that are, or from the original formula, which is Shong, which I mentioned before, wan and Zu. These are all the original formula of but I also added another.

Two herbs that really support the young, I added and wan to enhance the young ability the young strengthening aspect of this formula. But as again, both Tu and are also support the and are not too stimulating in terms of young activity. I added the next group of herbs is SH

and Za. These are all focused on strengthening the Central Chi. Sharon helps in moving the chi in the middle burner, as well as supporting it and is really important. So to, to reduce the. The CLOs of some of the herbs that are in this formula. So it’s there also to support that.

The next set of herbs are UE and UE and which really help in nourishing blood and supporting liver. The liver blood in particular. And then the following set of herbs is

Ma sorry, fu and which help to move liver chi and also calms the. . And then finally we add, I added some herbs that support the Kidney that, sorry, the uterus. These are herbs that are sometimes used for what, what is called concern for miscarriage. So these herbs help to calm and nourish the uterus and prevent prevent any, Danger of miscarriage.

So these are ngk. Then the last two, as I said, were the ashwaganda and Shava, the Ayurvedic herbs. So this creates a very rounded formula. I’ve used, I’ve been using this formula to support my fertility patients for many years before coming out with it. With motion. So I know from my experience that it works well whether in any case, when you are working on a fertility patient, you will also need to address, and you could do this with acupuncture, with some diet, with some lifestyle recommendation or with Or if you are actually, making a specific or making a a formula for your patient, you will definitely need to evaluate the specific constitutional imbalances of each patient to really address the more specific needs of every patient.

So every patient has more needs. So Sprout is a general formula, trying to hit the most common disorders and supporting the most basic needs of anybody going through fertility issues. That could be a support formula for you, but please make sure. Whether with acupuncture or with other techniques that you support the more individual aspects of each patient that you are trying to support their fertility.

When we talk about seed, which is the ba which is the formula that I use to support sperm health. Again here we use the same formula Huang shall done to be our basic general formula. But I’ve modified it again to. Sperm health by addressing a variety of common presentations that happen with males who are, or males who are looking for support for their for her, their sperm quality.

But also I usually would recommend if a woman is coming to get or help with their fertility. I, and I’m not seeing necessarily the. The other part that I recommend that they take seed to support their health qual their sperm quality. So it, what I took in in, in account when I was forming this formula is, Different issues like how to support sperm count, how to support sperm motility, and how to support sperm morphology.

So I included herbs in all for supporting all those aspects as well as different constitutional aspects and the stresses that we encounter in our day-to-day life. To help in calming those to so that we are able to form a better quality sperm. So from a Chinese medicine perspective, we really st focus on strengthening the jing and also regulating the liver chi, as we all know, the liver chi the liver.

Channel really and circles the gen genitalia. And therefore once we move the liver chi, it helps in circulating the chi around the testicles. And that’s really important for a lot of men or people who are trying to enhance their sperm quality. Always address the liver.

Whether it’s, again, with acupuncture and points that really help to promote the circulation in the genitalia area points like liver five, for example. It’s one of my favorite points to help with that and really get chief flowing in that particular. And also I really take a very specific look at this.

What’s the balance between the heart and the kidney? A lot of times what we see, if there’s too much heat in the heart and not enough young in the kidney, that means that maybe we need to regulate or try to balance the two. And I always believe that the. That the sperm quality is much influence, both, both the all three aspects of sperm health is affected by this balance of energy between the heart and the kidney.

So I always, I. Take a really deep look at what that balance is in order to try to harmonize it and make it more harmonized and Therefore I think the herbs or whatever you’re doing might work better too. And our, the body will create better quality sperm. I’ve modified the base format, the Aldan, by also adding some Western an Ayurvedic herbs, including Demi which is a western herb that used for increasing libido.

And as I mentioned Ashwaganda before in the other formula. That has really shown, there’s some actually research, actual research that shows that it increases sperm count. So this is another addition to the formula. So let’s take a look at the the structure of this formula because . One of the things that is helpful, I think that especially if you’re doing herbs, you can use the idea that I used here, but also adjust it.

If you want to create your own formula, you can adjust it to the needs of your specific patient. As you can see, the first herbs that I’ve our first herbs in the list are, her and all are really important herbs for increasing jing and blood and yin. We know is a really important Jing tonic.

That is, that is, I found I thought it was really important to add to this formula. And as we mentioned before, and is part of the are part of the Huang Chan combination. The next herbs. Zu and Tu are all herbs that help to Shia of course, is part of Huang is as I mentioned, it helps to support the kidneys, but also through strengthening the spleen.

And then we have Zu U, which is. As stringent as well. Astu Suzu Shri is actually part of the al down formula to Suzu. Also and you saw that in that I added that to sprout. We as I mentioned before FU and Newgen and. Are both also as stringent herbs that help to consolidate and strengthen the kidneys.

And are really important herbs for regulating the liver and helping bringing down that young. Especially in muan, p, we know helps to bring down the young and prevent any liver, young rising. So it balances the liver chi. And and also Baha, we know helps to with liver blood.

Then we have sh wonk are really important strengthening the chi herbs. And then we have y

Sue Young and are. Really a group of young strengthening gin Jin Tonifying herbs. In this formula. Then I add Chen, which helps to regulate the blood and connect the kidney and the heart and the kidney. So it really is helpful or supports this kind of connection between the kidney and the heart as well.

That strengthens the kidneys and cre and support circulation. And Huang are another two herbs that I added si for its balanced or support of kidney Jing in particular. And Huang Jin is also a fantastic underused, I think herb for supporting kidney gene and in strengthening the blood overall.

That’s the group of herbs, the Chinese herbs included in In seed. And then we have we have three herbs added to that damiana and ashwaganda, which I mentioned before. I also added So Palmetto because of its effect on. Supporting prostate health as well as balancing the body’s I think yin yang balance by making sure that there’s the eliminating the.

Testosterone that might be circulating in our system. Those were the two formulas that I wanted to review. I wanted to, again, really thank the American Acupuncture Council for supporting these webinars. And you can have the website of motion herbs on the, this last slide. Thank you and please visit us at the above website for more information.

Thank you very much.


AACCollins04122023HD Thumb

Get Claims Paid The 1st Time You Submit Them



But let’s talk about making sure that when you are dealing with insurance or dealing with claims that you’re not getting these common errors and common denials that are so frustrating because we wanna make your life a little simpler.

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 everyone. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and you the profession. As always, we’re trying to make sure your claims are getting paid. You can make your life a little simpler and more profitable. and you can do what you like to do, which is care for patients.

But let’s talk about making sure that when you are dealing with insurance or dealing with claims that you’re not getting these common errors and common denials that are so frustrating because we wanna make your life a little simpler. Again. I want you to be able to treat patients. Let us take care of the billing part.

Let’s go to the slides. Does that talk about common denials and how to correct them? What goes on for acupunc? Why do claims get denied? What are some of the common things that we see? The most common thing that I run into, and I deal a lot with this, I lecture every year to thousands of you, many of you’re members of our network service, and one of the issues we run into, you’ll get a denial that says, The plan is not covered and you think I did the verification.

How is this not covered? What happened? One thing I want to really implore you to do is make sure you understand the coverage the patient has. Often you will see coverage that will say, we cover acupuncture, and you think, great, you’ve verified it. They cover acupuncture. Then you send a claim and it comes back denied.

What do you do? First I’d look to make sure was it really covered or ask this question. If there’s coverage for acupuncture, must the provider be in network? A lot of plans do have acupuncture benefits, but only for providers who are in their network. So don’t be confused. Often you’ll call and hear all these great answers like, is acupuncture covered?

And when they say Yes, you hang up, or you hang up and say, great, that’s phenomenal. Then you send a claimant, it’s not paid. It’s because you didn’t ask that other. is the coverage for in or out of network providers. And then I would further ask this question, do you see my office as in-network or. , if you’re out of network, is there no benefits?

