So I wanna give you a short primer on what you must do in order to make sure the documentation you are using meets the standard to make sure you get paid.

Click here to download the transcript.

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

Hi everyone. This is Sam Collins, the coding and billing expert for acupuncture, your Advocate, and I’m part of the American Acupuncture Council, specifically the network. We’re always here to help. We’re always here to help make sure your practice is better, and that’s what the American Acupuncture Council is about.

We wanna make sure that your practice continues to thrive and prosper. 2023 is right here, and one of the questions I get as the coding and billing expert is, how do I document acupuncture? And this has been an ongoing issue for many acupuncturists because of course, unfortunately there is a lot of bad information that’s out there as to what you’re gonna require to do.

So I wanna give you a short primer on what you must do in order to make sure the documentation you are using meets the standard to make sure you get paid. And more importantly, making sure the patients has documentation of the services they received and the outcome. So without further ado, let’s get started.

Let’s go ahead and get to the slides. Let’s talk about documenting acupuncture for compliance, for accuracy, but ultimately payment. Let’s make sure you’re getting paid for what you do. And of course, prevent denials. Now, I’m not gonna be too worried about denials if we do the right types of things. So let’s talk about documentation generically.

Documentation is such that an acupuncture should maintain accurate and complete records. It’s what we do for our patients. Forget insurance or anything else. We have to reflect what was done to assure that what was done was compliant and protects us as well. We should ensure that they’re C correct also, to make sure we’re getting the proper payment for services and we can support that.

Good documentation practices also assures that your patients receive the appropriate care from you as well as it becomes the record for future. If they have to have go to another provider, they can make sure it’s there, realize it’s part of their permanent legal record that we’re required to keep. And I’m not saying it has to be fancy.

but it has to adequately meet the needs of what we do as acupuncturists or what you do. I’m just your advocate. So the few things that I’m gonna focus in on today is gonna be acupuncture, but I wanna highlight all the things. E and m services or exams should reflect the level of service that you’ve provided and it wouldn’t match the code.

or price that you build? Of course the acupuncture itself must reflect the time and the points, and this is what we’re gonna focus on. There’s often a lot of misunderstanding on what is required for documentation or acupuncture. We’re gonna clear that up. And then if you’re doing any therapies, let’s make sure that the therapies are identified specifically where they’re being applied by example.

You just don’t wanna check off, I did infrared heat, but tell me where you. for how many minutes? So we know what the intensity and time, so we know comparatively how we do it the next time. So we have to make sure that in a way that if someone were to read what we’ve done, They know what we’ve done. They wouldn’t have to guess by just checking I did acupuncture.

They would know where did we do it? What were the points? How much time did we spend? And these are the problems I run into as the coding and billing expert. I’m contacted by state boards, department of Defense, meaning the va. The wa Hoag, world Health Organization and almost every carrier out there, including malpractice carriers that deal with documentation issues.

So I wanna give you the definitive way of making sure this is correct. You’ll notice here, this is a denial if you’re not familiar from the company, UnitedHealthcare, and it quite frankly, is a very good pair of acupuncture. And you’ll notice it indicates. The information submitted does not contain sufficient detail to support the services.

So what is it that they’re missing? And you’ll notice they’re missing it on the initial set. And the follow-up sets. So notice it says the documentation submitted, does not indicate the time was personal, one-on-one contact with the patient, and the duration of the needle placement or retention. Therefore, it cannot be supported.

So we have to start to look at what is it that we need. So the American Acupuncture Council, we provide at our seminars, this list here of the acupuncture codes, their description, but more specifically also the details of what the requirements are. So let’s pull this up a little bit. As you’re familiar with, acupuncture has four codes.

Two of the codes are for manual acupuncture, meaning, and certain needles with no electricity. And then the other two are for electro acupuncture, meaning inserting needles with electricity. In both instances they work the same. So let’s make sure we understand what these codes mean. They say for 9 78, 10 it says acupuncture one or more needles.

So the first thing you’ll notice what we need to document. Is that we’re inserting needles, so you have to have, what points are you inserting? That’s number one. And then of course it says without electric stimulation. So it means nothing there other than just the manual insertion. But then it says initial 15 minutes of personal one-on-one contact.

