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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.
So what’s going on HIPAA 2026, because this is the email I’ve been getting, in fact, several. And it says, hi Sam. Hope all is well. I’m getting a sudden surge in emails about the new HIPAA laws going into effect.
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 my friends. It’s Sam Collins, the coding and billing expert for acupuncture for you, the profession, and of course, the American Acupuncture Council. But most importantly, really it’s just you and I wanna make sure that each time we’ve got something new, something that’s changing to make sure you’re up to date.
If you’re a network member with me, even better, let’s make sure we always know what’s going on. Otherwise, even if you’re not a member, this is a place where we’re gonna give you the updates. Let’s go to the slides. Let’s talk about. What’s going on, and some of you may have gotten some emails to this and it’s always one that I’m always careful, hyperbole and if you have stress, it sells.
So what’s going on HIPAA 2026, because this is the email I’ve been getting, in fact, several. And it says, hi Sam. Hope all is well. I’m getting a sudden surge in emails about the new HIPAA laws going into effect. Now, I do understand HIPAA is misspelled here, but I left the email just as it was sent and it says, is this accurate or is it just marketing hype?
And I’m so glad they reached out to me. As good as Google searches and chat, GPT can be, remember, those are still limited to the information they can gather, and is it always correct? No. So we wanna be careful and we also wanna be careful. Is it also subject to hyperbole as well? Potentially to some extent.
I always look at the context. Obviously HIPAA is a big deal. It is. But how big is it? It depends on the size of the office, what you’re doing. At the end of the day, what is hipaa? In a acupuncture office? Don’t let anyone have someone else’s records. Many of you’re using paper charts. That’s pretty hard to get records unless they break into your office.
So let’s make sure what are we really doing and talking about let’s update. There are changes that you have to make. Or potentially February 16th. However, these updates probably will have nothing to do with you. I will tell you, I’m gonna be very acentric when it comes to these things. Code changes, everything else.
I’m like, how does it affect us? That’s what I wanna know. These updates chiefly concerned, a heightened confidentiality, protections for substance abuse disorder and reproductive health privacy. And this is mostly related to. Reproductive rights of people that some states allow certain types of birth control, others don’t.
If you go to another state, they can’t get access to it. It’s just protection. All this is about protection of a patient’s information. Same for substance abuse, that if someone has, gone through some substance abuse treatment, that no one just can easily get access to it. In fact, the easiest way to keep everything private, always pay cash.
If you’re not aware, cash means you don’t have to disclose at all, and the patient has a right to. Now, with this update though, what if it does affect us? What do we really have to do? It’s really updating your privacy practice. I’m gonna say 99.9% of you won’t, but let’s say for some reason you’re doing some reproductive health.
Now, I’m not saying necessarily fertility, I’m talking about reproductive birth control and that type, but let’s say you were, what would you add in there? The patient has rights for reproductive protection and that these records will not be disclosed unless specifically requested. And even then you would make sure who’s the requesting party, who they have access.
In other words, you’re gonna exercise a lot more caution for records, particularly if they have things like substance abuse. Same applies with HIV. So what this really is a defensive way just to make sure patients are aware of their new rights now. Does this mean you need to change your privacy notice?
Probably not. But let’s say for some reason you did, you would update your privacy notice with this additional information of that protection. If you’re not maintaining records on reproductive rights or substance abuse, though change is nothing. So continue the same, which means I don’t update anything.
Now let’s keep in mind though, what if you did have to update it? Would you have to have all patients sign the new privacy practice? No, you wouldn’t. Once they signed one from years ago. That remains in effect. Do post up in your office if you’ve made an update somewhere where they can see it. Make people aware.
But for the most part, they do not have to sign a new one. This is more so just to make sure that if you have these, you’re gonna make the change. Chances are you don’t, and this is where I want to keep things with simplicity in mind. Avoid hyperbole. At the end of the day, what is hipaa? Oh, by the way, you know how you’re supposed to do a yearly HIPAA training?
This isn’t at the very least part of it. It may be for some of you, the whole thing, depending on the size of your office. The basics of HIPAA is that we are protecting protected health information. What does that include? Names, date of birth, social security number, their diagnosis, treatment. In other words, all the information you have on the patient, you’re protecting it.
What does it mean? I don’t let anyone have access but realize. There’s things that can make it more vulnerable. If you do all paper notes, it’s very hard for someone to get it ’cause you physically would have to send it. But what if it’s electronic? Could someone hack into your system? So we have to have other things in safeguards there.
And even verbal information. Be very careful by example. Here’s a common one, A friend recommends a friend and you start discussing things about it. Like someone’s recommended a friend and they said, Hey did my friend John come in? Do you know? You can’t disclose that. You better get permission from another person.
And this sometimes you go I just wanna thank them. Gotta have permission. ’cause maybe they don’t want them to know. So at the end of the day, think of it this way, HIPAA is about giving the least information that’s necessary. We use the term minimum necessary. So if someone’s asking for a very specific date on a patient and it’s a valid request.
You’re gonna limit it to that date. Don’t send everything. Don’t send extra things. Here would be the reason why if you send too much, you never get it back. You know the barn door’s open, but if you send not enough, it’s easier to send more than to try to pull it back. Make sure, of course there’s administrative safeguards in the office.