So let’s often make sure that the plan, you know what it’s covering. Also know the types of coverage that it has. What does it cover in the sense, does it cover acupuncture alone? Does it cover therapies? If you do therapies? So be careful. That is a common area of denial. Make sure you verify the coverage.

The other area that we run into lots of problems with are claim forms. We’ll get into those specifically, but how to fill it out. None of it is very. But there’s a couple unique things. If you don’t do correctly, will commonly come back and it’s very frustrating. What about just improper diagnosis?

That’s certainly an area improper use of A C P T code, if you will, but also just missing a modifier and you’re gonna wonder what modifiers do I need to do? Don’t give you a quick primer on that today to make sure we’ve got the right information, but also make sure you don’t run into the one where it says insufficient document.

Is, do I have enough information to make sure the claim gets paid well? Let’s talk about claim forms. What are some of the common things that I run into that offices have? When someone comes in, they’re gonna present an insurance card, and on that insurance card we’ll have their information for the claim.

That’s what goes to the top part of this claim. Whether or not it’s a standard or group health insurance plan, or maybe it could be Medicare under some circumstances, but nonetheless, check that off properly. But the bigger issue. Do I have the patient’s name proper? Please note it says here, patient’s name, last name, first name, middle initial, whatever it is, make sure it’s exactly as appears on the insurance card.

So often I’ll see denials because the patient will have a name that they’ll say, oh, just call me Patty. When on the card it says, Patricia, don’t put nicknames. Also, make sure you’re putting the exact insurance ID number. We will often see numbers transposed. Because it just goes in and makes a quick error.

So do make sure now, once we’ve got that set, that ends it, but it’s nothing more frustrating going, wait a. , what information do I have to have? And this is often concerned. Many times it’s gonna be the patient and you’ll indicate self, but what if it’s the spouse or the child? Often you’ll put the patient’s name here, but if the name is different on the car because maybe it’s a child or it’s the spouse’s plan, remember their information goes here as the insured’s id.

so be careful. Sometimes the patient may be different from the insured, though they’re both insured. It depends whose name is on the card. So don’t run into that common era. But here’s a big one that comes up quite a bit. What about block 14? When you’re filling out the 1500 form and block 14, it says, date of current illness.

And so many people look at that and say what does that mean? What do we put in? Were you gonna put the date generally of when the patient had the first symptom and or an injury? But often you might say This patient had an injury or this pain has been there for years. Obviously if I put something 20 years ago, they’re thinking why are you putting that date down if it’s a very old date, or it’s a type of a chronic condition that continuously flares up?

Always update this date to the date where the patient presents to the office. So it doesn’t always necessarily have to be a date of injury. It could be the date of the first visit, but do make sure it’s completed and put in this area. And one quick note, if you’re billing Anthem, Anthem is a little bit weird.

Anthem wants the date of the first symptom here, but they also want to block 15 the date of the first visit. So this could be a week ago, and this is today’s date because it’s the first visit. And then the qualifier you’re gonna put there is 4 54. I know a little bit odd, but 4 54, that’s gonna be Anthem policies.

Anthem policies seem to require that a little bit more than anyone else. Now, again, just Anthem. Now the other area that I commonly see, and this is really a big issue for acupuncturists, is not having a complete code. Do make sure if you’re using coding, make sure that code is complete. Often you might be using a code that’s a little bit old.

Remember, codes do update. Some codes are three digits, some could be as many as seven. So please make sure if you’re using any coding, assure your codes are correct with a number of digits. Notice this one for just pain. R 52 is just three characters, yet this sprained strain. Is all the way up to seven characters, so do make sure it’s the proper one.

But here’s one to keep in mind though. , it’s more important to know what codes are gonna be payable for acupuncture, and this is where things get tricky. Last time I did this class with you, we talked about specifically certain types of insurances, specifically Aetna, on what they cover. Let’s look at a few other ones.

Here’s the company, American Specialty Health, and as you’re aware, well aware, they manage a lot of particular companies, particularly Cigna, some of the Blues, some Aetna plans as well. And they use what I call , I don’t know, physical therapy or chiropractic end of coating for acupuncture in that they want the neuromuscular skeletal type pain things.

Notice the things that they cover, headaches, hip or knee pain with osteoarthritis, extremity pain with or without osteo osteoarthritis or mechanical irritation, and just other syndromes related to the joints in muscles back and neck pain. So you’ll notice that’s not including like abdominal pain in other internal symptoms.

It’s really musculo s. Except for nausea and vomiting. So no, for this plan, if you were to code abdominal pain, not gonna cover, but if you code low back pain, it will. Now also, keep in mind, some things could be tricky. If you’re ever dealing with a Medicare advantage plan, common denials are because you’re using the code thinking, oh, I need low back pain and put M 54 50, when in fact, for the Medicare plans, whether it’s Medicare, part B, or.

You have to have M 54 51 or M 54 59, so it’s good to understand the nuances of what’s covered. Here’s an example of a course, the one we went through last time, which is the Aetna plans. These are the codes they cover, which tells me if you bill these codes, they’re gonna pay you. Bill something not on the list, they’re not gonna pay you.

So it’s important to start to learn the nuances of what codes are covered or not covered. That’s one of the things that we cover in our seminars. Or more importantly, if we do one-on-one as a network member, I can go over with you. Here’s what Health Partners has, here’s what UnitedHealthcare has, cuz it’s important to know what codes are payable.

Nothing’s more frustrating thinking something is. and it comes back not covered all because you didn’t understand the codes that they require. Another area that commonly comes back is that hey, I build for four sets of acupuncture. . They only paid me for three. What’s going on? Or sometimes, maybe they paid me for one, depending on the plan.

Under the standard rules, and this is across the nation if you will, there’s something called the medically unlikely edits. And what, these are the maximum number of services that are payable per a visit, and this includes all types of chiropractors, physical therapists, and so forth in every code or service.

Has a maximum number of services or units that they will allow. In this case, for acupuncture, it is three. They allow up to three. So if you bill more than three, they’re not going to pay it. They’re simply gonna bundle it. So do keep in mind it’s three, I’m sure you’ve seen as if you’ve ever dealt with the va, Cigna, United, and many of them.

Now, are there some plans that may be. Sure I’m familiar with plans out of New York, particularly New York ship that will generally pay up to four. So I’m certainly gonna say, bill, what you do, but do understand some plans will max out at three. So that denial is simply one of just fruition. They just don’t allow any more than that.

So again, if you’re billing more than three, that could be an issue. The other issue for acupuncture though, Modifiers and denials. So you notice here’s a claim form someone with simple back pain. But notice there’s the acupuncture codes billed, but then notice there’s modifier 25 on the exam. This is probably the most common denial I get for acupuncturists, is Sam, they didn’t pay for my exam.

The first thing I’ll ask you is, did you bill with modifier 25? And most of the time the acupuncturist will say to me what do you mean by modifier 20? As soon as they say that I know the reason. Remember, anytime you bill an. With your treatment, any treatment, you have to put modifier 25 on the exam code because this demonstrates that this exam is above and beyond the day-to-day evaluation.

In fact, what it means is what’s printed in bold here, if and only if the patient’s condition requires a significant separately identifiable e and m service above and. The pre-service and post-service associated with treatment. Remember, acupuncture or treatment includes a little bit of an evaluation, so every day there is evaluation.

It’s small, but there is, Hey, how are you feeling today? Is it better? Is it worse? Maybe you’re doing some palpatory findings, tongue and pulse. That small exam is embedded into. the acupuncture code, and that is the reason we put modifier 25 is cuz what we’re stating is this exam is above and beyond what we do on a normal day to day.

and therefore is payable no 25 no money. So make sure it’s there. Now what about a plan that doesn’t cover an exam? That might be a bit unusual, but it depends on your contract. What if you’re contracted with a company like a UnitedHealthcare under Optum, where they pay you per diem? They don’t pay separately for exams because they bundle it all as one payment.