So we’re gonna highlight just on the basis of this code, you’ll notice there are two things you must have. You must have the time. That you’re there with the patient, but also the points of insertion without both, it’s not billable. So be very clear in your documentation each time you do a set of acupuncture, how much time did you spend and what were the points of each set?

Because notice 9, 7, 8 1 1, the additional set gives you the same parameters, each additional 15 minutes of personal one-on-one contact along with reinsertion of needles. Now, I’ll be very honest, I’m not a big fan of that term reinsertion because it gives a connotation that you may be taking a needle and putting it back in.

And of course, that’s of course against clean needle technique. So we have to be clear that it is inserting a new. an additional needle. So again, points and time and notice. It’s the same for electro. Whether you’re doing electro or manual, we have to have points in time. The difference for electrodes indicate what needles were electrified.

That’s all we have to do. So think if there’s two things, you must have time. and points, but let’s be clear, what does this time indicate? This time, as you notice, each code says 15 minutes, and I wanna make sure everyone sees that the 15 minutes. That’s true. But for 15 minute codes in C P t, same applies for physical therapy services.

Whenever there’s a time code in this way, time doesn’t follow 15 minutes, but what’s called the eight minute rule. So the actuality is that do you have to actually spend 15 minutes for a single. You don’t, you could potentially spend as little as eight minutes. Now, frankly, I don’t think too many people are gonna spend as little as eight minutes, but nonetheless it could be.

So let’s talk about how this 15 minute session is defined. What is this 15 minutes? Is it the time that you’re inserting the needles or is it more than that? So you notice here it says this means that the physician acupuncturist is in the room with the patient and is actively performing a medically necessary.

that is a component of acupuncture. And so what does that include? Literally everything. As soon as you walk in the room with the patient, that’s an activity of acupuncture because you’re asking the patient, Hey, how are you feeling today? Because notice what this includes, the history, any day-to-day evaluation, tongue pulse, palpatory findings, range of motion, whatever you do, including cleansing the hands, choosing and cleaning the points.

Inserting, manipulating, adjusting, anything like that, but also including removal, the disposal of needles, as well as completion of chart notes. So what I want you to think of acupuncture begins when you walk in the room and say, hi, Mrs. Jones, how are you feeling today? That literally is the starting point of the first set.

Because it includes that pre-service, the intra service and post-service work, even the time as you’re finishing with the patient, giving them home recommendations and writing it down. So what I need you to do is to document that. What time did you enter the room? What time constituted the first set, if you will, or when you left or came back.

Just make sure it’s there. And frankly, you can do it one of two ways. If you want to indicate that I spent 12 minutes, 15 minutes, 18 minutes, that’s. If you would prefer to indicate I started at 10 and ended at 10 22, that’s fine as well. But you’ll notice as I mentioned, the eight minute part of it. Notice one unit or one set of acupuncture could be as little as eight minutes.

Now for the first set, that’s pretty easy. I don’t think anyone’s gonna spend less than eight, cuz it includes all those things. Now the additional set, though, is also eight minutes. But notice how this. It’s eight minutes plus 15 because the second set must have a minimum of eight, which means you must complete the total time of the first.

What I’m getting to is you can’t do eight minutes for the first eight minutes for the second. That’s not two sets. Eight plus eight is only 16 minutes, which means one set. So a second set doesn’t begin until you spend 23 minutes or more face to. notice for the third set does the same thing. It’s 38 minutes, which means two sets, two full-time, 15, 15, 30 plus eight.

So it’s always eight into the next. And remember, there must be additional insertion. So by example, if you have a patient, they come in, you spend maybe eight to 10 minutes interviewing palpating and inserting the needles, and those needles remain in the patient for 30 minutes. You then remove those needles, sit the patient up, discuss with them, even though the total time might have been 30 minutes because of the retention, there was only one insertion.

So remember, whatever is the minimum, if it’s the insertion or time, it’s gonna default to the lesser. So be very clear because you have to indicate the time of active care. It’s not just the time that the patient is resting on needles. So be very clear that rest time is. If you’re leaving the patient arrest on needles, often you’re not in the room anyway, so that time wouldn’t count.

So be clear in the notes, how much time was spent face-to-face, what were the point of each set. Now, along with that, what I wanna focus, oops, I move that. Excuse me. Let me move this up. Here we go to make sure you can see where this comes from. This is a document from the company Regents, which is part of the Anthem Blue Cross Blue Shield Network.

