Click here to download the transcript.

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

Greetings, everyone. This is Sam Collins, the coding and billing expert for acupuncture for you, for the profession, for the American Acupuncture Council, and of course, for my AAC network members. Let’s talk about, have you really decided, how do I determine

Have you ever thought of what the costs are? As most acupuncturists, you’ve probably dealt mostly with cash and you’re charging one fee no matter what you’re doing. I want to start to do something that allows you to make more money in your practice by identifying your services and creating a true value to them.

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I can’t tell you how often I’ve had acupuncturists come to me and say, Charging a fee that is well below what people will accept. By example, if someone is willing to pay you 70 for a service, but you only charge 35, how much are they going to pay? 35 is what you charge. And I say this really from an insurance standpoint, because if an insurance is willing to pay you 70, but you only charge 30, they’re going to pay you 30.

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So have you ever really taken some time to look through your fee schedule to understand the value and what we’re going to focus in on what’s called relative value units. So let’s go to the slides. Let’s talk about that. Every single service. In CPT, any service you can provide as a licensed acupuncturist to a patient, that service has a value.

And that value is just to compare one service to another. By example, if one service has a value of 1 and another service has a value of 1. 5, It tells you the one that’s 1. 5 would be 50 percent higher than the other. So what I want you to do with this is start to really use just your fee for acupuncture.

If you tell me what you’re charging for your first set, I will tell you what the relative price should be for everything else you should do. And I’m going to implore my network members, in particular those that are viewing this, Make sure if you haven’t reached out to me this year to do so we can go through with you on a one on one Zoom on Establishing and understanding a fee schedule that’s specific to your area.

There isn’t generic across the United States It depends on your area. So I’d like to start this though with all of you taking a look at what is your current charge? Have you ever really thought what do I charge for stuff? I want you to write this down. What is your charge? For the first set, an additional set of acupuncture.

We’ll just choose manual for now. Keep it simple. What is your charge for a 99203? A simple mid level new patient exam. As well as 97124. Just simple massage. Nothing fancy. So acupuncture. mid level new patient exam and massage. How did you choose the fees? How do you know what one should be to another? What we’re going to focus in on is the relationship of one to the other.

Now, what we’re going to start with is what is your fee for 97810? Now you may think how do I come up with that? There’s things to do there. And again, network members can contact me about that, but I’m going to just keep it simple. What do you currently charge? If you tell me what you charge for a 97810, I will tell you what the other fees will be and what an insurance will pay.

Give me what an insurance pays for one code, and I’ll tell you what they’ll pay for any. Now I want to keep in mind, a lot of your managed care contracts don’t necessarily follow this. But, this is one of the reasons I don’t like managed care, but things that don’t. By example, workers comp, personal injury.

Even the VA follows this because I will tell you the VA and Medicare rates are much higher than what you would get from American Specialty Health in a lot of these. So I want something that’s going to make sense. So what this is about though is understanding the value of services. So on this page I’ve given some examples of the relative value units for common codes and you’ll see right in the middle I’ve included the acupuncture codes.

And you’ll notice 97810, 97811 all have relative values from one to the other. To make this the simplest way to think of it, if you charge 138 for the first set, I’m just making it an obvious example, what should be the cost of a second set? 80. Now you may think, wow, that’s a big, yeah, there is more than a 50 percent difference.

between the first set and the additional set. The first set includes more of the initial part of the visit, all the exam part. That’s why it’s a little bit more. And I’m going to warn everyone, this has gone up 20 percent this year. If you’re not aware, and you’ve probably seen it within the VA for those that are billing, there is a 20 percent increase in the relative value.

RVU’s updated substantially because I think they really looked at the cost. and value of acupuncture in relation to other services. So 97810 and 97813 both increased 20%. So if you have not increased your value of 97810, I’m going to let you know you’re losing money. Now, the value differences of 11 and 97814 did not change, but those two increased substantially.

By example, on a Medicare slash VA patient, That is literally 10 to $15 more per code. And remember that’s based on a $40 rate. The $40 rate for 9 8 9 4 0, which was fairly common, is now 50 plus in most areas. So start to look at that. But what this also does though, is give the relative values of other services by example.

Notice simple heat, infrared heat, 9 7 0 2 6. It has a value of 0.2. So if you think in relation to a 9, 7, 8, 1 0, you’re gonna think my goodness. That’s literally around 15 percent of that. So if you want to know the relative value of a heat lamp, it’s about 15 percent of the price of your acupuncture, which means that’s why it’s worth like 10.

I, in addition here, though, I have other codes, 99203, 3. 37. Now here’s something to look at notice 97810 is 1. 38. 99203 is 3. 37. Now, this is not exact, but what we all see here, that’s close to, if not quite, three times that rate. I’d say about 2. 6. What you want to start to think of is, what should be my price of a mid level new patient exam?

