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Hey, guess who? It’s acupuncture time. It’s Sam Collins, the coding and billing expert for chiro, for acupuncture for you, if you will, the profession as well as the American Acupuncture Council. I’m gonna speak to you directly as a network service today because a lot of you, and this means those of you who are network members with me, have gotten some letters recently that said, Hey.

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We paid you money for the va, we want it back. This is very similar to what went on last year. So I wanna talk about how we can go to dispute this, ’cause I’m getting several of you with some really big requests for recoupment. So let’s go to the slides and let’s talk about what is going on. And this is coming directly from the va, which is VA Community Care.

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And again, it’s the care for veterans. You have to be enrolled. And remember, if you’re on the East coast, you will be enrolled through Optum Health. If you are in the West Coast, and now when I say West Coast, let me say Texas and west of Texas, you’re gonna be through Tri West. But it’s happening in both areas.

And what it’s relating to is you’re getting letters that are coming to you saying, Hey, we paid you money. We shouldn’t have. We want it back, pay us back. And if you don’t, we’re gonna take it out of future payments. So we wanna talk about how do you really respond to this, what’s gone on and what we need to do.

Part of it I’m gonna say to you is, this is why I hope that many of you are network members with me, because you would’ve avoided this whole thing had you known. Been part of that. We did go through that last year a bit. So many of you’re getting letters similar to this one. Try West. I’ll leave this one small.

But what this does is it’s just saying the purpose of this letter is to inform you that pricing information, allowable reimbursement on claims previously paid you has been adjusted, given the correct payment is lower. We want some money back in this case, $388. Now that’s not very much, but I don’t like paying anything back.

When I do not have to. So let’s talk about what has gone on specifically and what is the issue that’s happening. How do you overpay it? Let’s face it, fees paid for the VA pay at your state, Medicare allowable. So how could to be wrong? I had someone that sent me a letter and said, Hey, Sam. I went through all my pricing and this is what they paid me before.

How could this be possibly overpaid? There could be two issues here. One of them is called the multi procedure payment reduction, and what this refers to is that secondary services on a claim now I’m not talking acupuncture exams, but therapies by example. If you’re billing a therapy, the first therapy is paid at a hundred percent of its normal rate.

But then each subsequent therapy on the same day is reduced what’s called the practice expense ratio. And what this refers to as the practice expense of a service goes this way by example, let’s say I’m gonna do massage for an hour. I have to do a certain amount of setup for that room. That’s the practice expense.

That practice expense doesn’t have to be done. If you think of it, if I set it up for the first 15, do I reset it up for the next? We don’t. So what they’re doing is reducing that portion of it. Now that practice expense comes out to about 15%, 20%. So it’s not a big amount. Let’s say the code is worth 30.

The multi procedure prov reduction would be that it would be paid probably at about 26 or roughly about 15, 20% difference. So not a big difference, but nonetheless a difference. Now, that’s something they should have been doing and they didn’t, so that’s really on them. My pushback is gonna be at least parsing on that.

However, for acupuncture, the biggest issue is not that, because those would be small potatoes. We’re talking three, $4. It is the use of 9 7 0 3 9 and 9 7 1 3 9. So when you get this letter, what you wanna do is verify with them, how are you indicating it’s overpaid? Is it overpaid because of the procedure reduction portion or is it being overpaid because I use 9 7 0 3 9 and 9 7 1 3 9 for cupping.

Please be aware. Since February of last year of 20 24 9 7 0 3 9 and 9 7 1 3 9, were no longer part of the standard episode of Care for Acupuncture, which meant you could no longer use it. I’m hoping some of you go, oh yeah, I remember when that happened, and you were no longer to use that code. Now, of course, if they were allowing it and they were.

Prior to this change 2024, they were allowing you to bill 9 7 0 3 9 for cupping. And frankly, many of you were getting paid 45 to $50 for it. So if someone’s willing to do that, I’m willing to take it. However, let’s keep in mind, let’s think about that logically for a second. Cupping is a much simpler service than acupuncture.