But the reason I included it is I wanted you to see how they indicated it as well. They note the acupuncture codes as we’ve talked about, but notice it indicates seven minutes or less of a single service is not billable. That’s true for any time service. If you do only seven minutes of. That doesn’t count either.

So make sure it’s at least eight minutes and notice the same protocol. Eight to 22 would be 1, 23 to 37 would be two, but that includes that you’re doing a second insertion and so on it goes. So that sounds good. That doesn’t seem too hard, but I know for many of you, you’ve come to me and say, Hey Sam, you’re the expert.

Can you give me an example? So here’s an example of an office, and this is one that actually was. and past. I wanna make sure you can see that this is what you need to do, or at least something similar. Notice how clearly it’s indicated here. Treatment set one, it says the face-to-face time. It then indicates what points were needle.

It then notices that there’s eim added to two of the points, which means is this enough to bill for one set? Absolutely face-to-face Time, 20 minutes with those insert. and electricity electrical set. Then notice though it does something unique. It says needle retention after insertion was 12 minutes.

That’s fine if the patient’s resting on needles indicated. Then when you come back in the room, then you’ll indicate again after the patient rested with needles. Maybe they were withdrawn and repositioned. Do. Keep in mind, you do not have to withdraw needles for an additional set. It could just be more time and insertion.

So notice second set says face-to-face. Time is 18 minutes. It then highlights the points and then talks about if there was e-stim. But notice how clear this. From this, I bet you could all perform the service. What I want you to think of is that you should document in a way that another Accu Acupuncture could read it and go, oh yeah, I’m familiar with that.

Now you could argue maybe Sam, it doesn’t take me 20 minutes to insert those. I agree. It doesn’t take 20 minutes just to insert, but all the things that go on before the insert. During, and then of course even after just resting on needles doesn’t count. So anything you’re doing, that’s the component of it.

I want that time to count. So be very clear in your notes. The time acupuncturists generally indicate they spend more time with their patients than most other providers, and I would agree as an acupuncture patient I can certainly say that. I just need to make sure you document it. So here’s one simple example to do it.

Notice points and time for each one. Let’s do another example of a soap note. Now, this is an example SOAP note for those of you that are part of the American Acupuncture Council Network. In our ACU code, we have a template of this that you can use, but let me show you how it works. What it does is it gives a breakdown of the treatment, so you’ll notice what it.

It gives a very simple, what were the sets? Notice set one, two, or three. If you have more, you would just add a line, but notice it indicates the points and then the face-to-face time. Now this one’s a little different. This one indicates five 20 to 5 45. Either ways acceptable. If you wanted to put 25 minutes, that’s fine.

Notice the retention time is separate. They just make sure retention time doesn’t count towards face-to-face. And then notice each set does it that way. So don’t make this overly complicated. Make your notes in such a way that someone can read it. You can show them the time you spent face-to-face the points, and then do that same thing for each set.

Just realize that in order to bill for three, as you can see here, there’s gotta be more than 38 minutes face-to-face and insertion. So let’s take a look. This is 25. Notice this one’s only 10. Now it’s 10. Still enough? It is because it has to be at least eight. But remember, for three sets we need 38 minutes.

So 25 for the first. 10 for the second that brings us up to 35 plus an additional 20. That’s 55, so that’s more than enough than it would be required for the time. In fact, if there were a fourth insertion in there, could that have been a fourth set? Maybe. What I wanna point out though is that you might look and go why did they spend 20 minutes on this one?

At the end, when you remove the needles, is there time you spend with the patient taking the needles? Discussing with them the treatment. Realize all of that is a component, so I need it to be clear in your notes. Give me the time you’re with the patient for acupuncture. Remember, exams are separate, but for acupuncture as well as the points of insertion.

And remember, could it be one point? It could be. Generally it’s multiple, but it could be. Then notice the other thing. Notice the infrared heat. Infrared heat, lumbar spine for 20. , not a problem. There again, very clearly. What I want you to think of is, could you read this note and perform it and think of that as the gold standard.

Another provider can read it and clearly identify this service and could perform it. Again, you might say you spend less time because I know acupuncturists could put needles in fast, but remember, it’s not the time you’re putting the needles in only, but all the things that lead up to during and after that are a component, so don’t over complic.

