Tag Archives: Sam Collins

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Cupping – Coding, Billing and Reimbursement

 

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how do I code for cupping? Can I get paid? What is the proper code? Let’s really get into that.

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 and the American Acupuncture Council Network. With our other episode on always looking to continue to grow your practice, to give yourself more opportunity, to see people and help people. And as always, I’m going to give you tips on coding and billing and really practice management.

This is a great time to be an acupuncturist, but how do we make sure we’re getting from gaining full advantage to get access to patients and the services we provide? So what I’d like to do with you today is to talk about coding and billing specifically for cupping. This is one that I get this question a lot is that seminar producer, as well as doing our network services, where people call them with questions.

One of the questions I get is, Hey Sam, how do I code for cupping? Can I get paid? What is the proper code? Let’s really get into that. So let’s go to the slides. Let’s take a look. What’s going on with. And how do we do it? What’s the coding and billing. Please note, there is our website. This is the network, not the insurance company, ACM phone network.

Remember we always have updates and news for you there. So what are we looking for? What do we need to do? What is. A cupping as well. Let’s define that cupping as a therapy at ancient form of therapy, where a therapist puts special cups on your skin or a patient skin to create suction.

That suction is to help with circulation, for pain, inflammation, blood flow, and so forth. And of course has become very popular. You’re seeing it all over. Let’s talk about, we know what it’s good for it. How do we use it? But can we get paid for it? Let’s talk about cutting more to define it more clearly.

What I’ve been able to research is that there’s about 10 different types of cupping, and I’m sure some of you might say, oh no, I think there’s five. This is just what I was able to research. And it shows you can have things that they call weaker, like cupping medium or. Moving cupping. I see that commonly needle cupping using moxa or needles with it empty or flash cupping, full bleeding, cupping.

You got to remember that. Is it within your scope for your state, but I’ve seen it used with herbs water and realize the cups can be made of several substances. I generally see some type of glass. I seen some very heavy plastic metals I’ve even heard. I’ve never seen it. I’ve even heard of bamboo.

And that kind of makes sense. What we want to focus on. How do we bill for it? Is there a CPT code that we can use that says it? The first thing we have to remember is whenever you select a code, and this is something that you must always do, you must select a code that accurately describes the service.

Not has to accurately do not be creative. Don’t select a code because it’s like it, like my example, if you were to use. Would you be able to code that as acupuncture? Just because you put seeds on a point, doesn’t make it acupuncture because it’s not needle. So it can’t be it’s gotta be all the way.

So don’t be creative with what you describe, do not select the code that climate is close. Always has to be exact. And within that. If there’s no code for it, there is a code, always. There’s a code called the unlisted code and it can be a modality or a procedure. So whenever you have any service and we’re talking cupping today that doesn’t have a code, that’s going to be the more likely code to use, but let’s take a look at is their way of coding.

It’s I’m going to show you something. I deal with a lot, which is dealing with audits. Many of you are insured with American acupuncture council. And remember if you’re audited who’s there. Remember, if you have American acupuncture council of malpractice, they’re going to help you with audits depending on your policy, anywhere from 30,000 to $50,000 a defense.

And this was one of the cases we had here was an office that had issues with coding. And you’ll take a look. I highlighted in blue. So here it says on 52 claim lines, manual therapy was identified as. In the medical records and reporting of the code 9 71, 4 0 is not appropriate using for the Madame for the modality to indicate as cupping.

So I want to make clear, some people will say Sam, I’m putting the cups on manually and I’m moving them around. So it makes it manual therapy. Nope. That would not make it manual therapy. It’s. And though you’re doing it manually, it doesn’t make it manual therapy. So again, be very careful and you hear a lot of people say, oh, sure.

When I use a cup, Nope, that would not be correct. And I want to make sure you can see this. This is directly from. And again, very clear that it’s not to be used for it. So is there a code for cupping? So if you start thinking of all the codes, infrared heat. Okay. Hot packs, electric stem.

You’ll notice there is no code for cupping. So we want to talk about how to do it. And frankly, let’s be clear. Is it really even a covered service? And I think that’s what I want to focus more on. How do you get. And to get paid for it by insurance. That’s what we have to have a code, but is it a covered service?

Take a look here. This is the VA and I’m sure you’re all familiar with VA claims. The VA is one insurance that will indeed pay for cupping 100%. You’ll notice here and I highlighted it where they indicate the services that can be provided along with your acupuncture. And clearly. Cupping, along with other things, but cupping is there.