Two and a half to maybe 2. 75? Of the value of the acupuncture code. So if I’m charging, say 60 for a 97810, my price for a 99203 is going to be 160, 170, somewhere in that range. What I find often is a great deal of undervaluing. of the services. So here’s how we’re going to do this. Let’s talk about what you charge.

Let’s just make it simple. What if we were to charge 75 for a first set of acupuncture? I’m just using this as a random number, so that’s what your fee is. Great. I take 75 and I divide it by its relative value. So I take 75, divide by 1. 38, and it gives me this conversion, which is 54. This conversion number then is what we multiply any other code by.

To tell me it’s relative price. So if my first set of acupuncture is 75, notice the additional set 5434 times 0. 79 means 42. Now I’d probably round that up to probably 43, but needless to say, you can see here. Oh, okay. It’s not going to be the same price. I’ll give an example. I had an office that was charging 60 for every set, and they were paying in full for each one.

They’re thinking, this is great, Sam. You know what that told me? If they’re willing to pay you 60 for an additional set, do you think you have undervalued the primary set? You bet you have. So I want you realizing that this swings both ways, that you really want to start to have a reason behind the fees.

And again, with network members, I want to push you that. Let’s start to set this up, because here’s what I’ve learned. Most acupuncturists bill roughly 8 to maybe 10 codes on a regular basis. Exam codes, acupuncture codes, a handful of therapies. I find of that, usually more than half are undervalued. Which means Half of the codes you bill, you’re getting less money than you should.

So by example, look at the exam price. Now again, remember I said it’s about 2 point whatever above, but notice 54. 34, 183. So again, not quite three times, but you can see the range. But notice for massage. Massage has a higher value than the additional cent. Hence why that one is going to be 49. 99 or again I’d round up to 50.

Now to show you how this works, here is the fee schedule for Arizona. And I just picked Arizona. Obviously this is going across the U. S. and I have network members everywhere. Network members contact me, we’ll go over what’s in your state. But this is always a good starting place. This is the Medicare rates.

for the state of Arizona. And every state has this same breakdown. Now what I’m showing here though is the Medicare rates notice for the acupuncture codes, exam codes, but let’s do the math here to show you how RVUs work. Notice the value in Arizona Medicare is 43. 86. By the way, last year that was like 35.

It’s gone up substantially. So I take 43. 86, I divide by 1. 38. It gives me a conversion of 31. 78. I then take that number, 31. 78, multiplied by any other codes RVU to give me the price. Now notice how this works. 31. 78 times 79 is 25. 10. Do you notice the fee for 97810? 25. 17. I know it’s off a few pennies, but you get it’s in that range.

Notice 3178 times 3. 37 for 99203, 10710. Notice 99203, 10695. Again, within 15 cents. 3178 times 0. 92, the value of a massage, 2923. Notice the value of massage. So you may want to start to realize that, oh, this is exactly how insurances do look at fees, particularly when it comes to personal injury and non managed care.

Now here’s what’s further interesting. My general rule is An office probably wants to be maybe twice the Medicare rates as a typical fee. Now, I’m not saying necessarily that high But that’s a starting point. I would say maybe even 1. 5 But here’s where I bring this up in Arizona for workers compensation and let’s face it.

Would anyone say? Oh, yes, the workers compensation fee the mandated fee is the highest fee in the state No, it’s not but notice the conversion in Arizona is 68 So instead of being 3178, it’s 68. So think of it 97810 has a value of 1. 19. If 68 is your first, or you’re going to use 68 conversion, the worker’s comp rate is going to be, oh wait, 68 times 1.

19 is about 120 percent of that. You’re thinking that first set then is going to be around 80. Yeah, what would the additional set be? 68 times 79 or 80 percent of that take off about 13. Again, right about 52 or 53. Please be careful of undervaluing. If you are billing 50, And a carrier is willing to pay 80, but you bill 50, you’re going to get 50.

So be mindful that if someone ever says, how did you come up with a fee schedule? Have a real reason Not based on what my friends have been doing. We don’t know what your friends are doing. We’re right. Your mom told you that Did you ever get away with it when you said that’s what Johnny did, mom.

Mom’s not going for that. We don’t care what Johnny does, what we do at my house. So network members, I’m mom right now. I want to know, what are you charging? We can go through it. Make sure you set up a zoom for that. I want you to really start to realize, make a competent fee schedule, not a guessing fee schedule.

And that’s what too many of you do. And that’s why a lot of acupuncture struggle. I want to end that struggle. By setting up a good sound fee schedule now bear in mind when you sign a contract With an insurance company you’re accepting the pay less. That’s why they like you to sign up By example, if you sign up with UnitedHealthcare, what do you get?