But do make sure it’s there. When someone looks at it, can they clearly see the time? Can they see the points of insertion? Of course, we all know that this year, 2022 is the year of the tiger. Next year is the year of the rabbit. But what I’m gonna say to you is, you know what? Acupuncture is always in the year of time.

You bill a time related service. You need to indicate. Now remember, it’s face-to-face time. If the patient is resting on needles, that doesn’t count towards face-to-face unless while they’re resting, maybe you’re stimulating. That could work, but not just the period of resting. I know the acupuncture side go to often what she does is she’ll spend 10, 15 minutes insertions.

She then leaves the room for a while. I’m sure she’s probably treating someone else the time she’s gone. She comes back in the room and generally at some points, once she comes back in the room, that time. and then again, the time she spends with me, even after the needles, taking them out, doing the notes and so forth.

So just make sure time is there. The thing I run into that’s difficult for me to defend is when I don’t see any of that in your notes. So be clear for acupuncture time. And points must be documented. If you do, you’ll resolve almost every issue I’ve run into when it comes to acupuncture documentation.

Let’s get ready. How many of you have an expert on staff or someone you can go to? I am the expert. Let’s get ready for 2023 updates, coding changes, fees, and all those things are gonna be occurring soon. Go to our site, go to our network. We’re there to help. We’re always gonna be a resource for you. The American Acupuncture Council is always your.

don’t be afraid to reach out. Be careful. Don’t use Dr. Google. Go to a trusted resource. Until next time, everyone wishing you the best.

Click here to download the transcript.

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

Hi everyone. Welcome to another episode with the American Acupuncture Council. I’m Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, as well as the profession in general. This episode is gonna deal with a very common question that I get whenever I’m teaching a seminar or doing our network services.

People always ask, Hey, Sam, I got a payment. Now the insurance company is asking for money. What can I do? Is there anything I can do to fight this back? What if they recoup the money? There are many things you can do, and there’s laws and statutes that are on your side. Never assume what they tell you is correct.

Let’s face it, you do an insurance verification, you bill the insurance, they pay it, and then they come back later and say, Hey, we paid you money six months ago. Turns out we shouldn’t have. So let’s take a scenario like that. The insurance company pay. . Then they come back and say, Oops, we shouldn’t have paid because there were visits that were applied towards the whole overall benefit.

Maybe it’s combined with chiropractic, maybe with physical therapy, and now they want it back. What are our rights? What do we do? So let’s go to the slides. Let’s talk about what laws and things protect you in understanding how we have to deal with this. This is not uncommon. Now, I don’t want this to scare you off.

This doesn’t happen a lot, but it happens enough. You have to know what your rights. What are my rights when someone says, We shouldn’t have paid you and we want this back? So here’s a letter and please note everyone, this is a letter from Federal Blue Cross Blue Shield and notice what it’s saying. Dear Billing Department, they’re talking to us directly in regards to the request for repayment for claim.

The request made to you was a voluntary overpayment request. Because you are in network provider, you do not have to pay back any overpayment if the overpayment was discovered 365 days or more after the claim was finalized. So I wanna take a look at this letter and notice what they’re stating here.

They’re stating that they can request an overpayment if you are in network, but not if it’s over 365 days. So notice that’s why the letter says a voluntary overpayment realize most often when an insurance company is requesting a re. they’re doing. So just to see if you’re willing to pay it. So by example, let’s say a policy, as I mentioned, has 20 visits per year.

You verify it and they pay it, and then later they come back six months later, a year later and say, Oops, it turns out the patient already had visits with some other provider. Therefore, we shouldn’t have paid you. Frankly, whose fault is that? You did the proper verification, you bill it, they paid it.

Now they’re saying, Oops, we made a mistake. We want you to pay it back. So notice that’s why this says voluntary. So even though this provider is in network, they’re saying please pay us back. My issue is gonna be no thanks. Why should I pay you back if it’s your mistake? In essence, what they’re saying is, we made a.

And the patient’s benefits weren’t there. Therefore, we want you to pay back our mistake. My rule would be, no, you go to your insured, That’s who you made the mistake with. Cuz essentially what they’re trying to push you to do is you pay them back and now go after the patient. Why would we have to go after the patient if that’s your insured?