So do keep in. That sometimes it’s a contract issue, but other times it’s just the fact, did I have the proper modifier? Now, you’ll notice none of these other codes have any modifiers on it because it’s not needed. However, what about this last 1, 97, 1 40? I know some of you’ll say I wanna put modifier 59, truthfully, a modifier 59 to indicate a separate services never needed.

However, you will need for some. Modifier gp. Now, this is why I think sometimes acupunctures go, I don’t know if I wanna do insurance at all. It’s just too much hassle. It really isn’t. It’s just understanding the nuances of it. Once you understand it, it’s not hard. So now here’s the rule. If you’re billing United Healthcare, You’re gonna put a gp, G as in George, P as in Paul at the end of a physical medicine code.

So that’s all physical medicine codes, whether it’s from heat all the way through the unlisted service, but massage, manual therapy, you name it. And it’s gonna go on all of these payers, UnitedHealthcare, that includes Optum Health and everything affiliated U M R U P M R, VA claims will. Anthem requires it.

And if you’re in California, here’s a weird one. Blue Cross of California, not Blue Shield. And of course, any of the Medicare plans or federal plans you may do. So again, think of it, a denial will come back and you’re thinking, why didn’t they pay for a therapy? is because you were missing the modifier when it’s one of these policies.

So do keep in mind, focus in on making sure that I have the claim form right, and that’s one of the things I help with. That’s why I’m an expert. I’m here to help you to make sure that you do well and that’s what these short courses are for. Now, one thing to keep in mind, you’re thinking if I’m gonna put a GP.

I’m just gonna put a GP for everybody. Nope, do not blanket it. Don’t include it for plans that don’t require it. Only the ones that I’m showing here. And here’s the final thing I’ll get into is that it’s just INS insufficient information. And you’ll notice here it says, according to 9 7814, it’s not supported.

The medical records submitted do not indicate the needles were inserted and does not indicate the face-to-face time. Now this is something for another course, but do keep in mind if they look at your. Can they tell what you’ve done? Now, here’s something interesting about this claim. You’ll notice the initial set is paid.

They’re saying it was supported, it was the follow-up set. So you gotta start to look at your notes and go, wait a minute, do my notes demonstrate what I need? Do I have the face-to-face time? Does it meet the minimum standards for each individual set? So that includes first set in multiple sets. And again, we need the time face to.

As well as the points of insertion. None of this is hard. Let’s face it, it can seem daunting if you’ve never done it. Once you get a good feel for it, you’re gonna go, wow, that’s really easy. I want you to think of, you sometimes will say, I don’t think I want to take insurance, cuz there’s these hassles. Do you realize the majority of people have insurance and they have acupuncture coverage?

Don’t you think they’re gonna want to use it? I want to give them access. What I have to do is make it simple. That’s what we’re here to. That’s what these courses are for. And that’s it. If you wanna really get some one-on-one help where we work together, we zoom directly one-on-one. You can even go to our seminars for free.

Take a look at the American Acupuncture Council Network. We’re here to support you. Your success is ours. Until next time, my friends.


AACGELLIS04072023HD Thumb

Treating Neuromuscular Facial Conditions-A Multifaceted Approach



Today I am going to be speaking to you about neuromuscular facial conditions and a multifaceted approach to treating them.

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, my name’s Michelle Gellis and I am an acupuncture physician. Today I am going to be speaking to you about neuromuscular facial conditions and a multifaceted approach to treating them. So a lot of you know me for cosmetic acupuncture.

one of the lesser known things that is really important to have under your belt if you’re doing cosmetic. Acupuncture is a really good working knowledge of the muscles of the face and how they can be affected through different physical conditions. So will you go for the fir to to the first slide?

So I had, many years ago, about 15 years ago, I had started. Researching using some of the different techniques that I was using on my cosmetic patients to help patients with different neuromuscular facial conditions. And I wrote a journal article in the Journal of Chinese Medicine about the topic, so if you’re interested, you can look it up.

It is called a multifaceted approach to treating neuromuscular facial Conditions. And yes, I am outside. I don’t have a bird in my house. I live in Florida, so there are some birds tweeting. So what. Is a neuromuscular facial condition. That is the first thing that we are going to talk about, and then I am going to go through the whole theory of why using a multifaceted approach can be very beneficial.

I’m going to talk about submuscular needling, scalp acupuncture, facial motor points, and then a little bit about facial cupping and guas. So a neuromuscular facial condition is any sort of a disorder that affects the face and it can be muscular meaning it. Prevents you from being able to move any of the muscles of your mouth or your eyes or your cheeks or something that has to do with the neurological system of your face causing pain, twitches a lot of sensation like heat or cold or lack of sensation.

So there’s quite a few different diseases and I’ll touch on some of those that can cause these problems to happen. But the theory that I came up with, that I teach and I’ve been using for many years is that instead of just doing your typical constitutional treatment and maybe a few face points that if you use.

Several different modalities at once. It can really provide for the best results for your patients. So I do a combination of traditional TCM treatment. Then I use facial motor points, sub submuscular, needling, scalp, acupuncture, and , the person is not in too much pain. I can do facial cupping in Gua and even dermal can be incorporated in.

So what are some examples of neuromuscular facial conditions? The most common is Bell’s Palsy. Most of us throughout the course of our treatment career. Through our practice, we will come across at least one patient with Bell’s Palsy and some of them will be, it’ll be a new case and they want help so it doesn’t get any worse or so that it gets better faster.

And for some people they might have had Bell’s Palsy many years ago and they still have some of the residual. Signs and symptoms. Ramsey Hunt Syndrome, which is similar to Bell’s Palsy, but has some additional issues. Ptosis, which is a drooping of the eyelid synkanesis, which is where you try to move one part of your face and another part of your face moves.

Stroke, which can affect the face drooping in the face. Tmj. Any sort of temporal mandibular joint disorder trigeminal neuralgia, which is spatial pain, ms. And there are many others. Okay. . So the face is unique because the face is the only part of our body where the skin is directly connected to the muscle, and that is why we can move.

The skin on our face without having to move any bones. You can blink your eyes, you can smile, you can purse your lips, and you don’t have to move any bones anywhere else on your body if you want your skin to move. You have to actually move a bone in order for it to move. This is a cross section of the face and you can see this is the cheek here.

We have the mimetic muscle, which Goes out to the outer layer of the skin. We have some fat here. And the mimetic muscle is invested in this mass layer. It’s a superficial, muscular, epi neurotic system. And it is what allows the muscles to make our facial express. and the facial nerve is invested deep within the facial fascia.

So by using a submuscular or in some instances an intramuscular needling technique, you can increase the flow of blood and chi in the area. You can break up those fossil adhesions that might exist, and you can stimulate collagen production in the area. . So there are various places in the face where.

Submuscular needling is very beneficial. Not just the face and the scalp. So the auricular muscles, and I incorporate this as part of my cosmetic acupuncture treatments, the temporalis muscles, and this can help a lot with. Headaches and it also can help to get movement back in the face.

It’s very beneficial for T M J and trigeminal neuralgia, the maier. This is great doing submuscular needling underneath the maier for individuals who have tmj. The digastric muscle underneath the anterior digastric, underneath the chin. This can help to lift up underneath the chin area. The frontals can help both with cosmetically, with wrinkles, but can also help.

Lift the eyebrow, get movement going cuz your frontal is connected to your eyebrows. So for individuals who’ve had a stroke or a half bells palsy, by doing the submuscular needling, you can help to get that movement going back in the eyebrows and in turn in the eyelids, the procerus muscle, which. Is in between the eyebrows, the lader muscle, which is underneath the eyebrow, and oh, I missed the platysma.