Again, that’s what we’re doing today. Who’s your officer? Probably you, but make sure you have things in place. Do you do a risk assessment? Have you looked recently? Hey. Have we done all the right things by example? Do all your employees or people you work with get some initial HIPAA training from you and is it done yearly?
Now, I’m not saying it has to be a big yearly thing, but enough to go over it again to make sure there’s no issues. And you should have some type of a written policy. It could even be a page. I’m gonna suggest some of you may have to have more than that, but for the most part it’s like just the protocols of how to deal with it.
Like when someone calls. How do we handle if someone’s asking for records? You know what the answer is? We don’t give ’em anything over the phone, not without a signed authorization. Remember, if you’re working with outside vendors, billers or other people, they have to sign up. A business associate network manager with me, we have that.
We’ve done so because everything, I have to keep private. Make sure that if you have any type of service that’s shredding documents and you’re not doing it yourself, they need a HIPAA notice and then make sure you have. Rules that what happens if there’s a violation? I don’t think you’re gonna have some big sanction.
It just means, Hey, we’re gonna reprimand that this doesn’t happen again. Put safeguards in place and it’s just gonna be, I did a reprimand. You’re not gonna say, I’m gonna suspend you for a damn I, I guess you could, but that doesn’t help us. And then make sure you’ve got reasonable physical safeguards, meaning secure the charts.
Now if you have paper records, that’s pretty easy. Don’t put ’em in a place where people can get them. Now what if you said I don’t have a locked cabinet. Do you need a locked cabinet? Not necessarily so long as it’s protected from the public getting to it. So if it’s in an open area behind where people can walk in, you’re always gonna have some type of safeguard.
It’s never left alone for people just to wander. And now patients are escorted back. Now obviously electronic could be a little bit more difficult ’cause now what if you’re sending an email that’s not secure, or you’re not sure because your system could be hacked? Make sure you’ve got the proper encryption on your computers.
But one simple thing is make sure just when someone comes in your office, they can’t look and see someone else’s information on the computer. It should always blank out. In fact, I’d recommend just the privacy screen. That way when you look only dead on, can you see it? Nope. Nothing from the side.
Okay. And then make sure, as I mentioned, restrict access. No, you can’t go back there. We don’t let you, those are obvious, but it’s something to remember. That’s part of the training that staff have to remember, Hey, we just can’t let a patient go to the restroom. And then they’re wandering around the office and trying to look at someone else’s chart.
Not that I think people. Do that. But every now and then you get a couple of people that are a little quirky that may try to do something like that. And then of course, make sure that you’re shredding documents when you discard them. You can’t just throw ’em out, shred them, okay, by a cross crutch shredder, or there’s a service out that’ll do it.
Remember, you do wanna keep the records timely. On the minimum time for many states. Could be five years, some or seven or 10. Know your state if you’re not sure. Contact me network members. I can make sure, but you don’t need to keep a bunch of records if you’ve been seeing a person for 20 years. You honestly don’t need all 20 years.
You need the last seven years, let’s say. Alright, now what about technical safeguards? Here’s something to make sure this is training with staff passwords. Everyone should have their own no shared passwords. That way we know who was on or what there was a problem. That way, if something happened, we can find out how it happened, who it happened with, and not everyone gets blamed.
If you will make sure there’s log off. The computer should log off after five minutes, maybe even shorter, depending. How about encryption? Now, it’s pretty hard to buy a computer without that, but check to make sure. Where I’d be more concerned are mobile devices and backups. If a staff can have access to records on their mobile device, let’s remember if you have Google or Microsoft, they look at everything, if you use email through Google, they’ve read it and they’re sending you ads based on it. Okay. And they’re selling it to other people. So make sure you keep things very private in that way. I would recommend no mobile devices unless we know it’s encrypted limit access based on job role. If someone’s job is only appointments, then they don’t necessarily need an EHR access.
Okay. It just lends to less people touching, less problem we can have. And then make sure, again, the personal devices. I have a concern because everyone does it now, and then you wonder what things have access. I had a friend that said, Hey man, I have a TikTok. I never had TikTok before. So I put it on, I watched the thing.
I thought it was pretty it’s not for me. I’m an older person, so I don’t wanna sound like I’m down on it, but the thing, I deleted it. Do you know, I get an email now and again from TikTok that says, Hey, this person’s on TikTok. We saw they were in your contacts on your phone. So again, there’s a lot of access there.
I would be really conscientious of. And then remember, patients have rights. Make sure they all do a privacy notice, do they have to sign that every year? No. Once is enough. If you amend or change it, then of course, put a post, a new notice. But at the same token, they have to resign. And if a patient wants, can they have access to the records?
Sure. Can they make amendments? Not really. They can’t amend it. What they can do is give what their opinion is. But don’t make them change the record. They can just write what they think. It should be a little odd. But on the medical side, you might see this. And then if they want confidential things like, Hey, I don’t want you to speak to my spouse, I don’t want you to let this person know, you have to honor it.
And in fact, I would say always simply, I don’t wanna say hide, but use that as your protection. I’m sorry. HIPAA allows me not to do that and just leave it at that. No excuses. That’s just what it is. And if they want any type of authorization, I want it in writing. From them. I don’t want there to be any issue later saying, I didn’t give you authorization to do that.
It’s not complicated in a small office, but you wanna make sure we have the right things in place. ’cause if someone does make a complaint, could that be a problem for us? Maybe which means other simple things too. Verbal discussions. Avoid, obviously if you go in a hospital, you ever notice everyone gets quiet when they get on the elevator.