So a lot of people look at the codes that are allowed under the VA. And I’ll give you the list here. Here’s the codes that the VA pays for an acupuncturist. Notice it was updated for this year. And you’ll notice that code. I put the blue arrows it’s 9, 7 0 1 6. Now I would say in theory, I think the VA is saying you could use that code.

I don’t think it’s quite correct, but let’s talk about. Should you use it? 9, 7 0 1 6 indicates something that’s called a Vasos nomadic device. And the indication for it is to reduction of a deem after acute injury lymphedema and the use of a pop. So I want to highlight you see this little, long kind of blood pressure cuff goes over the area.

That’s what a visa nomadic devices. It’s a large pressure device that goes over an extremity or part of the body that gets pumped. To prevent a DEMA post-surgical maybe prevent blood clots. It might have vibration to promote circulation and deal with lymphedema. Now I’ve had some people argue that well, could a cup be listed under that?

I would say I can see the argument, but I think this goes against the rule. It has to either fit it or not. I don’t think this would fit it. So I don’t think this is the best choice. And I also don’t think it’s the best choice, because if you use it, I will say the VA will pay it. But the VA Medicare rate is 12 to 1400.

It has a relative value of 0.35, which means it’s about 25% of the value of acupuncture. So again, not a very expensive code, 12 bucks now that’s better than zero, but is that potentially the best code? So remember an application modality, one area Vaser pneumatic says devices that provide external pumping forces to soft tissues to the lower and upper extremities.

And I would say trunk as well. So you would say with cupping, could it fit that definition? I could see you dovetailing it, but I still will stay. It is not the best. Cupping is very popular. You’re seeing it amongst sports and athletes and my goodness, the rock has even had it. And I love what he does because he has moons of followers that if he’s getting cut, the more people are likely to try.

Do I see even the person’s left, had a lot of cups place it’s really popular. It really has efficacy. I’m seeing a lot of additional practitioners from chiropractors to physical therapists that are doing it. So how do we. I mentioned the visa nomadic device. And I said visa, nomadic. I think you can argue it for the VA.

I would never use it outside the VA, but for the VA you could. But I think from a monetary point of view, you’re losing money because it doesn’t pay as well. Using 9 7 0 1 6 will literally get you paid less than 50% of what you would be paid. Otherwise when you use what’s called the unlisted modality code.

Now I want to go back for a second and I’ll go back here and show you. You’ll notice those codes are like, 9 7 0 3 9 and 9 7 1 1 3 9. So you can see they’re all on the list for the VA. In addition tonight 7 0 1 6, but those codes do not have a Medicare value, which means when there’s no value purported by Medicare, they pay at usual and customers.

So what I’m saying to you is simply. If you’re billing, even the VA for cupping, what is the best code to use? It’s going to be the enlist of modality. Whether you want to say it’s unattended or attended. Now here’s the difference. 9 7 0 3 9 says unlisted, modality and modality in this way means something.

You apply to a patient, but you don’t have to be there. Like I know when I’ve had cupping, they placed the. And they leave them there for a bit. I would say that’s an unattended, probably appropriate code, but I’ve also had cupping where the provider is constantly in attendance adjusting and moving them a bit.

That’s going to be more of a procedure or hands-on. So the more hands-on and that you’re spending time with the patient 9 7 1 3 9 would be the better choice if it’s completely unattended 9 7 0 3 9. The difference, just to give an example, if you bill 9 7 0 1 6. They’ll pay a 12 to $14 bill 9 7 1 3 9. I’m going to say payment is going to be between 30 and 45, depending on your area.

So would you rather get paid 10 or 30 or 40? I would opt with the higher one. So how do we code this though, to make sure they know what’s coming says it says unlisted procedure, which means it could be for anything. So you have to indicate cupping on the 15th. Actually, it’s not hard. You’ve all seen a 1500 for here’s an example.

Notice on this line item, it says 9 7 1 3 9. And then in the pink shaded section, right above it, you simply indicate that tells the insurance it’s cupping. Oh, by the way, what if you’re doing moxibustion how would you do that? Actually the same way you would just indicate moxibustion whether it’s fully active.

Or one that it’s unattended. My point here is that coding for cupping, the best code for you would be the unlisted code and indicated this cupping, the VA will cover it. They will pay for cupping. It’s part of the authorization. They will pay it under 9 7, 0 1 6, but at a third of the price. So I think it’s better to use this one.

Now, what about regular? Do regular plans generally cover cupping. The unfortunate answer is no, I’m not finding any type of consistent payment here and there I’ve seen it, but not enough for me to really say yes, it’s covering out. The more likely places to be covered would be personal injury more than likely.

