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 is Moshe Heller, and I’m from Motion Herbs and also from The Motion Center in New York. I’d like to thank the American Acupuncture Council for letting me present this topic today. And today we’ll be speaking… I’ll be speaking on the heat of summer and how to… how we can support children and adults through this period of time through the summer months.
So you can go to the slides
Click here for the best Acupuncture Malpractice Insurance
All right. In the past right now we have just passed the summer solstice on the 21st of June. And we have in the past two months have already experienced a few heat waves, and it was very hot here in New York at least. And but the weather here in New York has actually been quite fluctuating and we’re having hot days then we’re having really cool days which is usually a cause for illness, right?
That’s these weather fluctuations is that, is the time when we are exposed to pathogens and we can be hit by heat or cold or wind combinations. So in the summer, we usually expect more of the warm disease, summer heat, and a lot of digestive issues, a lot of damp and heat here in New York, especially.
And those are the de- disease patterns that we expect. But in this summer which I’m usually not concerned about having too much external pathogenic fa- factors influencing my patients I am actually thinking about that and supporting how can I support my patients better in these weather fluctuations.
I’d like to talk about this formula, which at Motion Herbs we call Shield. But it’s really based on a very traditional formula, which we know as Yu Ping Feng San or Jade Wind Screen. And I combine that this formula with Wei Ji Tang which helps to harmonize the yin and the wei. So these formulas together strengthen the exterior, but also harmonize the functioning of the wei and the yin qi so that if we encounter a pathogen, we can effectively resolve it very quickly or without, or not let it invade So when I formulated Shield, I wanted to make sure that the qi is supported and also the huachi, the transformation and transportation is complete.
And for this we added the combination of Ban Xia and Chen Pi, which we s- we know as the formula Er Chen Tang or two cor– two, two, two cured decoction. That will help in transformation of dampness and that usually this dampness, if it accumulates, can hinder the function of the spleen.
And we also… I also added Tai Zi Shen which we call Prince Ginseng. And it allows the formula to support the qi and the yang, but also is m- very much appropriate to children. It also supports the formula’s ability to to support fluid generation so it’s not so drying. In addition, we added Wu Wei Zi which helps to consolidate the exterior by bringing the kidney support to the lungs and supporting the exterior finally, we a- also added Ge Gen to harmonize the muscle layer and and support digestion, and Ling Zhi which is an adaptogenic mushroom and considered a potent immune system tonic.
So together it creates a very nice protection for the exterior and is something that I definitely use during winter and fall time. But in this summer I feel that patients need that added support Here you have a little bit of a structure how its shield is built. And then I want to also talk about another formula which traditionally is called Kan Ning Tang or curing, the curing pill.
This is a great preventative formula for summer digestive issues and external pathogenic factors that might be have a warm nature to them. It’s a very effective formula that a patent formula, you can get that in many Chinese herbal stores as well as different companies make version of Kan Ning Tang.
It’s you can see that this formula has a lot of herbs that drain dampness and relieve the exterior. And therefore, it’s really good for different varieties of stomach viruses or what we might call stomach heat if that is something that’s happening. On the same token, there is the other famous formula called Bao He Wan, which Motion Herbs also has a version of that which is from the Yin Nourishing School of Zhū Dānxī.
This formula really helps with reducing food accumulation if we’ve been out and eating too much and there’s some food stagnation that needs to be resolved. You can think of Bao He Wan or Digest to support that issue. So we’ve modified Bao He Wan a little bit to clear some wind heat and regulate the qi.
We included formulas herbs like Lian Qiao, Ge Gen Zhi Qiao, Ju Hua, and Tai Zi Shen similar to the ones that we had with Shield. That will support the body’s s-spleen and stomach functioning and also in case there is an external pathogenic factor, relieve that aspect of that Here’s a presentation of Digest.
You can see how the herbs are distributed. And then I created this kind of combinations that support the same aspect in terms of acupuncture. Du 14, we know clears heat as well as large intestine 11 in cases that there’s we need to clear heat from the digestive system.
Supporting the, the spleen and stomach with stomach 36, supporting s- spleen and stomach qi, as well as spleen nine to help drain dampness that may have accumulated. Stomach 25 to regulate the intestines and pericardium six if there’s any nausea involved with the heat invasion. And sometimes I will combine heart six and kidney seven if I feel that there’s an imbalance in the Shaoyang, meaning that there’s some heat that’s rising, and to bring heat down back to its source, we use this combination just as a closing remark diet in, in the summer is the the season of the fire, the yang, the growth and maturation, and therefore the food we eat has to reflect that.
Very light and colorful from all colors. Lots of vegetables that are in season. The, the… I think one of the most important thing that we have to remember is that our diet should always be according to, Chinese dietary recommendations to include a large amount of vegetables more than anything else.
I know that today most people are concerned about how much protein they’re getting in their diet, but I’m always concerned of how much vegetables you’re getting in your diet more so than the protein. That’s extremely important that we get a wide variety of different colored vegetables as part of our meals.