You wanna make sure you’re not talking. You gotta be very qui quiet. My son’s an attorney and it’s interesting when they have meetings. They literally have soundproof rooms. A hundred that no one can hear anything. It’s really, in fact, if you sit in the room with no sound, it’s a little scary because there’s like anti sound in there.
But that’s how careful they are with the type of things they deal with. So use good discretion. If you’re releasing information and you’re not sure, or they’re asking, don’t release it. You can always get more information. Again, you can never get it back if you’re not sure where you’re sending it.
If you’re not sure. That was them on the voice. But don’t leave a voicemail. In fact, make sure they have permission for you to do so many patients will. And then if you’re gonna send a fax or an email, verify who it is before you send it. Because once you send, if it’s the wrong one, and I, when I say verify it, I mean I want you to send, my rule is you’re gonna send a test email first.
Make sure the respond back saying it’s theirs before you send it, okay? Because once you send it, there’s no coming back. The network, myself and the HJ Ross or American Acupuncture Council, we’re always here for you. We wanna be your support. If you’re a member with me and you want to go into some more details or some training, by all means do that.
Otherwise, for everyone else, use good common sense when it comes to hipaa. You always be on the right track and not saying things can’t change, but remember hyperbole often is just that it’s trying to excite you about something. We’re always gonna be that good and honest resource. So until next time, my friends, I wish you well.
And remember, acupuncture got a nice increase in fees this year. Go forward. Take care everybody.
In 2026 for acupuncture, I’m pretty darn excited because of the changes to relative value units. Relative value units are set up each year to give the cost of a service compared to any other, and that value changes the amount of revenue because there’s a standard conversion they multiply by, and when that number goes up, you get an increase in revenue.
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, friends and colleagues. This is Samuel Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and maybe more importantly, the profession. And you, as I warned you last month, there is gonna be changes. And of course there are. Let’s go to the slides and talk about what is coming, or frankly, what is here for the new year.
In 2026 for acupuncture, I’m pretty darn excited because of the changes to relative value units. Relative value units are set up each year to give the cost of a service compared to any other, and that value changes the amount of revenue because there’s a standard conversion they multiply by, and when that number goes up, you get an increase in revenue.
So this is applied by Medicare, the va. Workers’ comp, personal injury, and frankly, health insurance. Maybe not all health insurance. Let’s face it. If you’re dealing with a SH or some of these, they’re probably not using rvu. They’re just trying to set a fee. But the bottom line is we use RVU to help us convert.
So let’s talk about what has changed in 2026. Here’s a big list of it, and of course you’re gonna look, this has a little bit of everything. This is something you get in our seminars where we give you the whole detail and go through that. But I wanted you to at least see, what the RVU are for this year.
Where they have changed and in fact to see that better. Let’s really talk about for acupuncture, you’ll notice 9 7, 8 1 0 is now 1.44 conversion. That is literally a 4% increase. You’ll notice 9, 7, 8, 1 1. Now at 0.85 is a 7% increase, so therefore there’s been a nice change. Acupuncturists are really fortunate.
Do you know you’re the only profession that’s got this much of a raise in the last three years. You got about 8% two years ago, another 4% this year That’s doing good, but you only get an increase. If you increase the fee, think of it like owning a home. If your home increases in value 10% and you’re gonna go sell it, you’re not gonna sell it at the value it was before.
So I want everyone to start thinking, how do I use this? So let’s say by example this year, just with a 4% increase. That would mean if you’re charging $78, now I use $78 because that’s gonna be roughly the 4% increase based on a $70 if you will. And you can see here that 4% increase means if you’re charging 78 for the first set, additional sets are 46.
Wow. That’s a nice big difference. Think about that for a second. A VA patient, a Medicare patient. Now you’re looking at probably $170. Maybe not that high, 160 something per visit. That’s quite a bit more than it was. Notice the big jump up though for e and m codes, you’ll notice e and m codes here increased 4%.
They went from 3.37. To three point five, two. Big jump. Most of all of you are undervaluing. Now, you may look and go, but Sam, we had a decrease in the massage rate. Yeah. Body work did go down, but I want you to know the reason it went down. They kept everything else flat. Even though they raised rates on some codes or values, they increased the revenue value by 3.2.
So the conversion they have is 3.2 higher. So that’s a much bigger difference for acupuncture and e and m. And it’s about flat for the massage part. So for the most part, maybe some of those fees will stay the same. But if you’re not increasing your fees a bit, it’s gonna be a problem because every state uses a multiplier and here’s some.
Real prominent examples. Michigan, Florida, Indiana use 200% of Medicare. So you just go back, you just take this rate, 200%, you’re gonna go. Wow. Sam, are you saying 200% means 150? That’s what they would allow. Now, I’m not saying you should charge that much, let don’t get me wrong. I don’t necessarily say that, but would that be within reason?
Potentially. So notice in other states, like California, it’s 150%, or in other states you simply do a number 69, 49, realize the Medicare conversion is about $35. You can see all of these are well above that as a good rule of thumb. Probably 1.5 to two of your Medicare rate, though that may vary ’cause your practice may be dependent upon cash and how do you balance the cash discount.
What I’m highlighting though, is you better start to get online to make sure you’re not undervaluing network members with me, my platinum members. Please reach out. We need to get in a meeting in a Zoom and go through these in detail to know what’s good for your area. ’cause I will guarantee most are losing money.