But outside of that, if you go to, gosh, the Cigna, Aetna, the blues general, they’re going to come back and say, it’s experimental investigation, which doesn’t it. From your standpoint, it’s not effective, but you know how insurance companies are without a double-blind study. We’re not going to cover, explain to the patient.

This cupping services is going to be integral to you getting better. We’re going to apply it. This is why, and what we’re doing. And here is the cost. If you show the value and the patient sees the value, they will pay for it and it will be covered. So don’t be afraid to pass it on because if you’re not willing to pass it onto the patient, why bill and insurance, if you’re going to give it away, So I would say, yes, I don’t want to bill for it.

It takes time. It takes effort and it is effective. Quite frankly, I’ve seen some really good responses with muscle injuries that I’ve never seen with other types of modalities. Now we’ll hacky puncture too, but that cupping is really been something I’ve noticed because of the amount of use I’ve seen has really made things work better for patients.

So make it available. Billing wise, what’s the best. Unlisted therapeutic procedure or modality, identify it as cupping and then simply put your price. And when we’re talking just simply price, you’re far better to bill cupping under the unlisted code to the VA. Cause it’s a little bit worth three times the money.

So keep it simple. You know how everybody makes insurance billing hard. You just have to understand the parameters. And that’s what our program with you is to do and realize I do articles and acupuncture today, and this one date back to 2010 and actually talks about it and why I wanted to bring it up today.

That this question though, a lot recently, and it’s because it’s become popular because of the VA. Here’s the thing. You can have me as your. Don’t be afraid to reach out to the network service, because from that I become part of your team where you can call, email me, fax me. However you want to get ahold of me to help you with coding and billing, and frankly get paid my goal to make you better.

I’m your doctor of billing to make your office work better. So go to our side, take a look. I would suggest take a moment to go to our Facebook page AAC. Give us a like there and we always update and put news out. We’re always going to be a resource. The American acupuncture council of course, is your malpractice resource, but will your billing and coding and business to resources as there’s our site, there’s our phone number.

Please reach out to us. Don’t be afraid. My email was at the front end as well. What I’ll say to you all is thank you for the time and next episode, we’re going to have Poney Chiang and again, always go out and be successful. But remember, the success is more about being. Which means being good to your patients, be that person.

And I’ll see you next time. Everyone take care. So what I’d like to do with you today is to talk about coding and billing specifically for cupping. This is one that I get this question a lot is that seminar producer, as well as doing our network services, where people call them with questions.

One of the questions I get is, Hey Sam, how do I code for cupping? Can I get paid? What is the proper code? Let’s really get into that.

 

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Limits to Acupuncture Sets 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.

Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council. With another episode to always make sure that you’re on point and making sure your practice is continuing to thrive and to grow our role with the American Acupuncture Council and my service, the network is to always help.

Be the best it can be in implementing the care for your patients and ultimately being paid. One of the things that comes up and I’ve had this question quite a bit from members is there some sort of limit to the amount of acupuncture I may provide someone and that’s a question, certainly some people think do what can I only do two, can I do four?

What is my protocol? Is there some sort of. That I must follow and in a way, yes, but in a way, no. So let’s talk about that. Let’s go to the slides. Let’s talk about what’s going do the type of acupuncture you’re gonna do and what are the limits. So from here, you can see just my basic information, there’s our website, my email address for those that need some extra help, but let’s talk about the care of.

Let’s talk about what is reasonable or what is necessary and what I’d say that always comes back to as a medical necessity. So I’d say the limits to acupuncture more than anything is going to be, what does the patient need? What does it medically necessary? Let’s define that here’s a statement from Cigna Insurance specifically on their acupuncture policy, which by the way, just recently updated.

And it says medical necessity decisions must be based upon patient presentation, including diagnosis severity. And documented clinical findings. So in other words, the more severe the case, obviously the more severe the diagnosis, the more care they might likely need. So you’ll see here, they’re not really putting a limit per se.

What they also indicate is that an individualized treatment, meaning frequency, duration, and so forth is appropriately correlated with the clinical findings. So again, it goes back to severity. So when someone says to me, Sam, is it okay? I do four sets. I’m going to say it can be. But it’s gotta be, is that’s what’s needed it.

I would be careful of a being something that’s based on my style that everyone gets four sets, no matter what. It should be based on what the patient needs. Let’s give one more. Let’s take a look at what Aetna says, and this is Aetna’s clinical policy bulletin, which has also just been republished again, but for 2022, and it says this acupuncture services are considered medically necessary.

Only if there is a reasonable expectation that acupuncture will achieve measurable improvement in the patient’s condition and is reasonable for a predictable period of time. In other words, we’re showing we’re making the patient better. So I’m trying to highlight here is that. They don’t really give a definitive that you can or cannot do whatever is necessary.