Cook lightly. Don’t make it too heavy. Steaming, sautéing, grilling are great ways to cook during the summer. Use slightly spicy and pi- pungent spices like ginger to warm up the interior and some bitter taste to drain heat and regulate the heart. For example a great vegetable to be eating during the summer is broccoli rabe which has a little bit of bitterness in it, and you can sauté it or steam it.
And that is a great way to get some bitterness into your food. So although we think that in the summer we dream of all these cooling foods like watermelon, etc., which are good in reg- in small quantities, but I want you to remember that in hot places usually we eat warm foods because if we wa- warm and spicy actually foods, if we warm the interior, there’s less of a difference between the interior and the exterior.
So it actually allows our body to maintain a better equilibrium if we warm the inside of our body rather than eating cold or iced things, then our interior becomes cooler and therefore there’s a bigger difference and heat can be much… has a stronger effect on our system I’d like to thank you for listening.
We are– If you want to have more information about our herbal line please log on to motionherbs.com. Also, we at Jing Cheng Pediatrics, we are doing some hands-on seminars for pediatric techniques. Thank you very much for your time, and thank you… I would like to thank the AAC for allowing me to speak, and have a wonderful day.
Click here for the best Acupuncture Malpractice Insurance
Did you know that chronic pain and depression often go hand in hand?
Research shows the two conditions can feed into each other, making both harder to manage.
One of acupuncture’s unique strengths is its ability to address multiple concerns during the same treatment.
Instead of focusing on just one symptom, an acupuncturist can create a personalized treatment plan that targets both physical pain and emotional well-being in a single visit.
Because every patient is different, acupuncture isn’t a one-size-fits-all therapy.
Treatments are tailored to your specific needs, helping address the underlying causes of your symptoms while supporting your overall health.
And remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.
There is a reason acupuncturists have trusted AAC with their business for 50 years.
Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!
Facial Acupuncture Techniques for Transforming Facial and Emotional Patterns
Facial acupuncture often brings cosmetic treatment to mind. Clinicians also use facial techniques for movement, neuromuscular function, pain, and expression. In this American Acupuncture Council presentation, Michelle Gellis describes a broader clinical framework. She discusses facial motor points, scalp acupuncture, facial cupping, gua sha, submuscular needling, auricular approaches, and body acupuncture.
Transcript: Keep the existing “Click here to download the transcript” link in this location. The current AAC page identifies the transcript as a downloadable Dropbox asset. The page also notes that the transcript may contain spelling or grammatical errors.
What facial acupuncture techniques does the presentation discuss?
Gellis presents the face as part of an interconnected clinical system. She starts with individual muscles of facial expression. She then expands the discussion to scalp, submuscular, auricular, and body acupuncture. Her framework focuses on assessment and treatment selection. The goal extends beyond cosmetic change.
Motor points and facial muscle function
Facial motor points offer one way to work with individual muscles of expression. Gellis describes both underactive and overactive patterns. A muscle may show weak recruitment. It may also remain tense or overused. This approach encourages careful functional assessment before a practitioner chooses a local technique.
Clinicians should separate this neuromuscular rationale from stronger claims about emotion. The anatomy may support a clinical hypothesis. It does not prove that a specific motor point releases a specific emotion.
Scalp, submuscular, and local techniques
The presentation also covers scalp acupuncture and submuscular or intramuscular facial needling. Practitioners may consider these approaches when facial movement changes. Gellis also discusses facial cupping and gua sha. These methods can complement a broader treatment plan.
Each method has a different proposed mechanism. Each also has a different evidence base and risk profile. Practitioners should not treat them as interchangeable.
The lecture places local facial work within a whole-person acupuncture strategy. In traditional Chinese medicine, a practitioner may interpret facial findings through channels, qi, blood, and pattern differentiation. The practitioner may therefore add distal or body points. This framework reflects TCM clinical reasoning. It does not establish a biomedical mechanism.
What does the evidence say about facial feedback and emotion?
Researchers have studied links between facial movement and emotional experience for decades. The evidence supports an association, but the effect appears modest. A 2019 meta-analysis reviewed 138 studies. It found a small overall facial-feedback effect. The authors also found substantial variation across experimental conditions.
A large preregistered multicenter study produced a similarly nuanced picture. Some facial-feedback manipulations increased or initiated happiness. Other manipulations produced less consistent results. These findings support a cautious interpretation.
For clinicians, the evidence does not show that one facial muscle reliably stores or causes one emotion. Facial expression can influence emotional experience and social communication. The effect depends on context and experimental conditions.
What is known about acupuncture for facial conditions?
The strongest related clinical evidence concerns facial nerve disorders. It does not concern cosmetic rejuvenation or emotional transformation. A 2025 overview examined 17 systematic reviews and meta-analyses. The authors found potential benefits for peripheral facial paralysis. However, most underlying evidence had low or very low certainty.
A 2026 network meta-analysis also reported potentially favorable results for acupuncture combined with other traditional interventions. The authors still called for more research. Clinicians should interpret comparative rankings within the limits of the available studies.