And this doesn’t just include acupuncture, but exams and some therapies as well, we will do for non-members. I have a seminar coming up January 18th or 25th, east Coast, west Coast. Let’s go through this because the revenue lost by most acupuncturists by not understanding what something is worth is a tremendous crime to your practice.
If you’re billing someone 50 and they’re willing to pay you 75, you know what they’re gonna pay you. 50. Now, I’m not saying you have to charge 75, but shouldn’t it make sense that you should charge what the value is? Relative values bring you there. I’m hoping for all of you, you start to realize that you need to look at this as a business part and not just, it’s the same year after year.
Costs go up as a general rule. Fee should increase about 3% every year just based on cost of living. And sometimes if you haven’t increased it in five years. Maybe you need to do a little bit more. Now remember, this could be indifferent to your cash part of your practice, depending, particularly if you’re doing packages.
So realize you wanna start to really fortify your practice. We’re here to help because notice Medicare increased rates 3.26% just based on that, if they increased. The value by 4%, then increase the conversion by 3%. That’s a pretty big difference that you may not be aware of. And this is gonna be just off of standard Medicare rates, which by no means would anyone say that’s the highest.
So get in line. I hope that you come part to the seminar, particularly for members. Remember platinum members, it’s free for you. Just call in and sign up. Otherwise, everyone else would love to see. And I wanna make sure, is your practice thriving? I have an incentive for you. Your practice is important to us at the American Acupuncture Council.
If your practice is not increasing, we don’t have a business either because we support you. We wanna make sure you understand the business side and acupuncturists, you’re good at your acupuncture, but have you really looked at the business side, allow us to have a chance to help you, seminars our network.
Hope to see you all soon Until next month, however, take care.
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, friends and colleagues, and of course network members. The American Acupuncture Council is always looking for your success. And here’s another episode we wanna focus in on. What’s happening for 2026? How do we get prepared? How do we make sure? Because if your practice is not adapting, you’re probably gonna start failing.
So we wanna make sure that doesn’t happen. Let’s go to the slides. Let’s talk about what is coming in 2026. What do we have to be prepared for? The thing I think we always wanna start with that first year, at least for me, is always money. So as network members, I always wanna make sure at first the year you’re doing a meeting with me on your current fees and codes.
And I don’t care that we did one this year. We need to update it for the new year because what we wanna make sure that is clear and it’s what every patient wants to know. How much does it cost? What are the fees? And we have to come up with establishing a good, fair fee to many of you way, un way undervalue, or do not understand your services and costs.
So first things first. What we want every patient to know is a good financial understanding. But you know what? That financial understanding needs to be from us as well. What is your cost of practice? What does it cost for you to treat a patient? ’cause that’s how we’re gonna start to set. Fees. We have to make sure the fees actually sustain the practice.
So the financial understanding starts with us, but also the patient. They wanna know what’s the cost. Do you have a difference for cash and insurance? I assume many of you do, but what’s legal for giving discounts? What about prepaid plans? What about do using these discount medical programs, if any of you’re familiar with those?
What I wanna make sure is that we have a clear understanding so that we can pass it on to the patient and let’s not take it, that we can’t make a slight increase every year. Cost have gone up. If you don’t increase cost or if your cost of increasing, you don’t increase what you charge. You better have a very high volume.
And for acupuncture that often can be difficult because let’s face it, many of you are gonna see a patient 30 minutes to an hour, and that just limits how much you can see, so it’s not unlimited. You can hear about a lot of chiropractors treating hundreds of people a day. That’s not happening in acupuncture practice, so we have to value this properly.
So let’s make sure the patients have a good understanding because we wanna make sure there’s no surprise. Make sure in simplest terms, you want a disclosure to the patient of what your costs are with a good estimate of costs. What is the first visit? Follow ups. What services are we doing? What’s covered by insurance?
What’s not? What are they paying out of pocket? This should be in writing, but given to them orally. And when you do this agreement, remember agreement. It can’t be any longer than 12 months. I would recommend every time they come in for a new course of care, reiterated, have them sign something else, because we don’t wanna reach a point where we have to go to collections or do any credit reporting.
In fact, many states don’t allow you to do credit reporting anyway. So to avoid credit reporting, to avoid collections, how do you do that? Collect at the time of service, collect an amount you think the insurance is not gonna cover, and have that paid by the patient. My rule is maybe make it about 30%. If the 30% turns out to be too much, it’s much easier for us to refund back to the patient or credit them than it is to chase after money.
So if you’re not sure at all what the insurance pays, you might even collect 50%. What you wanna make sure is insurance is not something we’re expecting to pay everything but part. And until we know for sure, we’re not gonna give the patient any idea that, oh, it’s gonna cover in full until you learn that and that’s what we need to do.
Have you really looked at the insurances that you’ve billed? What do they pay? What are your expectations? What services? So that way when a patient comes in with that same coverage, you can go, oh, okay, I’ve seen that one before. Here’s the amount you’re gonna pay. That’s when you ever notice, you go to the dentist, they know exactly the copay.
It’s ’cause they’ve billed it before. They know exactly. Based on that coverage. What if you’re all cash pay upfront? Or are we gonna pay over time? Or are you gonna do a prepaid? So we wanna make sure all these things are set up so the patients are comfortable. The barrier to care for most people is always money.