The platysma, which runs from your jawbone down to your clavicle, and using submuscular needling can help more on a cosmetic level, but with the skin on the. So how this works is I showed you that cross section of the face. The nerves can get trapped, the facial nerve can get trapped and by using needles, let me see if I have it in my next slide.

I don’t using a needle to needle from the skin. Down through the fascia, you are actually helping to break up some of those fascial adhesions and to release any nerves that have been. Entrapped. So for example, let’s say you had a pet patient who had headaches, frontal headaches or ha who had some sort of muscular weakness through MS or Bell’s Palsy in their forehead.

You can take your needles and go right underneath the muscles and do some submuscular needle. . So here is a video, so I gotta get it here.

So when needling the frontals muscle, the,

so when needling the frontals muscle, the. Way that you isolate the muscle is you ask your patient to raise their eyebrows. Go ahead and raise your eyebrows, okay? And then relax and you can find the border of the frontals. Muscle and the way that you needle is you’re going to go from the origin to the insertion.

So the origin is up here and the insertion is here. And typically what I do is I will put in. , usually three needles on the lateral edge, and I will put in two needles. On the medial side, and when you’re needling, what’s important is that the angle of the tube is the angle that the needle’s gonna go in.

So if you go like this, it’s going to go too deep. If you go like this, it’s going to be too shallow. I use. My thumb or a finger to help to guide the needle. So you wanna keep your fingers out of the way when you’re actually inserting. That way you can get to the correct depth right underneath the muscle.

That’s the lateral side. Then you’re going to do the medial side and usually. Two needles will suffice and I do the one side and then I do the other side and I’m using half inch needles. You can use one inch needles depending on how big your patience forehead is.

So as you can see, needling underneath the muscle as I mentioned, will bring energy to the muscle and it can help if there’s any sort of tension in the headache. And on a more cosmetic level, it can help to stimulate collagen in the. Another thing that’s really beneficial to incorporate, and you can incorporate this at the same time you are doing some of your other treatments, is scalp acupuncture.

And scalp acupuncture is part of a class that I teach on treating neuromuscular facial conditions, but I only teach scalp acupuncture as it pertains to the. And neuromuscular conditions with the face. So here is a cross-section of scalp and there are one of the important things when you’re learning scalp acupuncture is how to measure the scalp.

And it is certainly beyond the scope of this short lecture to go through the whole thing. But essentially you when you’re measuring the. it is in different sections. You’re not working with acupuncture points, so you find the horizontal line, you find the vertical line, and then within the motor area or the sensory area, it’s broken up into three sections and the.

Two-fifths is the area that pertains to the face. So you could be needling this and at the same time, so in order to help the motor function, you could be needling this and at the same time doing some local points to help to get some of that movement going.

and this is a short video of what that needling technique looks like

when you’re needling the scalp. It’s important to angle the needle properly so that it goes into the loose connective tissue. I like using a tube. You can freehand if you’d like, but I find that the tube helps me to guide the needle. To the correct depth. I tap the needle in, remove the tube, and then I use my free hand to guide the needle.

If the needle is improperly, your patient should not feel any pain, so you’ll know that you’re into the loose connective tissue. If your patient doesn’t have any pain, when you. Once the needle is in, you stimulate it gently for 30 seconds just like this. Or you can use electricity.

So next up are facial motor points and essentially when. Muscle is not functioning properly. It is either over functioning or under functioning. So it’s either flacid and it’s not firing properly or. It’s over firing and causing too much tension. What the theory behind motor points are is you find the most.

Excitable part of the muscle. It’s essentially where the nerve goes into the muscle and you are gonna place a needle there. Fortunately, for us, many motor points, especially on the face, are actually acupuncture points. So you find the acupuncture point that correlates to the muscle. And in this case, I’ve chosen the frontal.

and the motor point for the frontals is gallbladder 14. So you would needle this, you can stimulate it, and it helps. It serves as a reset switch to get that muscle back into normal functioning.

So I had spoken about Fossil ad Hess. Before, and this is a picture of fascia and here is where the nerve would go. And as you can imagine if you had all of this fibrous fascia, adhesions going on and there was a nerve that was trapped in here, it would be very difficult for. Muscle to function properly for the nerve to do its job.

So one of the things that can really help is facial cupping and facial guha because when you’re moving these small, so these are very uniquely designed glass facial cups, and the rubber part is really easy to squeeze as opposed to. The ones that are more difficult to squeeze and they’re small, and they move around really nicely, they glide on the face and they can help to bring energy back into the muscles to break up the fossil adhesions.

And the same thing with these Jade Guha tools. The Guha tools. When you can use these edges here and you can stimulate different points and you can really get in there up against the bone and help to break up some of the fossil adhesions that might exist.

and I think I just have a picture. There’s no video here, but this would be an example if you were working and you were doing cupping on the face, starting at an acupuncture point, moving the cup up to another acupuncture point. And this has a very lifting effect on the face and. Then going and doing a suction and release down the neck.

You never wanna drag the cup up or down the neck. In my webinar about facial cupping in Guha, I really emphasize safety because it’s so important when you’re working around the neck and the face to be very safe. You don’t wanna cause any bruising. You don’t, you’re working along major vessels, you don’t.

Release any blood clots. So suctioning and releasing down the neck and then just working underneath the clavicle can really have a wonderful lifting, toning, and rejuvenating effect on the face, especially your patients that have some sort of Like degeneration. It’s a wonderful, it’s almost like a massage, and it gets that blood flowing.

It gets the blood up into the muscle and can really help getting that muscle function going again. and the same with Guha. Here’s a picture of me doing some guha along the jawline. This was for cosmetic reasons for sculpting, but can really help to get that movement going. And if a muscle hasn’t been used in a long time, they can get stiff and gua can be.

Now dermal rolling is something that is used on a very superficial, gentle level, but it can help to. Reeducate the nerves and the muscles and the skin, because the skin, if it, let’s say someone has had an injury to the face, maybe they had a facelift and now they have neuropathy and they can’t feel anything.

by doing some of your maybe scalp acupuncture, some body points. And then I sell my patients Dermer rollers and they bring them home and I teach them gently how to use it along some of the channels to stimulate the channel, the meridians, and just to stimulate the skin to reeducate the nervous.

These are some of the publications, my publications, and the one I was talking about was from 2016. It’s a multifaceted approach to treatment of neuromuscular facial conditions, which goes much more into depth about what I was just talking about and. I also teach classes on that and you can find my website, facial acupuncture classes.com if you wanna learn more.

Also on social with my first and last name. And that is it. Thank you for your time. And thank you to the American Acupuncture Council for this opportunity to share with all of you. I look forward to seeing you next time.


AACYen04052023HD Thumb

4 Ways to Use Video to Bring in New Acupuncture Patients



If you aren’t having video as part of what you’re doing, then the reach that you’ll get from things like social media will become less.

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.

How can you have more of an online presence so new patients find you well? Did you know that there’s a study done by Digital Sherpa saying that over 80% of online visitors prefer video while only 20% of them will read something? And truly consume it well. So there’s also, in terms of social media, did you know that a lot of social media platforms are also moving more towards video?

For example, Instagram they had talked more recently, like their executives about how it will become more increasingly more of a video platform. And same thing with Facebook executives. They said that a long time ago about how Facebook will primarily be a video platform. And so what that means is that if you.

Sharing video. If you aren’t having video as part of what you’re doing, then the reach that you’ll get from things like social media will become less. And for the amount of time and energy you put in, it’s gonna bring in less bang for your efforts that you put in. And then overall, one thing that if people don’t really know much about how you could help, If you’re able to do if you’re able to educate them through video, people are able to build that relationship with you much faster.

So today we’re gonna talk about four ways that you could use video to, to bring in more new patients in your acupuncture practice. So this is Chen Yen, your six and seven figure practice makeover Mentor at introvertedvisionary.com and your host for our AAC live show today. So let’s talk about the four ways that you.