Cosmetic facial acupuncture has a smaller evidence base. Recent studies have examined facial acupuncture and acupuncture-based stimulation for outcomes such as wrinkles and skin appearance. These studies do not establish that facial acupuncture reverses aging. They also do not show that every patient will experience durable cosmetic change.
Evidence for facial cupping and gua sha remains less specific. Current research does not justify broad claims about cosmetic or emotional outcomes.
How can clinicians apply these facial acupuncture techniques?
Gellis’s approach offers a useful starting point: assess before selecting a technique. Document facial symmetry, movement, pain, neurologic history, prior procedures, medications, skin integrity, and patient goals.
For cosmetic concerns, clarify the patient’s primary goal. The goal may involve appearance, function, comfort, or several factors. This distinction helps the practitioner set realistic expectations.
For facial weakness, first determine whether the patient needs medical evaluation. Acute facial paralysis does not always mean Bell’s palsy. Professional guidelines recommend evaluation for other causes. Evidence-based Bell’s palsy care may also require timely medical treatment. Acupuncture should not replace appropriate diagnosis or indicated medical care.
Facial treatment also requires clear informed consent. Discuss expected outcomes and uncertainty. Discuss bruising, bleeding, irritation, and other possible adverse effects. Consider referral when a facial concern may reflect an underlying medical condition.
Use sterile, single-use needles. Follow applicable scope-of-practice rules. Follow infection-control requirements. Obtain appropriate training before performing facial needling techniques.
Benefits, limitations, and safety
Potential benefit: A multimodal approach gives practitioners several options for facial movement, pain, and cosmetic concerns.
Evidence limitation: Research varies by condition and technique. Evidence for some neuromuscular applications exceeds evidence for broad emotional claims.
Technique limitation: Current evidence does not establish specific cosmetic or emotional effects for facial cupping, gua sha, or every facial needling approach.
Safety: Proper acupuncture technique can reduce risk. Poor technique or nonsterile needles can cause infection, tissue injury, and other serious complications.
Referral: New or worsening neurologic findings need appropriate medical assessment. Ocular symptoms and unexplained facial changes also warrant referral.
Conclusion
Facial acupuncture can support a functional and whole-person clinical approach. Michelle Gellis presents motor points, scalp acupuncture, facial needling, cupping, gua sha, auricular strategies, and body acupuncture as complementary tools.
The evidence supports a careful interpretation. Facial feedback has a measurable but modest research signal. Acupuncture may help some patients with peripheral facial paralysis, but evidence quality remains limited. Cosmetic and emotional claims require more research.
For acupuncturists developing facial services, start with assessment. Set clear treatment goals. Explain uncertainty. Use appropriate technique and infection control. Refer patients when facial findings suggest a neurologic or other medical condition.
Continue Learning with the American Acupuncture Council
American Acupuncture Council: Explore AAC educational resources and professional risk-management information for acupuncture practitioners.
References
Coles NA, Larsen JT, Lench HC. A meta-analysis of the facial feedback literature: Effects of facial feedback on emotional experience are small and variable. Psychological Bulletin. 2019;145(6):610-651. PubMed.
Coles NA, et al. A multi-lab test of the facial feedback hypothesis by the Many Smiles Collaboration. Nature Human Behaviour. 2022;6:1731-1742. PubMed.
Huang Z, et al. The efficacy and safety of acupuncture treatment for peripheral facial paralysis: an overview of systematic review and meta-analysis. Frontiers in Neurology. 2025. PubMed.
Li M, et al. Efficacy of acupuncture combined with various traditional Chinese medicine therapies for peripheral facial paralysis: a systematic review and network meta-analysis. American Journal of Otolaryngology. 2026;47(1):104787. PubMed.
Luo Y, et al. Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation for Improving Clinical Signs of Facial Skin Aging. Journal of Cosmetic Dermatology. 2026;25(4):e70839. PubMed.
National Center for Complementary and Integrative Health. Acupuncture: Effectiveness and Safety. NCCIH.
American Academy of Otolaryngology–Head and Neck Surgery. Clinical Practice Guideline: Bell’s Palsy. AAO-HNS.
American Academy of Neurology. Update: Steroids and Antivirals for Bell Palsy. AAN.
Educational disclaimer: This article provides professional education. It does not provide medical advice, diagnosis, or a treatment protocol. Base clinical decisions on the individual patient, current evidence, applicable law, scope of practice, and appropriate consultation or referral. Only appropriately trained and licensed practitioners should perform acupuncture procedures.
I’m here to share with you over the next few minutes several challenges that you may be having, uh, in your claims in getting paid and getting paid as quickly as you should that may be related to your credentialing processes.
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.
Welcome, everyone, and thank you for joining me for a brief segment on credentialing components to your claims challenges. My name is Brandy Brimhall, and I am with Rapid Credentialing, and I’m here to share with you over the next few minutes several challenges that you may be having, uh, in your claims in getting paid and getting paid as quickly as you should that may be related to your credentialing processes.