About 60 a visit. What if you don’t sign up with UnitedHealthcare, what do you get generally? About 100. Same might apply with Cigna. Now ones that are HMOs, maybe we want to, but others you may want to rethink it. So to help you do that, what I’d like you to do is take a moment, and this is, this is not just for my network members, obviously this is for everyone, Use this QR code.

Go in here. You’re going to send us some information of what is your fee for 97810, where they’re going to send you back the calculations of the codes that we just showed you based on your fee for 97810. See if it makes sense, but I’m going to warn everyone. Be careful if you have not increased the value of your 97810 this year, you have flat out lost money because it went up 20%.

That doesn’t mean all managed care, but for everything else. As always, we want to make sure that your practice does well. Network members especially, I’m going to emphasize, if we haven’t done our meeting this year on fee schedules, get in contact with me. Let’s get moving. For everyone else, make this a good starting point.

Maybe I’ll see you in the fall for a seminar to make sure you really can make sense of it. Or how about this? Join the network. Make me part of your staff. Let’s work one on one. As always, everyone, I’m going to say thank you for taking some time with me. We always want you to be successful because your strength is ours.

Take care all.

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Let’s talk about what is going on with UnitedHealthcare. I’m sure many of you have received or have seen the letter that indicated about what changes you have to make.

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 everyone. It’s Sam Collins, the coding and billing expert. American Acupuncture Council and specifically the American Acupuncture Council network members. And I’m really appealing out to you as well. Not just that we’re not sending it to everyone, but I wanted to keep you updated on what’s new and changing.

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As we always promise, we want to make sure you get the information first, have the right information, can use it. I know a lot of you have probably gotten the UnitedHealthcare information about, we have to build differently and put the GA modifier. I wanted to help attempt to make this simpler, more easy to understand, and kind of.

Boil it down a little bit. So let’s go to the slides. Let’s talk about what is going on with UnitedHealthcare. I’m sure many of you have received or have seen the letter that indicated about what changes you have to make. I want to make it even that much simpler. Here’s what’s happening. Beginning February 1st.

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So starting this month, they want all acupuncture providers must bill UnitedHealthcare for all services they’re providing, even if the services aren’t covered. Now, for the most part, let’s be realistic. Probably you’re billing out mostly acupuncture. There isn’t a lot of services that you’re doing that aren’t covered.

But let’s just say there are services that you’re doing that’s not covered. They’re saying now they want it to be billed. So they want these non covered services to be billed, even if they’re not payable. And this will make an added step from what you normally have been doing. Now, keep in mind, the added step is just you’re going to add it.

The reality is, the No Surprises Act, as a lot of you are familiar with, which has been a couple of years, requires that all providers make patients aware of what their costs are. I think acupuncturists have always done an excellent job of that because that’s the number one question every has is how much is it going to cost?

So what this means is you’re going to make sure not only to do that with patients, make sure what they know, the cost are what’s covered and not covered. But more importantly, what’s not covered. We have to make sure the patient’s aware, like by example, if you’re doing cupping or moxibustion, you want to make sure to let them know, okay, this cupping service is not covered.

And therefore, it’s 25, whatever you charge. So again, think of it now, if it’s a therapy, therapies are for the most part covered, so it’s going to be the services that are not covered. Remember, contract and so forth will come into place. If you’re contracted and it’s bundled, it will be. So again, this is going to be services that they normally do.

Do not cover and the patient will be liable for it’s not going to be very many, but there may be instances where this come up. Realistically, this is should be something you’re already doing. Of course, every patient should be aware of, okay, if your insurance is going to cover, what is it going to cover, but also what is it not going to cover?

So therefore the patient understands what they’re having to pay. That’s again, part of your financial agreement. I hope you’re all already doing that to some extent. Now, what does this mean for non covered services though? I’m going to tell you for the most part, I’m going to look at things that are unusual.

Obviously, massage, manual therapy, exercise, heat, those are all covered. But services that aren’t covered, I’m going to put in cupping and moxibustion as being the most likely. Those are ones we’re going to have to outline. Now, by chance, let’s say the policy doesn’t cover therapies. They’re not bundled, then you would include therapies as well.

But for the most part, I’d say they’re covering therapy. So again, non covered services. And what does this apply? And this is where people are confused because it says commercial plans. So you’re wondering what’s a commercial plan? You know what a commercial plan is one that a person buys or they get through their job for the most part, you know, they get as part of their employment.

The only place that doesn’t apply is ones that are called self insured that are just managed by United healthcare. These would be. big giant employers, you know, large union groups and so forth, which aren’t that typical though. Obviously, if you work with a lot of people in those, you might run and cross it, but it’s going to be generally the commercial plans.

One patient’s purchase themselves, get through their job and Medicare advantage plans, but it doesn’t include if it’s self insured. So it is worth asking when you’re verifying. Is this a self insured plan? Because if it is, then you don’t have to do any of this. Again, I don’t see this as very hard. What do we need to do?