Used to bring in new patients by video. So the first way is to put it on your home page. So why? Because it’s such a great way to build that kind of connection and trust quickly. Did you know that most people come to website, they leave and they never come back? And did you also know that one of the most visited page.

is what? It’s a page where they find out who is this person, right? So being able to feel whether they connect with you and feel comfortable with you as their provider, as their acupuncturist it, it can speed up the process so much faster when you have a video on your website and it can also help people understand how you can help.

So I used to be very self-critical on video, and I also felt would often feel like, I wasn’t saying things eloquently enough, so I probably shouldn’t do the video, and then I would procrastinate and then just not do them. And then also sometimes I would feel like, oh, I don’t look good enough to be on video today.

So then I would just think, oh, I’ll just do another day and then would never really do it right. . What I noticed was that once I started being on video, Got more comfortable with it, then people ended up coming to us more readily and also were more aligned. When we started putting video on our website, we noticed that people who are coming to us are now they’re more enjoyable to work with.

than ever before, and definitely attribute that to video. And same with our acupuncturist clients who have put video on their website. Now does it have to be professional video or does it not have to be? I would say that certainly, of course, professional video is great, but we’ve had clients who have only posted pretty homemade kind of videos, but as long as the background was professional looking and then they were showing up in a professional way.

It actually still works really well because the most important thing is being able to connect and. Really be yourself. And and then I remember one of our acupuncturist clients who was really nervous about being on video. And I helped him with this what to say and gave him a framework for this.

And then he ended up feeling more confid confident about it. And then he ended up doing a video that he put on his website and more people ended up booking with him. And then now that he has associates, he also. Them do video too. So those of you who have associates you could have them do it of an intro video or you could interview them and as a way to help warm up your patient base to the, your new associate.

Because have you ever had people, if you have an associate, have you. ever had patients say, oh, I just wanna see you. So if you end up being able to introduce your associate to the practice, then make them feel more comfortable make your patients feel more comfortable or people feel more comfortable, then that can also smooth out that transition.

The other thing is that you don’t have to do videos of yourself even. Have you ever thought about this? You could ha post explainer kinds of videos on your website and what is, what does that mean? For example, there might be something about how acupuncture can help with sports injury or acupuncture, how acupuncture can help with digestive issues.

And there are different videos out there, for example, on YouTube that you may share on, can you. Embed their video on your website and certainly, give credit to, to where that came from. And so you don’t actually have to be the one doing the video yourself also. So another possibility is, so the second way to use video to bring in new patients as a practice is to share on social media.

So I already brought up some stats related to how. Video tends to get more views than if you were to post something written on, whether it’s Instagram or Facebook. And it’s because the algorithms are favoring video over the just regular written posts. And so you don’t need to do song and dance though either, right?

, there. , you don’t have to do that kind of stuff. You could do videos in a style that feels comfortable for you. So for some of you that might be more educational and and then it’ll help expand your reach beyond just written kinds of posts and organic social media. The other possibility related to expanding your reach via social media through video is that you can also do paid ads.

You could just create one video, for example, on Facebook. To attract new patients. One of our acupuncturist clients did this and her video was running for over a year and she was still attracting new patients with that one video that we just dialed in. And she just had a wonderful presence and it helped her with what to say and it was really awesome cuz just that one video, imagine just creating one thing and it brings in patience for you for over a year.

So that was really awesome. And the third way to use video. To bring in new patients into your acupuncture practice is to send videos to those who aren’t sure. If they wanna come in to your practice or not. So this could be either in the way of where people are on the fence or it ends up being a video where you share it and with your patient base, and then they share it with people they know or end up referring people to you so that when I say people are on fence, what I mean by that?

For example, have you ever had people call and then they aren’t sure about coming in. They’re like, oh but you don’t accept my insurance or x y. Reason for they can’t book an appointment yet and then just hang up the phone and that’s it, and you never hear from them again. What if instead you did what one practice does, which is they end up sending out videos tied into that person’s issue or condition and then say sure, let me sh send you something that can help you also with your, with your.

issue. And then so that video can start educating them more about how acupuncture can help with this. And or Chinese medicine can help with whatever that health condition is. And it could also be a video. So it could be a video that you just pull for them, or it could be a video that you create, which is more, even more ideal because then they will, they’ll get to experience you energetically and see if they resonate with you or not.

So that can be a great way to help. Inspire people who are on the. To actually book with you, and especially those of you who may charge higher fees or maybe an all cash practice or maybe some of you offer packages. It just really depends on your practice situation or you offer functional medicine and and you offer.

Packages. And so if, especially in those situations it will work really well because it helps warm up people who might be on the fencer who aren’t really sure. And to you and also your approach. The fourth way to use video to bring in more patients for your acupuncture practice is to email the videos to your patient base or, and, or.

Have you ever had people come in for one thing and then they don’t even realize you could help ’em with other things, so that can happen, right? They, even your patients who really appreciate you. I remember there, there’s a so I have, I see a naturopathic doctor who’s also an acupuncturist, and I fly to outta state to go see her, and she does some pretty high level stuff in terms of e.

Work not your traditional kind of naturopathic doctor. And her acupuncture treatments are incredible too. They’re I’ve never had acupuncture treatments like how lasered she, she really is when with very few needles in. And and so the, I fly to go see her and I’ve been, I was flying to see her for, it was at least a year at that point in time.

And I love her treatments and and I, she also helped me so much. But it was really amazing because I remember one day I asked her, Hey, do you can you help with X, Y, Z? I couldn’t remember what the issue is at this moment in time, right? But it was I asked her that and she’s oh yeah, of course I can.

And I thought to myself this, how funny, I’m a healthcare practitioner and I also really trusted in her helping me. But for some reason I never put the two and two together that she could help me with this thing. And so sometimes your patients don’t even realize that you can help ’em with these other types of issues.

They might come in for pain and then they have no idea you can help ’em with digestive issues or their Hoag hormone balancing. And so the only way for them to become more educated about it is if you share about that in the practice, which sometimes you may not have enough time. And then sometimes the, it may not be issues they’re dealing with, but maybe it’s an issue that their friends are dealing with and they would be totally happy to refer people to, but they don’t even know that what you, your services could really help their friend with some of their health issues.

So this is where. If you share videos to, with your patient base by emailing out to them, you could also have videos that are, for some of you, this makes sense for, you could put a TV in your waiting area, and then it plays different videos, educating patients more about acupuncture or Chinese medicine, or you could have them.

Periodically if you don’t want to have a TV or don’t have one and to put in there, then you could have a laptop that they watch. And it doesn’t have to be at every visit. But it could be while they’re waiting in the waiting area, then you mentioned to them, okay, I’d love for you to watch this while you’re waiting.

And then the also, would you, we talked a little bit about referrals. Would you love to increase referrals? And some people hear about the practice and even if they, like your patients rave about it to their friends and family, they may not come in right away. And sometimes it’s from having seen a video and then realizing, oh, okay, I get more about what this is and or they also see you if you’re in the video, then they’ll feel like, oh, okay, I actually feel like I, I resonate with this person.

So they’ll be more likely to come in as well. You could also. , if you’re sharing these videos with your patient base or your list, then you could share about upcoming things at the clinic that you’re excited about. You could also do, one of our acupuncturist clients did a clinic walkthrough and then talked about her vision for the practice and then what who she loves to, to treat and help, like what kinds of patients.

And that way people, that, that video can end up being easily shareable also. To people who could be coming in, friends and family who could be coming into referrals. So those are the four ways to, to use video to attract patients to the practice. And then it’s just a matter of, I and I get how sometimes, especially if you are starting or thinking about this it can be easy to feel like you’re either you get nervous or you don’t like to be on camera.