So we want to deal with the money first, get that outta the way, and then get to the true care plan ’cause they’re coming there to get better. Let’s focus on the value of the service, not that it’s necessarily cheap. Because I want you thinking of, have you really looked at your fee structure for a network member with me, please make sure we’ve done this, and if we haven’t, we need to do one right away because for 2026, we need to update it.
This changes every year. It’s not stagnant. So I want you thinking of what are your charges for the common services you do? I just give some examples here of manual acupuncture, a mid-level exam, and massage by example. How would I use this? How do I make sure? Because I want you to see how fees should be structured.
By example, the relative value of acupuncture. First set manual is 1.38. And you may look and go I’m not sure what that means. What I do with that is to help you establish a fee schedule across all codes. Every code has a relative value, and it’s one of the things we emphasize at our first of the year seminars, which are coming up by the way, January 18th and 25th.
But nonetheless, we make sure you understand it to set the fees, because what I have found for most offices. You’re simply just billing below what you can collect based upon lack of knowledge. So by example, the value of 9 7 8 1 0 is 1.38. Let’s say another code has a value of one. What does that tell you?
The difference is the code that has a value of one is 38% less. Simple as that. Every code has a set of value this way. So the way to use this tool is to do this. Take the price you charge, and I’m gonna say start with acupuncture first set, because that’s the thing. I think you probably bill commonly, you know the value, you know what’s being paid.
So take 75, divide by 1.38. It gives me 54, 34. Now what does that mean to me? This 54, 34 is then what I use to multiply any other codes. RVU. To tell me the price. So if I take 54, 34 and multiply by the relative value of 9 7 8 1 1, which is 0.79, it tells me it’s 42 92. So if the first set is 75, second set would be 42 92.
Now, realistically, I’m probably gonna. Make that go up to 43 or maybe even 45. But you can see here, it’s roughly when you look at this, not 50% less because it’s not raw numbers, but in that range. So it’s gonna be probably about two thirds or a little bit below that for that set. So make sure if your first set, 75, 42, 92.
What about other services though? This is where I find acupuncturists have to start to come to realization of the services. Exams are detailed. Take a lot of time and hence they’re more expensive. Notice the value of 9 9 2 0 3. Okay, mid-level new patient exam. Notice it’s 3.37 with 3.37. You can see here it’s not quite three times the rate, but notice it’s three times the rate.
Quite, but just below. So notice it’s 180 3. What I find often is people will charge exams for 50 or $60. Now, if you said, Hey, Sam, I’m running mostly a cash practice. Maybe you do it to keep it affordable, but understand if you’re billing out to insurance, this is the value. It’s worth quite a bit. Are you undervaluing?
For many of you, you are. What about something simple as massage? A lot of acupuncturists do massage, and you’ll notice the massage value is 0.92. It’s more than the additional set. In this case, 49.99. So simply going through each code now as a network member, if we haven’t, please make sure you set up a Zoom appointment so we can work one-on-one with this to make sure you understand.
Oh, that’s why I would charge this. ’cause we wanna do this with every code and start to look at what you’re being paid to make sure to set a fair value. Because here’s the truth. In states like Michigan, Florida, Indiana, they literally take RVs, which is double the Medicare rates. For personal injury, work comp and so forth in these states or California work comp uses 150%.
So keep in mind, for most of you, what is the cost of a first set in the Medicare rate? It’s roughly about $50. So if you look at this at 50, if you’re doing 150%, it would be 75. So again, just using those rates and realize those will update at first of the year. Now, how do you get those? Get with me Network members, of course.
Or come to a seminar so we can go through them because they will change. We’re expecting a nice change for you this year, by the way, but we wanna make sure you understand relative value. Certain more than that. Look in these states. Arizona just uses a pure qualifier of $69. You can see here if I, in Arizona, I take 69 multiplied by 1.38.
That’s $93 for the first set. That’s the fee schedule for the state. Now, if you’re charging below that’s fine, but can you imagine if you have a work comp patient, why would you turn away $93 for the first set notice In other states though, they just use a conversion notice. Idaho 49, Maryland 51, Texas 70.
Utah 59. So you can see here when you take this and divide, you’re gonna see here even Utah’s higher than a $75 rate. Idaho may be a little bit below, so be careful of undervaluing. If you’ve not really done a real review of your fee schedule, it’s time members. Please set up a zoom. Now keep in mind, we should see an increase this year.
Now you’re gonna see some things come out that say Medicare’s reducing, they are reducing for hospital based or facility base, but not for doctor’s visits. We should see a very slight, 3% increase. So that’s nice. We’ll wait to see at first of the year again, as a member or a seminar attendee, we will update that, but you can expect about a 3%.
So what does that tell you? Should you increase your fees? Probably maybe 3% at least. Yes, in fact, maybe higher because maybe many of you have not raised rates in years. Can you imagine if you said, Hey, I Hoag, I owned my house for 20 years, but I’m gonna charge the same price I did 20 years ago. That would be foolish.
It’s worth more. So make sure you update that and understand the differences. They’re projected to increase payments overall due to the new budget. And they’ve realized they had to increase, or you’re gonna make doctors not wanna stay in the system. Now you’re thinking how does that affect me?
Realize Medicare rates help to set other rates because often they’ll just use a percentage. Now the Medicare deductible will go up. Does that affect us very much? Not really. Unless you’re working with a MD or a nurse practitioner, you’re not treating a Medicare part B anyway. That deductible will go up a little bit.