It doesn’t matter if you are here joining me from a chiropractic practice, physical therapy, massage therapy, acupuncture, or an integrated facility. The information I’m going to share with you over the next few minutes could potentially help resolve some of your billing and collections challenges, your credentialing problems, and help you get paid faster.
Click here for the best Acupuncture Malpractice Insurance
So let’s go ahead and go to the slides, and I’ll jump in As we get started, again, we’re going to be covering, uh, at a high level the credentialing component to your claims processing challenges. So as we get started, what I’m actually going to share with you is sort of a high-level review of what those claims processing challenges are, and then as we conclude, I’m going to go through a bulleted list for you to really just help you hammer down what might relate to your practice and how to fix that, and really where to look to resolve those issues.
So really just covering a quick, uh, moment of really the foundation or the fundamentals. If you like to look at your business as sort of a brick-and-mortar, the three components that at least in my view make that up have to do with patient visits and patient care, rules and regulations, and so this isn’t just your state rules, but our compliance rules, our payer policy guidelines, and all of those things that help us to make sure that we’re getting paid properly in the best position to keep the money that we have been paid.
And then, of course, that other component is the revenue cycle system and all of the moving parts of that. We’re not going to be going through all of that today, of course, but the two components that we are going to be foc- focusing on in the topic that we’re discussing has to do both with the rules and regulations side and our revenue cycle system side.
So I’ve spent my career of almost 27 years now problem-solving with the revenue cycle system, and I’m going to share with you as it relates to a piece of the, of the com– the revenue cycle system and credentialing and enrollment that may well relate to you and again solve some of the problems you have.
So I first want to share with you really how enrollment and credentialing works. So first of all, what you want to know right out of the chutes is that if you’re enrolled and credentialed with a third-party payer, that doesn’t mean you’re credentialed and enrolled with all of the plans and products under that network.
That means you may have Medicare Advantage plans, Medicaid plans, other outlier plans under your contracted networks that you’re not in-network with. And so you may see claims coming in processing out-of-network for some payers where you believe that you are in-network with that payer. So again, you could be in-network with Aetna, for example, but out-of-network with some of their plans and products.
Enrollments, of course, must be maintained, and so once you’re co-contracted and enrolled with a third-party payer, that doesn’t mean you’re contracted and enrolled forever. Each of your enrollments are required to be maintained, and that means re-credentialed, attested, verified, and validated at a specific and set time period through your payer portals and with the payers directly.
If those verification or re-credentialing periods are missed, you well could lose access or enrollment status to some of the plans if not an entire contracted network Next, industry and network changes may require re-enrollment or re-credentialing. In other words, the payers as they sit today, in six months from now or a year from now, may have well likely added other plans and other products.
Maybe other payers have moved into your area or made changes. Maybe there’s been mergers with payers or departures of payer relationships and networks that impact how you’re credentialed and what steps you need to take in order to get credentialed or maintain your existing credentialing and enrollment.
So being aware of what’s taking a pl- taking place in the industry and certainly in your region can also impact your claims and collections and of course, your credentialing and enrollment status The next thing I want to share with you is contracting and enrollment is not the same process as your EDI and ERA enrollment.
This is another one of the questions I get across my desk all of the time is, “We’re contracted and we’re enrolled now with whatever third-party payer, so we can automatically bill.” You can bill, but you need to make sure that you’re first set up correctly in your clearing house so that you’re eligible to submit electronic claims and then ideally, of course, receive electronic remittance advice back.
So those are two distinct and separate pro- processes that often impact whether or not your claims are making it to the payer to be processed. Moving forward, I want to share with you how to confirm your enrollment with the plans and products, and so a few ways to confirm enrollment, and what I mean by that is you may be wondering now, “Okay, well, we are credentialed with Blue Cross of our state or Aetna or Cigna or whatever third-party payer, but how do I really know what list of plans and products my provider or our providers are enrolled with?”
There’s a couple of different ways to find that out, and I’m going to share with you now. The first one is you want to make sure that you’re utilizing any relevant payer portals, and so that could be ASH, Availity, Optum, and whatever of other portals may relate to the payers that you’re submitting. The other way to find out is to call provider credentialing to your third-party payers.
Understanding being one that does this on a regular basis, you may go through hold times, but once you’re able to get that information, it’s immensely helpful for your office at the front desk level, whoever is verifying benefits, certainly whoever is communicating payer expectations and coverage benefits and limitations to your patients, and then, of course, in billing as well.
It also helps you to know if there are other plans you need to be enrolled in or not. So you can contact your payers, again, through portals or by phone to confirm what’s called a plan list or a plan roster. Keep in mind, too, that these can change over time. If you were contracted recently or even many years ago, there’s an excellent chance some of the plans that are available now are, are either weren’t available at the time you enrolled or perhaps have been pulled from your existing enrollment because those plans are no longer in existence, and so networks do make changes that impact our clinics and our billing.
Everything to do with the revenue cycle system is imperfect. It’s always gonna be imperfect, and really, it’s an industry of constant change, and so it’s something we need to be aware of and know what to look for as we’re navigating our billing and revenue cycle system processes. So with that being said, you may find that you need to add plans and products to existing contracts.