It could feel uncomfortable. And what ha what I’ve noticed is that no, getting, just doing it will help you start feeling more comfortable and then knowing what to say too in a way that not only educates, but also inspires new patients to come in. So having a framework for it can also really help.

What could you say? And that way you feel more comfortable and confident. We actually have a a script for if you would like to, , for example, create a video that introduces your practice and what to incorporate in it so that people would not only feel more comfortable with you and your practice, but also inspire them to come in to also book an appointment.

We have a template for that. So if you want to email me, or, sorry, if you wanna message me and request it, I’m happy to give it to you. And then, so for those of you who are, or, and I’ll also give you our website too. Our website’s introvertedvisionary.com. And if you’re not watching this on a social media platform right now, then you’re welcome to go there and then request the script.

And I’m happy to give it to you. And for those of you who are at a place where you’re at a plateau in your practice or you just know you’re capable of so much more you would love to grow with more ease and flow and bringing a consistent flow of. Then feel free to check out introverted visionary.com.

So til next time.


AACCollins03292023HD Thumb

Aetna’s Mandatory Acupuncture Benefits



Click here to download the transcript.

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

Hey, greetings all, it’s Sam Collins. You’re coding and billing expert for acupuncture in the American Acupuncture Council. Most importantly, for the profession and for you. Let’s always work on getting your office. to be the most profitable in business that we can. I’m the expert when it comes to coding and billing, which means also though, for payment and how do I make my office survive?

And it’s not just insurance. It could be cash, and we work a little bit on all those. But today, let’s focus on what’s going on with insurance coverage, particularly with the company Aetna. It’s at some nice changes, but it’s important to know though they’re increasing or having mandatory. , what do they actually cover?

One thing that you have to be careful of is understanding what codes they will pay or will not pay to make sure and assure that your claims get paid. Frankly, make sure the patient gets the best benefit and you’re paid for your services. So let’s go to the slides. Let’s talk about this acupuncture under Aetna.

And its mandatory coverage, but what does it cover is what I’ll say. Well, let’s talk about where Acupuncture’s really move or has moved. There’s a much broader access to acupuncture. Why does that happen? Frankly, it’s consumers who want it realize that the additional coverage that people are getting is because the want of customers out there who want it.

In fact, you’ve probably seen some of the commercials for the Medicare Advantage plans that literally use acupuncture as a way of marketing, so consumers are looking for it. Obviously, insurers. Why are insurers looking at it? Well, they’re realizing it helps, saves. But it also is sort of mandated based on opioids and some other issues.

So we’re seeing access there. Obviously the Affordable Care Act has helped because it’s made mandatory in five states, but now there’s been two that have been added. So for those of you who are in Oregon and Colorado, you now have also mandatory acupuncture benefits on all plans under the Affordable Care Act.

So that’s a good thing. That’s in addition to the other five states. Of course, the VA has created. . That’s nice. Medicare has not quite where we want it, but we’re getting there. And of course the big thing is the opioids have probably created most of that to be there. Why? Well, let’s take a look. 37 State Attorney Generals of National Governance Association have now endorsed and say they want more acupuncture.

They need it to be included. Why? There’s a few issues. For the most part, it’s just a money saver. If you go to an acupuncturist, that’s $600 compared to a primary doctor, which is 17. In addition, when a person contacts an acupuncturist, 30% of the cases compared to 70%, they’ve done the work. When people go to an acupuncturist first, it will save Medicare 230 million in its medical budget per year.

That is a big change and a big money maker. So insurance companies are starting to pay attention. The American College of Physicians for back treatment guidelines now indicate acupuncture. Even the FDA now says, Hey, for non-pharmacologic people should be doing acupuncture. There’s a bill going through Congress now in California to specifically make sure that there’s always access to acupuncture for people that are gonna need opioid.

To know they have that access, that there is something beyond taking an opioid. Well, even the CDC has gotten on board saying, Hey, when prescribing opioids, clinicians have 12 recommendations for acute subacute acupuncture. Non-pharmacological has gotta be part of that. They highlight the benefits, the effectiveness of it, and health insurance should continue to improve that because creating more access saves everyone, not including the people who take opioids and can overdose The CDC guidelines now, all specifically all.

about acupuncture. So I think what we’re seeing with a company like Aetna is what they’re doing is creating where people have more access. So you’ll see here in 2022, Aetna is added standard acupuncture benefits and new and renewing commercial health plans. So anyone who has Aetna through their job commercial plan, is going to have now acupuncture benefits.

That’s really cool. Aetna’s always had acupuncture benefits for some plants, but not all. And I’m sure some of you’ve run into that. You’re thinking, oh, it’s covered. Then it comes back, oh, it’s not covered cuz we only cover it for, you know, uh, this, uh, surgeries if you will for, uh, anesthesia, that type of thing.

Now it’s gonna have a standard coverage, which means all plans have it. So here’s the good news. If someone has. Do they have acupuncture? They do. In fact, it’s governed under their acupuncture and dry needling guidelines, which is their clinical policy bulletin, and it says, now standard NAPLANs STEM coverage of acupuncture for medically necessary indications.

So now here becomes the difference because it’s covered. Does that mean they cover everything an acupuncturist could diagnose or. No it doesn’t. It’s still limited, but that still means there’s a lot of access here. So they’re gonna limit it to the coverage things that they do. Now, this is what I wanna be clear on.

You wanna know what codes they will or will not pay for. This is what we do with our seminars. This is what we do for my network members to make sure you’re updated. So you’ll notice here the next review was just this year. They haven’t published it yet. We probably won’t get any updates to this probably until June or July.

I’m not sure it’s gonna update very much, but it’s going to follow along these lines. And it’s very specific about what it covers and you’ll notice it gives about 10 things that it will cover. It covers when medically necessary neck pain. It covers headache. Now those are relatively new. It used to not cover those, but it does say chronic.

So kind of that it’s been there for 12. Now, I think for many patients, chronic conditions like this aren’t hard to muster simply because it’s not always an acute issue, but a patient will go, I’ve had these headaches on and off for months. Well notice also it covers low back pain. Well notice it doesn’t say chronic low back pain, which now means it can be acute as well.

It also includes nausea of pregnancy, osteoarthritis of the knee or hip. So knee or. Does it cover arthritis? Are there is No, they’re saying near hip. So near hip pain. It also covers nausea from, um, chemotherapy. So, so-called chemotherapy-induced nausea, dental pain, which is kind of weird. So they, are you telling me that Aetna will cover for someone that has tooth pain?

Maybe they’re getting a tooth removed or something? Yes, they will. Not. Through their dental insurance, through Aetna, they also covered TMJ conditions. Now that’s something unique to them, CIG. Has a much broader allowance of diagnosis. But do you know Cigna doesn’t cover TMJ yet? Aetna does. So here’s what I will tell you.

If you code within this range, they’re gonna pay you you code with these conditions, they’re definitely gonna pay you. Just be careful of maintenance treatment. Notice what they define as maintenance treatment. Maintenance treatment where the member’s symptoms are neither regressing or improving is considered not medically necessary.

So I’ll simply put it this. , so long as you’re making the person better, it’s medically necessary. Now, the difficulty is once they are better, should we keep treating to keep them that way? My opinion? Yes. However, from an insurance standpoint, they want them to have a fall off and when they do, can treat again.

So this is where you might see a patient periodically throughout the year for acute episodes of a chronic condition. It flares up, we take care of it. We do a handful of visits if they’re. A month later it comes back again. But will they cover it? The answer is yes. Now they’ve listed the conditions, but what are the codes?

So let’s take a look at these codes specifically. They cover headaches and it covers migraines. Now you’ll notice migraine headache is G 43 0 0 1 through G 43 9 19. So you can well imagine. Wow, there’s a lot of coats from migraines Now there’s not 900. There is about 35, but they vary between those sections.