That’s where you’ll notice the difference here. Notice it says here, the request made to you was volunt. And because you are in network and it’s over 365 days. So notice now the difference if they had done this within 365 days because you’re in network, they can take it back. This is one of the downsides of belonging to an insurance you give them to right to recoup.

Even when the error wasn’t yours. It was their own mistake. So it’s one of the downsides of being in network. Now, if you were out of network, could you just completely refuse this and say, Actually you could in the absence of fraud, where something you build wrong or maybe they paid you twice, you are under no obligation to refund this.

I’m gonna point you to this is a letter that we use for those in our network, or those that come to a seminar that deals with an insurance company that has paid you and then subsequently wants it back. So notice at the top it says, We received your letter where your company’s requesting re refund the payment, and you reviewed the benefits and nothing here shows otherwise.

So let’s move down here. It says, I feel that you have do not have the right to place this burden upon my office by asking us to correct your error. And this is backed up by Case Law. Notice it says, I would like to bring your attention to cases involving the Federated Mutual Insurance Company, and essentially it says the insurance company is in the best position to know the policy limits and must bear the responsibility of their own mistake.

So again, if you’re out of network and the insurance is asking for this back, understand if they made the mistake and paid more than they should. Maybe there was a deductible, they didn’t apply or they just applied more visits than the plan allows. They have to bear the responsibility for it. And again, case law noting dating back to 1974, so for many of you may not have even been born yet.

The next case goes from here for national Western Life Insurance Company. And it says in the absence of. A healthcare provider is not legally obligated to run refund payments. It receives from an insurer if the insurer subsequently determines they were paid in error. So let’s do this example. You call, the plan says they cover acupuncture.

Great. You bill it, they pay it, and then six months later they say, Oops, it turns out we don’t cover acupuncture. Whose fault is that? You did everything properly. What they’re saying is, pay us back and you chase the patient. My rule would be, You go after your own patient. That’s why that one said voluntary.

You’re under no obligation to pay this. So when you were out of network, , you may completely push back on this with citing these two case laws, because if there’s nothing wrong with the claim, you didn’t bill anything in error. There wasn’t something billed that you didn’t provide, or they didn’t pay you twice.

If someone pays you twice for the same data service, you do have to refund the overpayment of that. But outside of that, the answer is absolutely no. Again, if you’re out of network. Now, why is it different if you’re in. It’s different when you’re in network because part of the contract we sign, when we join these insurances, it literally says in the contract, Should we make an overpayment?

Even if the error was on our side, we can recoup the money. And I’m sure many of you, almost Sam, that’s happened to me before. They just take the money from another patient. They will if you’re in network. If you’re out of network, they should not be because they have no right to that. In fact, the case law stands up, but let’s talk about if you’re in network.

Notice it said one year. Now that’s the federal statute, which is generally equal to what the billing time is. So if the billing time is one year, they have one year to recoup again, if you’re in network. So if you are in network, they can recoup. Within the timeframe of the statute of limitations, and that’s where this is a little bit different from state to state.

So I’m gonna give you a little breakdown here. This has every state, and you’ll notice it can vary from some, That’s one year, 36 months, five years, two years, all the way down to as little as 30 days for some. And some states don’t have any, which to me means it defaults to the federal statute. But always know the statute of limitations.

Just like an insurance. You know how some insurances are? You have 30 days to bill 60, 90, or one. The same thing applies here for a recoupment. The state law will break it down. So is it one year or otherwise? So know your state and whether or not you can push back. My rule would be always send a letter like this in a response when you are out of network.

Even in network, I would use the same protocols, but then follow up with the statute of limitations. Do not be. To push back. The assumption is often you don’t know better and are just gonna pay, cuz we’re afraid of the insurance we’re gonna get in trouble. If they could recoup it in network, they probably would’ve.

So take a look here. Here’s an Aetna claim, and notice what it says As a result of a routine claims payment, we previously notified you that there were some differences between the amount paid and the amount, which you should have been. That’s their own issue. So notice and I highlighted it in yellow, it says, Our records indicate the overpayment as noted on the enclosed document, is not eligible to be offset from future claim payments.