At Rapid Credentialing, we call that adding lines of business, and we do a lot of enrollments to add different types of outlier plans or different, uh, categories of plans and products to existing provider enrollments, along with new enrollments as well, of course The proactive approach to credentialing and enrollment is always going to be your best approach.
Uh, payers will not generally grant retroactive effective dates, and so what you don’t want to do is find out months later that you’ve been out of network, didn’t know you were out of network, and had an opportunity sometime in the past to, uh, remedy that if that was what you really needed. So when you have questions, if you’re seeing claims not processing through as you would expect, make sure that you’re doing your due diligence to be proactive in peeling back those layers to determine why the claims are processing the way they are, and then obviously what next steps you might need to take in order to add those lines of business or those contracts to your provider or your business enrollments The next thing I want to share with you before we conclude is that EDI component.
So like I mentioned, this is a total distinct and separate process outside of the credentialing and enrollment and contracting process with your third-party payers. EDI stands for Electronic Data Interchange, and this is the communications pathway that you use through your clearinghouse in order to get claims to your third-party payers for processing.
If the EDI isn’t set up correctly, you’re going to find that your claims either aren’t making it to the third-party payer or perhaps are being misrouted to a different processing department than what you would expect, ultimately resulting in denials, claims being dumped, and you receiving nothing at all in return to know that action items need to be taken.
So make sure that you look at your clearinghouse, review your rejections and the reason codes and reason descriptions for those rejections to address those problems promptly. If you’re an out-of-network provider, it is still likely that you are required EDI setup, and so you may be thinking, “Well, I’m not contracted.
Does this matter to me?” It absolutely does, keeping in mind that some of our third-party payers don’t require EDI enrollment at this time, others do. So it’s definitely one of those areas you’re going to want to keep your fingers on the pulse of because there’s a lot of lost time and money in submitting claims and then forgetting about them and assuming they’re just gonna get to where they’re supposed to be, processed, and pay us back accordingly.
We all know it doesn’t always work like, like that, so you want to definitely make sure to keep your eyes on your EDI enrollments and, of course, all of the other related aspects of your clearinghouse. As we conclude, I’m joi– just going to leave you with a few of the common claims issues and some troubleshooting solutions that may resolve some of the claims processing and reimbursement challenges you’re having right now that could perha- perhaps be related to credentialing.
The first one is, we believe we’re in the network, but some of our claims are processing out of the network. Your troubleshooting for that is really going to be to confirm your payer or plan list, that plan roster that I mentioned, to confirm which plans you are really in the network with and which you’re out of the network with.
Again, you can always add those lines of business as it’s applicable Next, claims were previously processed in the network for one or more patients are now suddenly processing out of network. This could be because a missed attestation, cred-recredentialing or credentialing steps were needed to be taken that were certainly missed by the clinic or by a provider.
When that happens, you could certainly find that your claims, some of them for individual patients, aren’t processing the way that you would expect. You’d, of course, need to go back through the layers, make sure you’ve attested on your CAQH, your Availity, your Optum, whatever portals are related, and that you haven’t missed a specific recredentialing period that has ultimately caused termination to an entire network or some of the plans under that network Next, another example is provider is in-network with a local Blue Cross Blue Shield, uh, but an out-of-state plan is processing out-of-network.
So we believe the provider should be in-network because he’s in-network or she’s in-network with our state, but we have a patient from another state with another state Blue Cross, and those claims are processing out-of-network. This is another common one that comes across my desk, and really the way that it works with Blue Cross is there are many plans for in-network providers that cover all of the states if the provider’s in the network in their local region.
There are also state-specific or region-specific plans that are only eligible f- for in-network status with providers for providers in that specific region. So here again, if you’re seeing an out-of-state patient, it’s very possible their plan is not part of your provider’s network in another state. So you want to check that plan roster, make sure you’re verifying the appropriate set of benefits for that.
Next, we have a new provider that’s who, whose claims are rejecting at the clearing house or processing out-of-network. Couple of things to know and to look at, at on that, make sure that your provider is set up in the clearing house for proper claims submission. And then also, of course, make sure that your provider is properly credentialed, enrolled, and assigned to your business or your business group so that they are eligible to submit claims and your business is eligible for reimbursement for that new provider.
And finally, we have claims are being submitted and received, but they’re continually not, or they are appearing to not be processed, and there’s no remittance data that we’re receiving. This is typically through, uh, EDI, through your clearing house, and what you might find is that your claim perhaps could be being misrouted.
Payers will not often reroute claims to a separate processing department, even if it’s in w- within the same company. So you want to make sure that you’re verifying and setting up claims routing properly, because you won’t often receive a letter or a denial telling you that your claims are being rou- routed improperly.
Rather, you’ll often receive nothing at all and just assume that your claim is b- being received at the payer and never processing. So it could be an EDI setup issue, and that’s where you’d want to look and confirm, because keep in mind too, with every single payer we have, we’re on the clock just as soon as that patient, uh, is seen as far as timely filing goes with our third-party payer.