Remember Medicare Part C patients for acupuncture, you can directly access and realize relative value units will update. For many of you. You remember two years ago, you got a very nice increase in RVs for acupuncture. So with that being said, most of you should have had or should have increased your fees roughly 10% about two years ago.
If you didn’t, you’re simply losing money. Now, you may be hearing me say this and go, oh, Sam, come on. I belong to a SH or other plans. When you join those plans, you’ve accepted a lower rate and they do that because when they get you in contract, they’ll pay you less. So you may wanna rethink, should I join?
Remember we did a program on that? So be careful. I wanna make sure you have relative values that based on real information. Keep in mind, there are gonna be no changes to the codes you use regularly, but here’s what I would implore you to do. Do you really understand them? Do you have the full definition, how to document by example?
For our first of the year seminars, we’re gonna get into, Hey, can you bill for red life therapy? What about some of you wanting to do additional services? Cupping, moa? How do you code for those? How do we define them? We wanna make sure, but there are no new codes when it comes to the physical medicine codes that you do.
But are you doing the ones correctly? By example? What if you’re doing guha? Or deep tissue work. Realize 9 7 1 4 0 is more likely the best code for that, and it’s gonna have an actual two, two and a half percent increase above that other 3% y. They remove what’s called the efficiency adjustment. So the code is simply gonna be worth more.
So we have to make sure you’re up to date and understanding. So I want you to stay tuned. This is just to get you ready to say, okay, let me start looking because these will be published and we’ll definitely have ’em at our seminars on the 18th and 25th. Network members, it’s free for you. Just simply set up to register or give us a call.
If you’re not a member, please do we wanna make sure you’ve got the right information. Your practice depends on your understanding of the business then, and that’s what we do. So please make sure you’re ready for 2026. I’ll see you then.
…That they’re not paying for exams and they’re also still recouping.
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, friends and colleagues. It’s Sam Collins, the coding and billing expert for acupuncture, the profession, of course, the American Acupuncture Council. Of course, I’ve got a little update coming up because obviously many of you have been contacting me, network members, and even others have contacted me.
Say, Hey, Sam, what’s going on? I notice. That they’re not paying for exams and they’re also still recouping. We’re gonna talk a little bit about that, but we have to update from what we did in April. So let’s go to the slides. Let’s talk about what’s going on with recoupment and standard episode of care specific to acupuncturist and frankly non-physician providers.
So you’ll see here is a letter dated June 23rd from Tri West, and it says, we received the above claim. Let me bring it so I can pull it up. And it says. Try West. Receive the above-mentioned claim for your often notice I highlighted in yet it says evaluation and management procedure codes are not paid for this rendering provider specialty.
This is the latest thing we’re seeing. It appears, and I’ve seen it absolutely published way that to me would make it more, but it appears they have taken the ability for acupuncturists to be. Separate exams when it comes to the va. That of course is very frustrating because of course is an exam necessary thing.
Of course, I to determine the need for care you to determine the continuation of care. So what’s occurring, I think is maybe A-D-O-G-E cut here that they’re eliminating the payment for exams. That doesn’t mean you don’t need do one, they’re just not. For it. I think it’s probably we’re seeing the patient for the overall payments, but they’re not covering it.
We’ll see directly. Now the word that they did this in ap, what I’ve seen Pub in their newsletter is not quite clear enough for me. So I’m waiting to see the full publishing and episode of care, but I’m sure many of you have met. Now. Here’s gonna be the pushback if the exam after April when they published it.
They’re gonna be damn behind it because published, however. But then I want you all to think of standard episode of Care for Acup Occupy. Whenever you notice the standard episode of care, you’ll notice whether it’s going to be initial chronic follow-ups. They include e and M codes. You’ll see really, 9 9 0 2 to 2 0 5 9 9 2 1 to 2 1 5, and I bet probably your authorization as well.
So my argument’s gonna be, they’re saying they’re not gonna cut well if it’s after April, send an updated authorization’s not listed. I’m waiting to see that, then I would say, okay, but if it’s prior dispute’s gonna be, how did you send me an authorization? Clearly indicates exams and they’re, now, I’m not gonna pay for it now, it appears after April.
This is gonna true. But prior, it’s gonna be a pushback. Now that very frustrating. Of course it is. But I’m gonna ask you, is it worth it to still be part of it? I do, because think of the overall payment on a VA patient. You’re getting 12 visits to start, probably eight and eight to follow up. Assuming you’re doing three sets of acupuncture and a therapy or two, that’s maybe 110 to $150 of reimbursement.
Am I going to take away potentially, three to $4,000 a payment? Because they’re not gonna pay for a couple of exams. I prefer they do, but I’m gonna say I’m not gonna go that far. It’s something I think though we’re gonna be fighting. I shouldn’t say think. I know we’re gonna be fighting as a profession on a national level along with chiropractors and physical therapists, because this affects them too.
Because this goes against the equality provision. Equality says that if it’s within scope and you pay, other providers have to pay you because this is not Medicare. Now that’s gonna be a little bit of a fight, and that’s not gonna happen in short term. So when you get this, I do think we should dispute it.