In other words, you’re outta network. So we can’t force you to pay it back, but we’re gonna please say therefore we must request you issue a check or money order payable to us in the amount that’s requested. You know what my answer to that is? No thank. Why would I voluntarily send it? When do they ever voluntarily say, Hey, you know what?

We’re not paying you enough. We’re just gonna go ahead and pay you more. Know your rights. Don’t be afraid to push back when there’s a request for overpayment. Was it truly overpaid? Did they pay you more than you billed? That you would’ve to pay back the amount over what you build? Or if they paid you twice.

But if you’re out of network and they later decide, they didn’t feel they should have paid it too. That’s on them. They should know their own policy. And the Statue of limitation applies for those of you who are in network, just like they put a limit to the time that you can send a. They will have limits to when they recoup.

This is why a lot of providers think maybe I don’t want to be in network, cuz I give them a little bit of power that’s part of that tradeoff. We did this in an earlier talk with you of trading off what is it worth it or not. Now this doesn’t happen enough to where it’s gonna major problem, but it’s something to note within your rights because many times they’ll just send you a letter hoping you’ll pay.

Let’s say you send a hundred of these letters out, maybe 50 of the doctors know the rule. They’re not gonna pay it, but the other 50. That’s an easy way for them to recoup money by simply having people not aware of what their rights are. Notice. These plans aren’t necessarily there for you. Always be able to push back and know where the laws fit.

That’s what we’re here to do. That’s what the American Acupuncture Council is there to do. We always wanna enhance your practice as I do. For those of you who would want to have help, just what we’re doing now where we can deal with this one-on-one via phone or Zoom or otherwise, you may wanna join our network.

Take a look at our site. You can do the QR code or go directly to our site. Remember, it’s aac info network.com. We’re always here. The American Acupuncture is always going to be your resource, your place for help. And remember, first of the year is coming. What’s gonna be changing, lots of things, codes, fees, and otherwise probably time to get to a continuing education seminar with the American Acupuncture Council Network.

I hope to see all of the future date. Until then, best wishes everyone.

…can I get reimbursed for codes beyond pain?

Click here to download the transcript.

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

Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council. And of course, just the profession. Welcome to another episode to always help you get your practice uplifted, make sure you’re getting paid for what you do, because that’s what I do. We try to make sure that you get your claims paid, can get paid for your services.

One of the questions that I get quite a bit, is, can I get reimbursed for codes beyond pain? Now, of course, I’ve been teaching acupuncture seminars now for some 26 years, and so we often get people saying what’s now what was then truthfully, if you went back to a seminar I did in the nineties or early two thousands, there were very little reimbursement beyond simply pain that has changed quite a bit.

We still have to understand, that it’s not quite as open as we would like, but much more so it’s good to know what will get paid and can I get paid beyond pain? So let’s go to the slides. Let’s take a look at what’s occurring here. What’s going on with insurance and reimbursements for acupuncture now as always, here’s my email.

Here’s our website as well, but let’s focus in on acupuncture covering. When insurance has to pay, what do they pay for? And I think this is often where people get off track. The assumption is, oh, they pay for everything. Not quite. And there can be nuances that some will pay for more than others. In fact, there’s one that honestly will pay for everything, which I’ll give you a demonstration of.

One of the things we have to think of is how do people foresee or what do they see when they think of acupuncture? Think of it. Ask your friends, ask an acquaintance. What do you think? I. What do we treat in acupuncture? And I think you’ll invariably give you it’s pain and have an ignorance toward, and it’s part of our.

I think to make sure they understand we do more than that. So by example, I’m showing two offices this year that have some signs up near their office or in their office that talks about the things they treat. Notice this one on the left talks about fatigue, stress, anxiety, depression. And in fact, they don’t get down to anything towards pain until the very end, because how many times people have these types of conditions and think, oh, they don’t associate it that way.

Is there coverage for it? I think partly is making sure people know that acupuncture can treat. And more importantly, or maybe not more importantly, but just as a. Can I get my insurance to pay for it. Look at this other one, they talk about pain first, but then brings in things like anxiety, depression, Bell’s palsy.

Heck I think a Justin Bieber, if you’re familiar with his condition probably should be getting some help from an acupuncturist. So it’s really understanding what do plans cover. Can it be more than just pain? Cause that’s what. Obviously, many of you are aware of the American specialty health model, which I will call the musculoskeletal model or an often I’ll think of it as the physical therapy chiropractic model in that what they cover things like headaches, hip, or knee pain associated with arthritis or extremity pain with arthritis or other mechanical irritation, meaning strains and sprains, or just pain syndromes of the joints and soft tissues back and neck pain.