So we don’t want to wait too long and find that we’ve missed the opportunity to get paid at all And then next, the claims are rejecting at the clearing house, citing the provider is not eligible as a submitter. This is almost always related to the provider not being set up at all or not set up properly in your clearing house.
Those steps need to be taken. Once that’s confirmed, certainly you’d want to verify credentialing and enrollment contracts just to make sure that those are intact. Now, I know this has been a very high level and doesn’t cover all of the possibilities of how your credentialing could be related to some of your claims challenges, but I do think we’ve covered several of them.
If you have any questions at all, please feel free to reach out to myself and my team. You can see our contact information right there on the screen. Thank you so much for joining me. I hope this has been helpful, and I look forward to seeing you next time.
Click here for the best Acupuncture Malpractice Insurance
No practice will have perfect reviews, so do not let one negative comment define your reputation.
Instead of reacting emotionally, respond calmly, professionally, and without revealing any patient information.
Never confirm someone is a patient or discuss their care, even if they identify themselves first.
A brief, generic response inviting the reviewer to contact your office is often the best approach, and sometimes, no response is better than engaging in a public argument.
Focus on building a strong collection of positive reviews, since prospective patients are influenced by the overall pattern, not a single negative comment.
And remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.
There is a reason acupuncturists have trusted AAC with their business for 50 years.
Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!
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.
Click here for the best Acupuncture Malpractice Insurance
Hi, I’m Michael Coates of Personal Injury Made Easy, and I’d like to thank the American Acupuncture Council for allowing me the honor of presenting to you on personal injury So this is part of a series on personal injury, but today’s topic, we’re gonna talk about why PI. We’re gonna talk about the pros and the cons, what providers that do really well in this kinda what, how they’re shaped, and other ones that don’t do so well, and we’ll also talk about some common myths.
So the first thing I wanna hit to, into is about why personal injury, ’cause whether you should be in this or not, and I know that a lot of you have either experienced it in the past, and you may have had a very bad experience and a bad taste in your mouth, maybe from a law firm you dealt with or a particular patient.
And I wanna try to have you rethink and have a new perspective. You also may be someone who has maybe dabbled in personal injury, just not done a lot. Maybe you’re a little frustrated, you feel overwhelmed or it’s out of your normal skill set. And the last would be the griddles, the grizzled veterans, those who have really have a, a solid personal injury segment, but I wanna make you better.
So let’s first talk about why PI or why to expand personal injury. So the first thing about personal injury that I think is maybe the best for the chiropractic and also the acupuncture base, and even for physical therapy, as I call them, the CAP providers, is about that you can bill your full out-of-network rates.
So when you think about a business and a practice, you also wanna think about your patient mix. Not all patients are profitable. Sometimes it takes a lot more patients to make the same amount of money as it does on a single patient, and that’s one of the beauties of personal injury, is that one PI patient, when you’re paid your 100% of your full out-of-network rates, can make up for a handful of in-network pers- or in-network patients, and also for a number of cash patients.
So that’s the first major benefit. The second one, which I find very valuable for your segment, is because it, you can bill for things that insurance would deny. So when health insurance wants to deny for laser procedures or the things that you really believe are medically necessary, are gonna help your patient, PI allows you to bill for it, and you’re gonna get paid for it, and that’s really significant.
The next area I would say is like what Warren Buffett said on investing. He always said, “Invest your money and your time and your resources by following the money.” So where is the money going in healthcare? It certainly isn’t going to normal healthcare reimbursements because healthcare reimbursements in the insurance industry have been cut in half, and a lot of medical costs have doubled.
But the one area you’re gonna find that there’s more investment in is personal injury. All you’ve gotta look is at the minimal auto policy benefits and the minimum insurance coverage in whatever state you’re in, and most of your states have had an increase or will be having an increase. So California, for example, went from 15,000 per each patient walking in the door to 30,000 behind them So that means it doubled, and a lot of states have gone way up.
So more money is being invested into personal injury to pay, of course, obviously it’s gotta pay the attorney, it’s gotta pay all of you, and it’s gotta pay the patient. But that’s a real benefit. But there’s more than just money when I say benefits or profits. So here are some other ones that I think are really fantastic for personal injury.
One is you’ve got no financial paperwork you really have to get on your patient because it’s the personal injury matter that would be satisfying your bill. So you’re really not having to chase patients. Now, sometimes you do, sometimes that occurs, but the primary aspect of PI is you’ve got an attorney who generally has a fiduciary duty to watch your financial back when they receive monies.
Even if their own client says, “Send me the doctor’s money,” wink, “I’ll pay him,” they’re not supposed to. In fact, if they do, it could be a violation of state ethics laws and other problems they’ve gotten into. So you have to hold it for you. So that’s a real benefit when you don’t have to chase patients and someone’s protecting your financial interest.
Also, it’s a great gateway to new patients. A lot of people have never heard of the magic of what you do. You know how good it is, but they’ve never experienced your medical specialty ever before. But you have the opportunity now here to wow them on how good it is, what you do, and what your profession is.
