Tag Archives: Sam Collins

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It’s Coming in 2026 – Are You Ready? – Sam Collins,

 

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.

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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.

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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.

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Request for Refund – Sam Collins👍👊🕐📹🔉

 

 

…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.

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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.

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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.

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ICD-10 2026 Update – Sam Collins

 

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.

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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.

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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.

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Collections and Credit Reporting – Sam Collins

 

Let’s talk about what’s going on with recoupment and standard episode of care specific to acupuncturist and frankly non-physician providers.

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.

Click here for the best Acupuncture Malpractice Insurance

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.

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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.

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Reasonable Treatment Amount Per Visit?

 

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.

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Get a Quick Quote and See What You Can Save

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VA Recoupment & SEOC Updates – Sam Collins

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.

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.

Click here for the best Acupuncture Malpractice Insurance

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 acupuncture 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 blow it up. And it says. Try West. Receive the above-mentioned claim for your offer. And notice I highlighted and yes says evaluation and management procedure codes are not paid for this rendering provider specialty.

Get a Quick Quote and See What You Can Save

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 paid. 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, to determine the continuation of care. So what’s recurring I think is maybe a Leo GE cut here at they’re eliminating the payment for exams. That doesn’t mean you don’t need one, they’re just not. Pay for it. I think it’s probably worth 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 April, what I’ve seen when their newsletter is not quite clear enough for me. So I’m waiting to see the full publishing standard 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 am behind it because published, however, 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 pro your authorization has so my argument’s gonna be, they’re saying they’re not gonna cut well, if it’s after April, send an updated authorization, 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 April. This is gonna true. But prior to, it’s gonna be a pushback. Now, is 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. I. 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 pain 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 one three, you better focus in on something about activity, particularly a home or work activity that couldn’t do before. What they care about is the getting better. Because remember, once they’re stabilized, they have to be on a continua care with flareups.

So keep in mind, acupuncture works well. We need to demonstrate it. Show me on this general PEX 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 am. 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. I. 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 want to be resource. If you’re having issues, reach out to American 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 my friend, be well.

Click here for the best Acupuncture Malpractice Insurance

Get a Quick Quote and See What You Can Save