So you can see here for the most. It’s mostly just pain. A little bit to Nazi with pregnancy, but notice nothing here about abdominal pain or how about anxiety, depression, or anything else beyond that generally? No. Now the good news is pain is often what you’re going to have with any condition, how it manifests itself, but this can be fairly limiting and for many plans can be.

So by example, is there something I can do more than. And not all carriers are the same. There are going to be differences between each of these. And I’m going to demonstrate some of the differences that you’ll see among these to start to give you an idea of it. I’m going to recommend this is why you want to get more continued education with programs like ours, to really get the full breadth of what can be covered and the nuances from state to state region.

So by example, here’s the newest Aetna protocol. And as you’re probably aware all Aetna policies that are now from their commercial line have to cover acupuncture, but you’ll notice here it’s still pretty limited. It’s limited because it says it covers neck pain and headaches, low back pain, nausea, arthritis, chemotherapy-induced nausea and TMJ disorders.

That’s good. This is a pretty nice. Only pain, but it is when you look at these other than the arthritis, so this one could be pretty limited. The good news is Aetna will tell you what codes they cover. So here’s their list, everything from migraines, all the way down to postoperative pain to the teeth.

So pretty limited. Now the thing that this list says though, is that it’s not all inclusive. So the difficulty is you get a list like this and you think, okay, great. This is what I know they’re going to cover. You build these, they pay it, but are there other things that I can do. That they may pay. What we have found is generally other joint pain, but I’ve had a few offices believe it or not with.

That have been covered for anxiety, depression, with the code M 48.1, certainly something you could venture into and just say, if I’m treating that, is it a possibility? Many of them are working concurrently with some type of medical provider treating it as well, but you can dip your toe. What I can say is this one though is pretty straightforward.

This is what they’re doing. Without question, as you can see. That’s pretty much pain Sam. What about Cigna now? Cigna, this is their newest coverage and they cover a lot of things. You’ll notice here in the bullets that says tension types, headaches, migraines, musculoskeletal joint, nausea, post-surgical pain and chemotherapy induced nausea.

So you’ll notice it again is still along the pain. Now this list from Cigna though is vast. If you tell me any joint with a stranger. Or any type of pain to a joint, they’re going to cover it. Myalgia, fibromyalgia. You bet pretty ubiquitous, but again, is it beyond pain? Not really. Not until you get into companies like this particular one.

This is the company Evercore. And to give you the background, Evercore is behind the scenes for most of the products that are sold under Anthem, meaning blue cross blue shield. United health care. And of course, Optum and you’ll notice right off the bat, what they cover are pretty much pain codes. You’ll see.

Okay. The neck, the back musculoskeletal, cervical cranial lumbal sacral pain. But then you’ll notice that the very end of the list, it says internal medical conditions, and this is something that’s remarkable and has been around now for about three years. Take a look at what things. Adjunct cancer care.

Now I want to be careful. They’re not saying they cover to treat cancer, but they’re paying you to treat the symptoms associated, the nausea, the vomiting, the other conditions associated with it. Notice also the mental health conditions. These are things like PTSD. Believe it or not anorexia bulemia but also depression, anxiety.

I would suggest, always be working with probably concurrently, but at the same token, this is something they’re not saying no to notice allergic rhinitis, adjunct post-stroke dry eye syndrome, constipation prostititus pain, asthma irritable bowel. Of course the vomiting you’ll stupid. Look at the very last one medical.

And this particular one, they’re not covering menopause just to say what are we treating you? Don’t you’re actually treating insomnia. And hot flashes. So there’s really been a great growth here. Now I’m going to recommend, again, probably to dig in a little bit more. This is what we do, and that are more advanced or navigating the insurance seminars.

But you can see here while this is a little beyond, I particularly really hope some of the offices that when I first taught seminars, always taught to say, Hey, let’s talk about the code you get paid for. And they said, we didn’t do an internal medicine. I said we didn’t because it’s not paid. Now you can see here.