You get to educate that patient on the value, not just for them seeing you for PI, but for all the things you do. So that turns PI also into a great feeder to all of your practice segments. So that’s why I say when you’re growing a P- a PI practice, it’s not just growing personal- a personal injury segment, it’s using PI to grow all of your practice segments, and I think that’s a huge advantage.
So another really great advantage is medical, the medical lien area is a very collaborative one. So it’s not just you. There’s usually a healthcare team that is treating your patient. Now, usually because, let’s say you’re the chiropractor, you are the quarterback generally of that team. It is the only industry in this entire country where chiropractic is the number one lead medical specialty, just that one.
And for say for those in acupuncture, you’ve never even had that usually before, so it gives this whole new area to get into. But on chiropractic, being that healthcare team quarterback, you’re the one really guiding the referrals, and when you’re referring out or someone’s referring patients to you, it needs to be someone on lien, or if you’re in a letter of protection state, that will take it on LOP.
So that’s an advantage. In fact think of it this way. Every time you may have gotten a settlement notice from a law firm, and you’ve asked them to lay out all the settlement amounts, the attorney fees, costs, and all the lien holders, and the amount to their client that’s going, so you can make an evaluation of how much you should get paid, guess what you should be looking at?
the listing of all those medical lien holders. ‘Cause when you do, you now know in your community who is taking it on lien. It’s a great one to reach out to, to say, “Hey, let’s look about maybe collaborating.” But you’ve got to vet them first. Of course, you want really competent, good providers as part of your lien network, and you want to have that in the can, so when you do have to refer out to specialists, they’re there.
But what I’m getting to is that there’s a lot of peers that maybe doubt the efficacy of what you do, and they shouldn’t. It’s because just a lack of knowledge. So when you engage in the lien area, you have a chance to educate them also on how get it– good it is of what you do and how you do it, and you have someone else telling them, your patient Also their patient.
So that’s a great extra advantage. So there’s so many things that I think that are so pro– good about YPI, they outweigh the benefits. If we looked– outweigh the negatives. If we looked at the negatives, some of that’s gonna be obviously you have to wait to be paid, right? And it could be either months, it could be years.
Then again, going back to a positive, there is the fast cash options in personal injury. That would be MedPay, which most policies have, unless you’re in a no-fault state. For those states, you’ve got PIP, personal injury protection. Now, those are both auto policy benefits. They’re given for prompt care, they get prompt payment.
Now, attorneys do tricks and stuff, and we’ll talk about that later in the series. But in the end, it’s something really important to realize you can get paid on a monthly basis for you as a reha- rehabilitation professional, and that’s fantastic. You don’t have to wait. So you’ve got to learn how to identify when it exists.
You have to learn how to properly submit, and you have to learn when attorneys try to hijack it or maybe take fees out of it, how to address that so that doesn’t occur. So that’s fantastic, even though to offset the downer that I had. Now, of course, you are gonna be dealing also in an area that you get pushback.
Now, you don’t get people in insurance that are trying to sometimes degrade you or degrade what you do. It’s just the way that insurance tries to delay, deny, devalue, and defend. That’s what the attorneys do too, but they do it a lot more aggressively and forcefully. Why? They’re warriors.
They’re advocates. This is what they do for a living. Not just the attorneys, but a lot of the law firm staff. Back when I was first a defense attorney in my earlier years of course, everybody in law firms, whether on my side or the plaintiff side, all had law clerks and paralegals, so trained in the law.
They understood the law. That’s not today’s environment. All are– they are as a lien specialist is someone that follows a protocol the law firm sets, and they generally try to pay you less. But there are easy ways to work around that. You just have to learn. So that, again, is the beauty of this. And I think that personal injury’s just gotten this bad rap from prior bad taste in the mouth, like bad medicine going down, and it’s just from a lack of knowledge A lack of skill development and a lack of support for you.
Now, the great thing is all of you, you’ve got me to support you on whatever it is that you’re doing. So a little bit about me. I speak, teach, and coach around the country. I help providers in every state. All the state laws are generally unique in PI. I deal with really all medical specialties. And in the end, it’s trying to right the ship.
I think that medical providers have been used and abused, where first the attorneys are looking for themselves. They then try to make their clients happy enough so they will refer them or be happy and not slam them on Yelp. And so unfortunately, a lot of times they try to make the burden fall on you, the medical provider.
But that’s why I’m here, to help guide you along. And part of that guiding is this. When I say what is it that makes a good provider and a, maybe one who struggles more in this, and that’s learning how to be a value driver. What do I mean by a value driver? You al- are always to remain neutral as to the outcome of a PI case.
You’re there for the healthcare of your patient, and you’ve gotta stay in your lane. However, when you learn how to do personal injury right, you become a value driver to your patient, to your peers that you may be referring to or referring to you, and also to the law firms. That includes what are the things that could harm a PI case?