Yet you are getting paid more for cupping than acupuncture. So you can look and go that doesn’t make sense. However, because they allowed it, I’d say, go ahead. Technically, you should have not been using it after last year. Realize here is the newest list of codes I. Allowed for acupuncture with the standard episode of care since February of last year, and you’ll notice immediately none of the 9 7 0 or 9 7 1 3 9 7 0 3 9 or 9 7 1 3 9 is included.

They were removed. Now the pushback that I have, if you’re getting a request for a refund, that was prior to February of 23 for the date of service, the standard episode of care, up to that point. Did include it. Therefore, it would be appropriate for them to pay, and the pushback would be, hey, it was allowed at that point.

Now, if you are getting requests after February 23rd, now that’s a whole nother issue. That’s one that, oh, shucks, we should have known. Now, network members with me, you should have well known because I sent out a lot of information. This is why I’m sending this all directly to you as well, not to mention just for everyone, let’s make sure you understand.

If you’re billing the va, these are the codes they allow. They do not allow 9 7 0 3 9 if you are wanting to do a service that is not on this list. You must specifically get authorization from the VA to provide it, or it’s automatically non-paid. Now I will have you notice. Notice the last two codes in each one, the 0 5 5 2 T, and S 89, or excuse me, 0 5 5 2 T is the code for laser.

So they do cover laser. Don’t get excited. It doesn’t pay that much, but it is covered. So bottom line is do not use for cupping any further. If you have been. 9 7 0 3 9 or 9 7 1 3 9. Do not use them. They’re gonna be a problem. And if you get paid, you’re thinking I got paid. They’re gonna come back and take it back.

I. We’re gonna push back on that a little bit, but again, after February of last year, it’s gonna be a little bit harder. So for cupping, what should you do? I’m not saying not to bill for cupping, I’m saying for the va, however, it is only under 9 7 0 1 6, and that code, frankly, is worth between 11 and $15, which truthfully makes much more sense to me.

I don’t think cupping should have the same value as acupuncture. Not to say that cupping doesn’t have value, but is it as much as doing the needling? I think not. So therefore, yes, it’s still payable, but just under that code. Now, if you’re getting issues on the price reductions, that’s what I would still push back on, depending on when they’re implementing.

But remember, that’s gonna be a pretty small amount. If it’s a big amount, I’m almost certain it’s going to be cupping. So make sure you’re pushing back. How can I dispute it? The number one dispute I have, and this is the starting point, but I want always there to be two disputes, is just plain statute of limitations.

Let’s face it, we have only 180 days to bill the va. Does that give them infinite time to recoup, years later? No. Under federal statutes it’s 365 days or one year. Therefore, if they’re making a request to recoup money from you, that is over 365 days or one year. That’s the number one pushback. If you’re a network member with me, please contact me.

We have a dispute letter to that fact for you already formatted that you can send. Hopefully this is encouraging. Some of you, oh, this is why that network is so good anyway. If you’re not a network member, you’re just gonna have to go back and say, Hey, that’s statute of limitations. I would also push back though on this issue case law, there’s case law that’s been around since the nineties that says when an insurance pays something improper and the provider has not done anything.

To make that payment improper. The carrier is the one responsible under federal rules. They may push back on that, but if you recall last year, we were able to dispute that, but I’m expecting the same. So my hope is that given in another month or so, we should see some pushback where they’re going to no longer seek these recoupments, at least the ones prior to 23 or over a year.

My concern for you though, is make sure you understand, do not bill. 9 7 0 3 9. I know you’re thinking they paid me. They can recoup it. We wanna push back. Let’s make sure the claims are correct. If you’re not a network member with me, this is a great time to understand what we do. This is something we’re trying to get you ahead of the curve and not chasing after it.

VA patients are still very good patients. Remember, we got about a 20% increase in the Medicare fees for the first set this year, so that’s a good patient. Just understand the rules. Again, no use of cupping. If you’re not a network member, please take a look. If you’re a network member, please contact me.

Let’s go through. We can do a one-on-one zoom if we need to, but let’s make sure we’ve got some fire to push back on this. Until next time, my friends, I wish you the best.

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