This is beginning to get paid. Now this company again, I did Anthem’s Optum’s are going to be more or less. In addition. What about another company like health partners? I know a lot of you in the Midwest area will see this one and they do have a pretty good amount of coverage for all the musculoskeletal things as you’ll see here.

But it goes beyond that. Look at section V here, PMs or menstrual disorders. In fact, they give a list of codes and you’ll notice here things like interstitial cystitis, Macedonia, menstrual disorders, vomiting, but take a look at the last. Weakness fatigue, malaise. There’s a lot of change that’s occurring that there’s going to be more so it begins, start asking, will this plan cover and don’t be afraid to ask, does it cover fatigue?

Does it cover abdominal pain? Will it cover prostititus pain, things of that nature to know, because not often as much as I’m showing you this list, does every insurance company produce a little. Not always. So we want dig a little bit further to say what’s covered and I would suggest start keeping a list.

That’s one of the things we emphasize in our program to know the codes that are covered or not covered that way. You have the best idea of making sure you get the best benefit. One thing we want to be clear with the patient, what’s going to be covered. Don’t be fooled. Don’t let your patient before. If you’re not sure something is covered, don’t be afraid to say we will bill your insurance.

And we hope they cover, but we’re never going to guarantee that’s the downside. People want to make people or patients believe everything’s going to be covered. You’re going to give, we’re going to bill your insurance confidently with the condition you have. Will your insurance absolutely cover. We can’t guarantee it until once we build now, here’s the beauty of this start collecting this data.

Does this insurance pay this particular diagnosis? Keep in mind. Most of you don’t use a lot of diagnosis and that’s okay because you see a lot of the same things, but begin to learn which ones are or are not covered. Notice this one here. If someone just comes in and says, I feel tired, health partners is going to cover it, but take a look.

This is one of my latest VA. For the VA take a look at this. This is just this may and notice what it is. Provisional diagnosis, tobacco use to help console the patient there. Now the VA is authorizing for some people to go, let’s try acupuncture to help with this addiction. Notice it says to assist with smoking cessation.

So have we changed? Is there more access to what you do? Yeah, because it’s beginning to be recognized. It’s one of the reasons we’re moving towards ICD 11 is to make sure that we can better account for all the things that acupuncture can do. My hope is we move to something like this. One, take a look for any of you that are in Massachusetts.

You have the Mecca of coverage, blue cross blue shield of Massachusetts. Now covers is in way that most aren’t even aware of. I want to see every state do this. Acupuncture benefits for 12 visits per year, for any reason. So this particular plan is saying, I don’t care what you have. We’re going to cover you for 12 visits.

In other words, an acupuncturist can be an acupuncturist, treat what you’re seeing, not to try to fit into some other guidelines. Notice here, all the things they’re talking about, dental pain, addictions, headaches, menstrual tennis, elbow, fibromyalgia. Now some of that is painted up, but notice digestive, emotional ear, nose, and throat.

Gynecological issues, literally anything. My hope is that we continue to move forward this way, because part of the best way for acupuncturists to get coverage is to collect data among what we treat. So imagine someone with let’s look neurological that has Parkinson’s disease, and we start to collect data that wow, people who have Parkinson’s that get acupuncture have resulted better from.

Do you think that might be something that will be more useful for the patient, but also for the insurance, remember acupuncture is always going to be the more economical choice. And so the movement forward is acupuncture. Can’t be hidden. It works and it works with. So as a consequence, better coverage. So I want to start to say to you, get out and look nowhere you can go.

That’s why we offer this service called the network, get an expert, which means me on your staff. Just hold your phone up to that. QR code will bring you right to the site so you can dig into this. Our Accu code has this list as well. We want to make sure you have the best information. Or no one it’s not going to be paid.

The American acupuncture council is your ally and your resource. Our group is the network. You can go to our site, take a look. Obviously many of you are insured with us as well, but at the same token, we want to be a resource that you can be helped to make sure that your practice continues to thrive and grow.

And that’s going to be about access to your. So I’m going to say to all of you, thanks for that time. Next week house will be Jeffrey Grossman, as always, I’ll say to you, it’s good to be important, more important to be good, be that person to your patient, make sure they can get access to care. The number one problem with acupuncture is people not understanding what you do and gaining access and gain their trust.

Let them try it. They’re going to get better. See you next time.