I would certainly push back if it were pre-AP April, that they should, if it’s after April, not so much. Of course, if you’re a network member with me, reach out. We’ve got some letters for that as well. But I do wanna highlight also beyond that, just a couple of quick updates. Let’s talk about what’s happening and what’s gone on with doing.
Things with 9 7 0 3 9 or 1 3 9, and that’s of course what a lot of offices have used for cupping. Remember that was removed more than a year ago, so please do not use that code for cupping. It is not appropriate. Do not list it. They may pay it, but they’re gonna recoup it. So do not, if you’re gonna do cupping, use 9 7 0 1 6, which is a vaso pneumatic device.
It’s not a high payer. It’s about 11 to $15, but at least you are being paid for it. But again, do not use 9 7 0 3 9 and if they are recouping that, if it’s pre 2024. I would argue they can’t, but if it’s after 2024, they can. Now some people have argued. What about statute of limitations? Statute of limitations, I would argue certainly does apply.
Unfortunately, you know what I’ve realized or what I’ve learned, the statute of limitations for the VA is actually six years, so we’re not gonna win on that one as far as this goes. The other thing here is, and this has come up recently because obviously a lot of you are using paint indexes or similar.
To verify how the patient’s improving. I recently had an office, or actually a few that they were denied few further care because they weren’t showing at least a seven point difference on the general pain index. I really like the general pain index. It’s certainly the similar to the pain interference.
Make sure though, if you’re using it. If you’re doing it once a month, there’s gotta be at least a seven point change to be considered significant. Now, most of you, I hope, are getting bigger than seven point changes, frankly, but if you’re not realize it’s going to be a problem ’cause they’re gonna push back, which means you also have to focus in what if I’m using the pain scale?
That also has a limitation, which means it’s gotta be three points or more. Obviously if I say I’m a seven, I go to a six. That means I’m better, but it’s not considered significant. So if they start at seven, the next time you do it to really be considered significant, say on re-exam, it’s gotta be four.
So a three point difference, I would say. Then obviously those two factors are important. If you’re not getting at least seven or three, you better focus in on something about an activity, particularly a home or work activity that couldn’t do before. What they care about is the patient getting better.
Because remember, once they’re stabilized, they have to be on a continua care with flare up. So keep in mind, Acture works well. We need to demonstrate it. Show me on this general index pain scale or function, how much improvement there is. Now this brings me to, for some of you, and I’ve had this question a lot, is being part of the VA worth it?
Does it cost anything to join? No. Do the patients sometimes have some hassles getting authorization? Yes, that’s true. But when you’re paid. Let’s go over it. If you’re getting a standard episode of care for 12 and eight visits, just say the first two 20 visits in a year, considering just the treatment, that’s probably 2000 to $2,500 now, even with taking out exams.
Is that worth it to me? Absolutely. However, am I frustrated with the exam part not being paid? I. But at the same token, that’s not gonna stop me, but this is where if you’re not part of your state and national association, this is where we need to belong. ’cause this is where we need to push back because how are they treating us differently?
Now the downside is they are doing it to chiropractors. To physical therapists as well as massage therapists. So it’s not just you. But at the same token, I think it’s valid to say that it should be covered. ’cause how are you supposed to determine care without an exam because they’re doing this based on a Medicare rule?
Medicare only sets the fees for the va. It’s not the protocol. ’cause if that were true, they shouldn’t pay for acupuncture at all unless it were chronic low back pain. And under supervision, so we know that they’re just choosing and picking certain ones. So I think we’re gonna have a pretty good pushback.
But I do still, it is worth it if you’re thinking, I’m not so sure. We are doing next month in August. A whole seminar on the va, what to do, how to make it work for you, make sure you tune into that. Otherwise, I’m gonna say to everyone, we always wanna be resource. If you’re having issues, reach out to our Connect Acupuncture council.
The next specifically, we highlight updates right on our website. And if you’re a member, it allows you to have direct interaction with me via calls and zooms. And otherwise, until next time to our friend, be well.
However. Let’s talk about what’s going on now. I CD 10 for 2026. What has happened? As they do every single year. October 1st, there’s some new codes.
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 to all my friends and colleagues. This is Sam Collins, the coding and billing expert for acupuncture for you, your practice, and of course for the American Acupuncture Council. Always wanna make sure that you’re getting paid correctly and to the fullest extent. To make sure that’s gonna happen.
What is gonna happen coming up? Here’s a riddle. When do the 2026 diagnosis begin? When do they start? You may be thinking 2026 Sam. Not so fast my friends, the 2026 diagnosis codes will update October 1st. So let’s go to the slides. Let’s talk about what’s going on, obviously, and I hope that you’re aware that diagnosis codes, when they update and they update yearly, always update on October 1st.
In fact, right now is the 10 year anniversary of ICD 10, and so it’s exciting to think wow. It’s been 10 years, so I want everyone to recall. Remember when ICD 10 came, I CD 10 came about and people lost their mind thinking, what the world’s gonna go off? No, it was all fine. In fact, for acupuncturists, I’m excited because you are going to be getting something called ICD 11.
I’m hoping it’s implemented sooner than later because there’s gonna be specific coding directly for acupuncture providers. Are traditional medicine in their descriptions, so it means you’ll be able to code cheese, stagnations, different types of patterns and all other things related to traditional medicine, which just gives a little more granularity of severity.