The most common one, G 43, 1 0 9, that’s your standard run of the mill migraine. But does it cover migraines? It does. Does it cover tooth pain? It does, but look at the code K 0.89. I bet many of you’ve never seen that. That’s literally a code that says disorders of the teeth. But because there’s no specific code for tooth pain, we use this one to document that in the notes.

It’s gonna have pain, but this is the code you use. It will also cover arthritis, but notice it’s arthritis of the hip, the hip, the hip, the knee. The knee, the knee. So it’s covering hip and knee pain. Now, you know what frustrates me about that? If you can tell me that acupuncture is gonna help with the knee and arthritis, pain of the knee, or.

Why would that not work in other areas of the body, such as the shoulder or the elbow? I think it obviously would, but again, they’re specifically indicating here it does indicate TMJ disorders, so TMJ dysfunction of any type or pain notice, neck pain, and then the low back pain codes. Then of course, vomiting of pregnancy, vomiting, chemotherapy, headaches, and that adverse ad, adverse effect of anti-neoplastic immunosuppressive drugs.

And notice, parenthetically, it says chemotherapy-induced nausea and vomiting. The fancy term is adverse effects, but it’s just chemotherapy-induced nausea. One quick note, this code has a plus at the end. Please note that this code any, anytime it’s an S or a T, prefixed to a code, it always ends in an A for acute.

And then the last one says Other specified post-procedural status. This is the code for post-surgical pain. They’re specifically indicating it dental, but obviously if you’re using any other type of post-surgical, this could work. One quick note please. Everyone take note of this, this code Z 98.89, even though it was published this way by.

it’s incomplete. It actually should be Z 98.890. So do write that down. Z 98.890, not 89. It shows you that insurance companies aren’t always infallible as well. But here’s what I’ll point out. If you code these two Aetna, I am going to guarantee they’re gonna make payment because these are on their list.

In fact, at the very top it says, these are the codes. If the selection criteria is met, which means is it chronic pain in some areas or is it, you know, manifesting that way. But you’ll notice they do something tricky. They say, parenthetically not all inclusive. Now that frustrates me because what they’re saying is these are the codes we cover.

We may cover more, but we’re not gonna tell you. Well, what I will tell you is generic. There’s some additional things that they’ll cover, and two of them, one of them is really gonna surprise you. I talked about the knee and hip arthritis and pain. What I will tell you is arthritis wise, they’ll cover here.

They’ll also cover pain. I have found through many people that pain in a joint will be covered like shoulder, elbow, wrists, so you’re pretty safe there. What they will also cover surprising. is anxiety. Now not full on depression. We’re not coding that probably from an acupuncture standpoint, but anxiety, depression, unspecified.

The code for that is F, as in Frank, 41.8. Now I’m pointing these out the other joint and this, um, anxiety just to say these are some other services. Some of you may say, Hey, Sam, I build a few other ones and they’ve been paid well. Great. I would like to say, let’s look at those and make sure we all know what they are.

That’s why I gave you those three extra ones, meaning joint pain and then of course the anxiety. What I will focus on though is to tell you be careful of coding things they don’t cover by example. You’ll see here it says Cervi. . That means neck pain. Now what if you have someone that has a strain of the neck?

You know, they do something active and they strain or sprain the muscle. If you coach strain or sprain to Aetna, they will deny the claim even though it’s neck. So what should you do? Don’t coach. Strain. Sprain. What? What is the symptom? What are the complaints a patient will have when they strain their neck?

You got it. Neck pain. So in this way, you’re gonna use the more generic, just tell me where the pain is. Don’t get specific that it’s spondylosis or other things of that nature. I kind of like that. It does keep it simple, but here’s what I’m again gonna point out. Make sure you’re looking at this list and if it’s not on the list, Make sure that you can find someplace that, okay, I’ve seen this elsewhere been covered.

This is one of the things we do at our seminars. More importantly, our network service. When members call me or get in touch with me, this is what I help them with is that here are the additional codes they may cover. I wanna at least give you a thumbnail though, to see what they do cover. So when they say they have mandatory coverage, I’m gonna say, yes, they do, but it’s for these codes.

So maybe take a picture of this screen, make sure you’ve got the right ones. What do they cover? Well, they cover acupuncture as you can. Well see, you know, initial sets, follow up sets where they’re manual electrical. But you’ll notice it also says tending the TDP lamp. No specific code. It says, well, what would that be though?

That’s probably just gonna be your hot lap. 9, 7, 0, 26 notes. It also covers dry needling. Will it pay an acupuncturist for dry need? Generally, no. What they’re gonna cover you for is acupuncture. I’m not gonna say an acupuncturist can’t dry needling, but I would assume it’s more acupuncture. These are the things they’re gonna pay you for, and quite frankly, they have a higher value.

I’ve had people ask me, Sam, can I bill dry needling? Well, I guess you could, but here would be my point. Why would you? The value of the dry needling codes are 50% of the acupuncture codes. Why would I bill a service that’s 50%? Than the actual service I’m performing. So I would focus in on the acupuncture.

Think of it, and this is something I emphasize when I come to you as a patient or when someone comes to you, guess what they’re seeking acupuncture. Therefore, what should you provide? Acupuncture. That doesn’t mean you might not do a little body work or some other things, but notice they’re not indicating these are covered.

I’ve run into some issues also where offices have had some plans with Aetna that don’t cover the. Now if the plan doesn’t cover it, does the patient have to pay for it? Well, they would assuming you’re out of network. But keep in mind, what I will tell you they will pay is the acupuncture codes. Now, be careful, stick with the codes I gave you because here’s their list of things they don’t cover, and look how far this is.

We have acne, pancreatitis, addiction, aids, Alzheimer’s, all of these conditions. If you code any of. , it won’t be covered, but let’s take this one here. Notice it says myofascial pain. Okay. What is myofascial pain? Pain in the muscles in some part of the body. Well, what if those pain in the muscles are in the neck?

How would you code it for Aetna neck pain? What if they’re in the low back, low back pain, and so forth. So in some ways, these things can be covered, like by example, carpal tunnel syndrome right here. What does carpal tunnel syndrome cause? Wrist pain or forearm pain, that’s what we code. So be careful they’re not covering these things, but they may cover it if you can keep it symptomatic.

So while I will say, I’m happy to see this, I hope it gets better, this gives us a good framework so that way you’re not fooling yourself. One of the difficulties that I’ve run into offices is they’ll say, Sam, my claim’s not being paid in its Aetna. Then they send me over and they’re coding something that’s not on the.

and I say to them, let’s make a correction. So these are the things that I wanna make sure that you understand that you can solve that if a patient comes in with a condition that clearly doesn’t relate to any of those, you know what you’re gonna tell them. This is not covered by your plan. However, here’s what we offer for cash patients, whether you’re doing a pre-pay plan or just a discounted time of service, that might be something you can do.

But I don’t want a patient thinking it’s covered and it’s not. Cuz do you ever notice, sometimes people wanna blame. when you are, when their insurance doesn’t cover, how is that your fault? It’s not. Obviously it’s their coverage and so don’t give them the false sense that it is covered. This is what we do at American Acupuncture Council, specifically the network.

You want someone to be helped to you. I’m an expert. I could become part of your team. Join us. You can call me, you can email. We do Zoom. We are here to make sure you’re getting. Many of you have lots of problems of things that don’t pay you we’ll fix that. Take a look. Otherwise everyone, I’ll see you next time.

Until then, I wish you the absolute best and continue doing what you’re doing. Take good care of your patients.


AACSmircina03222023HD Thumb

Can Advocacy Help Build Your Practice? Nell Smircina



I wanna thank AAC for having me here and letting me talk about advocacy and how it can help build your practice.

Click here to download the transcript.

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

Hello and welcome to another episode of To The Point. I’m Dr. Nell with the American Acupuncture Council, and I wanna thank AAC for having me here and letting me talk about advocacy and how it can help build your practice. So let’s go to the slides.