What are the things that when you put them in your documentation, it helps, as I call it, and we’ll talk again more later in the series, storytelling documentation, focusing on the ADLs, the DUDs, and the loss of earning. The other thing that, that’s so key when I talk about what works really great is when you can get across that value to an attorney early on in a case.
One of the biggest areas of tax that the law firms have to deal with for you, aside from poor documentation, and that is rampant in this area, I’m gonna make you better in this series. But one of the areas is of attack that the adjusters always do to the attorney, and it rolls downhill, is that you overtreat and overbill.
Now, usually you don’t hear about that till the case is already over. So a lot of times it’s a red flag. It’s not really the truth. But imagine this, if you could help the attorney support your fees and your billing before, when you’re first treating a patient, so that when they’re dealing with the adjuster, they cannot allow the adjuster to drop your bills, your fees, and lower them.
Because what does that do? That increases the value of every case. Because one of the, the tricks when I was, of course, being an insurance defense attorney is lower the value of the bills, lowers the settlement offer that we’ve gotta deal back and forth with them, and we save money, right? By you being, making yours more solid, you’re taking that kind of trick away, and it’s fantastic.
So that increases settlement value, and that’s just you holding firm to solid fees, but you gotta learn how to do that. And I do find there are providers that don’t do this area right, and they do improperly set fees too high. They have something different for personal injury versus other things. And in the end, realize you’ve got one fee schedule across, right?
We’ll talk about that more in process of the next one, but it’s really important to understand it. Okay, the, the other side of the coin is when you have proven the value, shown the value, they’ve gotten better results, obviously it makes it easier to get paid, right? From the good firms Even when you’ve got the good ones, I think you’ve got to realize that personal injury is an industry of pushback.
Insurance pushes back a little bit like, “Where’s the paperwork? You didn’t have the right code.” But in personal injury, the pushback is gonna be our client said they didn’t show these days or they didn’t get these treatments or you billed too high or your per office visit is way too high you’re way past Medicare, all these things they try to throw at you.
So in the end, what you want to realize is that those are tricks and traps and you got to learn how to spot them and then to address them. So those that learn how to do it well do really well. Those who don’t know what they’re doing get so overwhelmed and being the healer mindset that you have, you generally give in and I find it disappointing that a lot of you in your profession are so happy when you get paid half your bill.
Why is that? Are you not worth what you bill? If you are, I believe that in the cap side, chiropractors, acupuncture, and even physical therapy, that you should be getting paid 100% of your bill 80% of the time, or if you did a blended rate, because not all are winners, it’s at 80% for your medical specialty. So use that as a barometer, and there are– And it’s being done all the time.
So when the four-minute mile was broken, everybody else could do it. That’s what I’ve been doing in helping people in personal injury for medical providers. At the same time, they get more patients. So the other thing, our, maybe let’s address a few common myths. So some common myths out there in personal injury that I want to hit today are that MedPay is okay to be held by the attorney, and that’s not correct.
MedPay, as I was saying, has been for prompt payment. And what– The same thing is happening with PIP, by the way, which is less but still happening far too often than as what I see around the country. So when you get that, you have to first be able to identify it, and you want to make sure to make the proper professional pushback demands of attorneys to get paid back.
And remember I talked about an industry of professional pushback? They are being pushed back on by adjusters, defense attorneys, judges and juries even sometimes. So they’re not new to being pushed back. It’s how you push back. Do it professionally. And when you can learn about the facts that matter, have enough of the law to where you can be dangerous to know.
You’re not there to be an attorney, but once you can assert facts and law, that makes you also someone that the good attorneys want even more. And why? Because in the really good cases, they may go to trial. Less than 3% of cases actually go to a jury trial, but a lot of them position to that, and that’s where d- adjusters and defense attorneys say, “Do we settle or do we go forward to try?”
And the better that the expert is, the better that the treating physician is, the more likely we need to settle. So when you learn how to stand for your fees and your bills and can support it, when you’re treating properly, when you have the storytelling documentation when you then push back, the good firms say, “I want that doctor.”
That means they’re gonna hold up well at a deposition. They’re gonna hold up well at trial. They know what they’re doing So with that, we’re gonna wrap up for the t- today on this first session. I hope you learned a few things. You see a little bit of the overall, and the way to look at the rest of the series is this.
We’re gonna hit three segments. We’re g- And I think it’s three segments that build any medical practice, and that’s processes, systems, you know that well, but there’s unique systems in personal injury. The next is being properly paid, not just MedPay and PIP, but how to out-negotiate law firms, the trusted ones to get paid more, but also the really difficult ones, and how to protect your staff or for your staff to do it better.
And the last is growth. And like I said, it’s growing not just a personally injury segment, including how to be a better value driver, but it’s how to use PI to grow all your practice segments, and it’s gonna be fantastic for you because this really is the high-profit highway. That’s what personal injury is.
And with that said, I’d like to thank the American Acupuncture Council for their support in allowing me to present to you this wonderful series.
Click here for the best Acupuncture Malpractice Insurance
This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Cookie settingsI ACCEPT
Privacy & Cookies Policy
Privacy Overview
This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience.
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