We’re not there yet, but we’re getting close, so pay attention next year’s seminars. I will deal with that. However. Let’s talk about what’s going on now. I CD 10 for 2026. What has happened? As they do every single year. October 1st, there’s some new codes. This year is no different. In fact, there are now 74,719 diagnosis codes.
And you may think, oh my God, that’s a lot of codes. Are you ever gonna use those, all those codes? Of course not, no. DR. Will, however, realize, keep in mind, we do need to make sure if there’s changes, are there specific to codes we use By example, this year it’s a lot of new codes, 487 new codes. 28 codes were deleted and then 38 revisions, and you’re thinking, Ooh, let’s be careful.
I’m always going to be for you and for our profession, very acentric, I care about the things that are specific to what we do. So by example, let me show you just a little bit of a list of all the codes that have updated and you’ll see here, whoa, malignant inflammatory neoplasm of the breast. And of course these are codes.
You look at this and go Sam I don’t think I’d ever use those. And I would say, you’re probably correct. You can see here primary apraxia of speech, multiple sclerosis. Now, a patient with multiple sclerosis may indeed. Be a patient of yours, but are you treating the multiple sclerosis or treating the symptoms?
Multiple sclerosis would likely just be the comorbidity. So let’s get into what are we doing that is specific to what you do. Now, here’s an important code like last year. Remember if you look at, there were some new codes for disc for the lumbar spine, though they were important. I bet. How many of you used any of those codes this year?
Probably none, but these are some, I think you might. Some of you are probably in likely coding pain codes, specifically pelvic or peroneal pain. The old code is R 10.2, but let me be careful when I say old code. That means as of October 1st, so by example, if you’re treating someone in September or before for pelvic or peroneal pain, you will continue to code R 10.2 for any date of service that was in September or earlier.
Once the data service is after October 1st, then you may begin using the new codes and here they are. So the new codes just get a little bit more specificity. Of course, there’s just the generic unspecified, which is fine, but my hope is when someone has pelvic or peroneal pain, you can identify what part of the pelvis is it?
Is it on the right side? On the left side, is it on both sides or is it more in the pubic area? This allows you to have more specificity and realize pain is gonna be one of the more common things you’re paid for. Certainly this is gonna be one that you add into your arsenal. In addition, there was some deletions of other codes or a deletion of a code here.
Also, the contusion of an abdominal wall. And you might think come on Sam I’m not gonna deal with that. You might, particularly for those of you who deal with personal injury claims, it’s very common. To have injuries to the abdomen from the seatbelt. So now we’re gonna have three new codes, contusion of the abdominal wall.
Then more specifically to the groin and to the flank. So it allows you like if the seatbelt’s going lower across the chest. Now I do wanna highlight, I hope you’re all noticing, I’m only using the A designation for this sprain strain or contusion code that A is indicating the initial visit. And it also indicates all visits with active care, which means that’s the one you’re commonly gonna use.
However, let’s say someone had a contusion and it’s six months old. That’s when you would use the S or the sequelae where there’s residuals. I think the important thing here is just making sure if you have been, or thinking you may be using contusion based on trauma, it’s updated when it comes to abdominal.
Another update here is again, some common pain codes for abdominal pain. Now, there is a code still you can save from multiple sites, and they’ve always had the quadrants, but now they’re getting more to flank and it’s not pain. Notice it’s going to be tenderness. Part of it, but then you’ll notice there’s also codes specific to pain.
So what’s the difference? Tenderness means that upon palpation, it’s tender. Where is pain is whether you palpate or not. There’s pain. I’ve put a little chart here too of what each of those mean, but the point will be if you’re using codes for abdominal pain, there has been some updates. So make sure you update your list.
This is again, those ones for the contusion. Make sure you’ve updated those again, contusions happen. And keep in mind, there’s some other ones. You’re gonna go well. Sam, I don’t know if I use this one. I doubt it. And here’s my point. Sometimes codes update of varus deformity or myositis. O Ossific hands.
Think of it. If someone has myositis o ossific hands in the upper shoulder, which means that’s the bone. What’s gonna be their symptom pain in the upper arm? So that’s probably the more likely code. The same would apply with cost of vertebral tenderness. If someone has cost of vertebral tenderness, that’s a symptom.
What is that probably gonna mean? Cost of vertebral is part of thoracic spine. I would argue that’s gonna be M 54 6. So keep in mind, it’s always nothing wrong with being specific to your profession because by example, I brought up the one for multiple sclerosis already. But are we gonna treat that directly?
There is a bunch of new codes. Are those gonna be ones you commonly use? I do not think so. So what I’m gonna say is just be conscientious of diagnosis, severity, specificity. Don’t throw spaghetti at the wall and do all types of codes. One of the things that I focus on at our seminars and with my network members is making sure you’re using the codes that are payable by insurance.
So network members expect from me, you’re gonna get a nice list because the best practice of coding. Is always gonna be giving me something about the pain, the symptoms, the signs, and there’s other codes that have within that. But what do each one pay? Get that list. That’s one for Aetna, for Cigna, what I’m gonna say is.
Let me be your advocate. Help me help you. We not only do programs like this for you that don’t cost anything, but we also do tons of seminars and other one-on-one with you to make sure your office is up to date. Again, network members expect from me, you’re getting your email with all the updates for everyone else.
I hope you be part. In fact, if you look coming this Saturday, or excuse me, Sunday for acupuncture, we’ll be doing a whole coding and update seminar. But until then, fr friends, I wish you well and see you next time.