We need, oh, did I hit the wrong button here? I apologize. What we need to do is to make sure a few things. Number one, when verifying UnitedHealthcare, inquire if the plan is a commercial or Medicare Advantage. If it is, we have to do this. Now, again, I’m going to emphasize, this should be something you’re already doing.

You should already be making the patients aware of cost and what services aren’t covered But this is now something they want a little bit more detail for them You’re going to complete a financial understanding with the patient with an estimate of cost which means your cost So let’s say you charge 25 for cupping you would indicate this cupping service is not covered and you would indicate something as simple as It’s not covered because it’s not part of your plan.

Your plan may not consider it medically necessary, but anything like that, the bottom line is make the patient aware it’s not covered and they’re paying out of pocket because in order to hold them liable, the plan now is saying their requirements to do that. It says there identify if any. If any are not covered and include a statement.

So some services are going to be covered. Your acupuncture is covered, but services that are not identified and simply again, state it’s not covered or may not be covered. What you’re doing is making clear. You’re not promising them that it’s going to get paid. It is non covered. Now this brings up, what if you’re doing acupuncture and the acupuncture is not covered, you would do the same for that.

I don’t believe we’re billing too many like that, but just in case, then what you’re going to do is bill for those services. Now in the past. We’re pretty much never required to bill for services. They weren’t going to cover. They’re just liable to the patient now What they’re wanting is that we do bill those services to the insurance What we have to do uniquely though is bill it and then put modifier G a so that’s G as an apple Or excuse me G as in George a as an apple and what you’re doing with that is simply indicating that the patient has signed a waiver meaning that financial agreement where they’ve agreed They’re responsible.

What this is really doing is putting in place that patients are never going to be surprised They know what it’s going to cost in addition the insurance now when you bill in this way They’re going to send the EOB back to the patient indicating what they’ve paid for But that service such as cupping like nine seven zero three nine or one three nine would indicate as patient Responsibility and at the fee you’ve charged and remember that fee is the fee you want to charge It’s up to you.

That’s your cash rate. Whatever your fee is and the patient’s paying. That’s all you’re putting there So is this a little bit of a hassle? Yeah, I think so Um, it’s only a hassle in that we need to bill it. Everything else is the same You still have to inform patients you’re doing a service not covered You start to make sure they understand the cost of it.

Now the only difference is that we also have to put it on the claim and when we do so just put it with the GA. So let’s say it’s a therapy this this plan doesn’t cover a therapy. Okay, we would indicate that therapy with modifier GA. Keep in mind it’s not required for services they pay for. This is only for services they’re not going to be paying for.

So they’ll process it and then they’ll indicate patient responsibility. So let’s kind of get back at synopsis here. Let’s go, what’s going on? UnitedHealthcare commercial policies for acupuncture. You are now to make sure a patient is fully aware of services that they’re going to cover, but also not cover.

That’s not different. We’re to make them aware of the cost of the services, whether they it’s covered or non covered, which is also not different. So therefore that’s all going to be the same. That’s something I think acupuncturists do a good job of. Haven’t you always made sure your patients know the cost?

This is just making sure it’s memorialized, if you will, the patient signing it. And now we’re going to bill it. With a GA, if it’s a non covered service. So just a GA. Now you might be saying, well, what type of form do I have to have? It’s going to be a pretty straightforward, simple financial agreement.

Where you would indicate, these are the services we’re being provided. This is the amounts. And here’s the cost. And also indicate if it’s non covered. Now if you’re a network member with me, AAC Network, just contact me. We do have some samples. If you’re not a member, I apologize, but that’s not available to you.

That’s why we do the service. At least you’re getting the information. But for those that are members. get in contact with. We have a couple of examples. It’s not that complicated, but want a straightforward statement that the patients know it’s not covered. Here’s the point. It protects us. Therefore, a patient can’t come and say, I thought it was gonna pay.

You’re gonna point out. No, we said that at the beginning, and so I think it eliminates a lot of that issue. However, there is an extra step. Yes, you’re gonna now have to put everything on the claim. Part of what United Healthcare is stating they want to see the services that are being provided. What my hope is is that they start noticing that, wow, this cupping service is popular, moxibustion, maybe it should be something that we’re covering.

At least that’s what I would think. So, that’s the change. Non covered services, make sure patients are aware they’re not covered, the cost, put them on the bill. Patient still responsible. Nothing crazier than that. Again, if you’re a network member, get in contact with me. If you’re not a network member, the whole reason I’m doing this is to get this out to our network members, though it’s going to everyone contact me, let’s get you started on into the network.

We’ll give you a lot more help. In addition to that, though, we can give you a day to day help as well as forms and other things. We’re here to help. So for all of you, I greet you and say thank you for listening for a few minutes. I hope to see you at a future program as well. Take care.

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