For those of you who know me you know that this is actually part of why I got involved with aac. So being trained as a practitioner building my own practice and really my goal was always how are there. Gonna be enough hours in the day so that we can focus on building this profession.

And so I designed my practice in such a way where I could also spend time being an advocate. And what I found through that process was that advocacy can actually help build your business. So some of the things we’re going to get into today, really surprising ways that you can be an advocate. We a lot of times all have certain views when we hear the word advocate or the word advocacy.

Might have certain assumptions around that and might think it has absolutely nothing to do with business building or practice building. And that it’s a very separate thing. But we’re also gonna talk about how you can leverage advocacy to bring more. Into your practice. And then, okay, what are next steps, right?

So are you involved as an advocate? Should you be involved? And what do those things look like? Like I was saying, this is a big reason that I did get involved with AAC because as a solar practitioner, there are certain things that you can do, but there was also this really great organization that was helping to advance the profession in really tangible.

And as one individual, we fit as part of a collective in the profession. So it’s an exciting time. We’re gonna talk about a few of those things today and how you can really get involved. But first let’s get into a little bit of what is advocacy and what are those surprising ways? , this is usually this picture or this previous picture is what people normally think about when they hear the word advocacy.

It’s that, oh, I have to be a public speaker. I have to be out in front of a large crowd, or talking to a lot of people, or. Doing some type of pr I have to be visiting legislators offices, and that can feel a really daunting and b, sometimes just unappealing to your general practitioner who wants to be able to sit there and talk with their patients.

And so really the goal is, all right, let’s understand what are some creative ways to be an advocate, because it doesn’t have to look like this. This is what it looks like for me because I enjoy going and speaking at schools, and I enjoy being a part of the national Association on their board and going out and talking to different legislatures.

But that doesn’t mean that’s what you have to do to really have an impact. So really simple ways that you can have an impact is realize that. You as a licensed acupuncturist, anytime you are talking to someone about this medicine, anytime you’re talking to somebody about acupuncture, traditional medicine, how it can help them the education that you have, you are advocating.

for this profession. And so that could be a one-on-one conversation, that could be a one-on-one conversation with a prospective patient with someone on the street. I always use the example of meeting people in coffee shops. I clearly go to a lot of coffee shops cuz that’s always my default on how people must meet people.

But let’s say you’re talking to somebody in a coffee shop about acupuncture and they’ve never heard of acupuncture. and they come and see you or they come and see one of your colleagues. That person can turn into a person who then goes and tells another person that they should come and benefit from this medicine.

So you are helping to grow efficacy. You are part of an effort. To expand awareness around care, to let people know the value that this profession provides. So it’s not always that you have to then go and talk to someone in Congress or at a state level. , although that is something that we’re gonna talk about as well, if that is something that you’re interested in.

So thinking of yourself as really this term of a professional model, professional modeling. We’re showing people who are coming into the profession, if we are more veteran practitioners, showing people the way, helping to advocate for. Effective business practices for being successful in practice so people know, oh, this is a safe profession to come into.

This is a great profession to come into. And so through those different avenues, whether it’s general public, your patients other practitioners coming into the field, you are helping to be an advocate, even if it is on a one-on-one level, and it’s not going directly to our legislature. , but let’s talk about this because this is sometimes the pushback that we get.

Let’s get past the public speaking and I don’t wanna do that. We can do that with our patients, we can do that, on a one-on-one. But, we’re also trying to build a practice, right? And we need to make a living. We need to be able to support the patients that we do have. We need to be able to bring in more patients than who we currently have.

So how can advocacy. Potentially build our practice. . A foundational concept of being an effective advocate is communication. So we’ve done a couple different Facebook shows around this topic, storytelling your elevator pitch, how are you articulating the value that we provide? One, using those skills in any of those avenues as an advocate, helping to hone those skills is going to make you more effective when it comes to building your practice.

But also, I have to tell you as I got more and more involved in larger skill advocacy work, so I was the president of my state association and now being on the board for asa, which is the National Trade Association, my patients really loved this. , I was a little nervous at first that, oh, I might not be in on this particular Friday because I’m gonna be going to this conference and speaking, or because I’m going to go and do a meeting with my representative.

I’m gonna have to block some time off and let patients know oh, you can see me Monday through Thursday next week because this is what I’m doing. Actually sharing that information with patients is critical in how it can help build your practice. I had more patients when I was practicing in LA who would refer people in and they would say, oh, my friend sees you, and he said, you’re the president of the state association.

That’s so cool. So patients get really excited. You’re knowledgeable about your craft, that you know the industry that you’re part of, that you’re part of a community, and you are, versed in how to leverage that community. Because resources that you have as a provider, that you have as an advocate then trickle down to your patients.

And when it comes to blending those two concepts of how do we get really good with our communication? . And then how do we articulate this information to patients that we are involved in our profession because we love it so much and we wanna see it succeed, and we want this medicine to reach as many people as possible.

When you blend those two things, then you get to the point where, You’re better at articulating that treatment plan and you have more credibility when you’re telling your patient that you are involved. So not only are we practicing the communication not only are we truly involved in our profession and know what’s going on but.

then we can fully articulate that to our patients. Have the credibility to be able to say, I know this medicine. I know other people in this medicine, and if you need an additional referral, I’ve got you. That gives patients a lot more confidence and a confident patient, a trusting patient. An enthusiastic patient.

Those are the patients who are going to help you build your practice. So then you’re not stuck in that one-on-one referral machine. You have people who are then out there advocating for you as a provider for your practice. So last question we wanna answer quickly is, Are you involved and should you be?

And what does that even look like? Like I said, for some of you, your involvement is going to be, I’m gonna get really effective at articulating the value of this medicine to people, and I’m gonna be an advocate on that level so that on a, in a one-on-one conversation, more people are gonna come into acupuncture.

You could take that a step further. You join your state association and there’s so many different levels of involvement there. You can simply be paying dues to help support the mission of the association. And I have to tell you, we’re like the only healthcare profession that makes this optional.

Every other healthcare profession, you get your license and you’re a member of an association and they have very powerful associations for that reason. They’re able to pass more legislation, they’re able to get the attention of representatives in a more effective way because of the strength of those associations.

We’re the only ones who just say, ah, if you wanna be involved. So to make it really easy for you all, you can simply be a dues paying member. What does that. It helps support the mission of the association. It helps advance the medicine, the people who are working on those boards, on those committees who are working so hard.

Those dues help that mission continue. But at the same time, you also get to be kept in the know. So maybe you’re like, I don’t have time to serve on a committee. I don’t have time to serve on a board. I wanna focus on my practice. At least you’re getting that information via email. Webinars that come up where there’s information available you can attend.

And you have the option to get more involved. You could be on a committee for your state association, you could be on the board. And then state associations in turn are members of a national association. So you could get involved with the national Association, through the state association as well, and work on things on a more federal level.

So there are conferences coming up for the asa as the National Association in. I will be there. AAC will be there supporting as always. One of my favorite things about this company is, man, do they show up for these associations and trade shows to make sure that the organizations are well supported.

And then you have. Organizations like the Society for Acupuncture Research, if you’re really into research, that could be a great organization to get involved with, to know what’s going on in an international level. They have a conference coming up too in May and. AAC will be there as well. So I’m hoping that as you’re going through this, you see it’s not just a one size fits all approach.

This is not something where you have to be out there doing public speaking. This can go anywhere from, I’m getting really good at communicating the value that this medicine has to provide to, Hey, I wanna be on the board of a national association. There are so many things in between that. So many ways to start honing your skills so you can help grow this profession, grow this medicine, and help improve the experience for your patients and your practice as well.

As always, if you have any additional questions for me please feel free to reach out. It’s nell@acupuncturecouncil.com. Loved seeing you all, and don’t forget to tune in next week for another episode of To the Point, tons of value to be offered for you guys. Have a great day.