In other words, could some patients get better with two, maybe three or even four? Here’s something that came out and we’ve had a lot of offices gotten letters like this. Here’s one from the company empire, which is out of New York, but this is an Anthem company. And we’ve seen this across the U S of course I teach seminars all over and you’ll see here at.

The review indicated your average utilization of acupuncture sessions of what hour are greater or what are greater for personal one-on-one time is greater than what we consider the average of providers. So right there, they’re saying, oh, you’re doing an hour. That’s greater than the others. Now you’ll notice it.

Doesn’t say you can’t do it. It just says, because you’re doing more. They’re trying to say why they’re questioning it, but notice what it says here. We are aware of many factors that may impact the coding of your acupuncture services. So they’re indicating if it is with, for I know someone who treats post-surgical, that is her absolute specialty.

That’s all she does is referrals. Post-surgical patients. She goes, Sam, I generally sometimes do two hours. She’s doing six, seven sets on these patients. But when you think. These are post-surgical patients, lots of severe pain. So would that be reasonable? If they were questioning this, you’re going to just have to be able to respond.

It’s reasonable based upon the severity and need. So is there an absolute artificial limit while in some instances there is. You’ve probably seen something, what they call the medically unlikely edits MUE it’s often termed and you’ll see here. This is the United healthcare is promotion of it. I won’t say promotion, but their indication of it.

This is set up on a federal level and it says this, it says in accordance with the code descriptions and or the centers of Medicaid, Medicare services, meaning medical. Guidelines that CMS national coding initiative, it says the following are, the service limits are as follows. And you’ll notice the initial set is one.

Of course, how many more sets can you have than the first set? The first set is always one, but notice the additional sets all indicate two. So in other words, the amount of sets per this guideline says there’s going to be three pre-visit. I will tell you a lot of carriers have adopted this. I’ve seen this, not just with, I seen it with Cigna plans as well, where they’re pushing these three set part based on this medically unlikely edit.

Now you might look at this and think, wow. Are they picking on our profession? Not really because every profession, chiropractors, physical therapists have limits just like this. And you’ll notice here, I’ve just given a quick list of common codes. Obviously I put acupuncture, chiropractic notice for acupuncture.

The one. The initial two additional chiropractics, only one. And then you’ll notice certain therapies. Like by example, if we moved down to massage, you’ll notice they allow up to four, meaning once you’ve over one hour, they’re going to say no, and these are kind of artificial limits, but they’re just saying they don’t feel that often.

It would be reasonable to do much more than that. So now the issue becomes, if I’m billing insurance, am I limited to this? In a way, it’s what the insurance may cover. They may only cover that many. Can you do more? So let’s say you’re an out of network provider and the patient has a policy where it only pays for three.

Could you still do four and be paid for four? You could, but not by the insurance company. The insurance company is going to pay three who would pay the. The patient. So you have to be willing to make sure informed the patient. Your plan allows a maximum of three. However, for your case, I believe we need four and here’s the additional charge.

That’s if you’re out of network, here’s the downside. What if you belong to an insurance? So let’s say you belong to United as a provider. You will be limited to three. And if you do a fourth, absolutely. You can do a four. But you will not be paid for it and you can not collect from the patient. Cause remember when you join an insurance, you’re abiding by their rules, which means if they allow three, that’s the maximum that we can do for reimbursement.

If you do more go right ahead. There’s no additional money. So you have to make sure beyond these plans. When you join an insurance, you now will become beholden to these rules. If you don’t belong to the plan, you can tell the patient, this is what your insurance covers. This is what we need. And so therefore you do, what’s medically necessary.

Obviously people want to use insurance and we want to give them the best access, but maybe it doesn’t always cover everything. As we’ve all witnessed. How many of you have been to a doctor and you’ve had to pay substantial money out of pocket or things weren’t covered because your plan didn’t cover.

What do you do? You pay out? Here’s one. This is tri west. Now try west. Remember is on the west coast. Basically Texas and west of Texas that handles the VA. And you’ll notice they follow the same thing, one initial and two followup. So you’re seeing this also for the VA side federal plans obviously, and realize that’s also for Optum, which is part of United.

So to answer directly for some plans, there is a limit of. That’s payable. That doesn’t mean you can’t do more. It just means your limit for payment is three. Which means if you’re in network, you’re stuck with three, but if you’re out of network, can you build a patient for additional you’ll notice the anthems didn’t fall that I’m going to always say, treat what you need to do for your patient.

Treat the patient. Not insurance. Remember insurance is nothing more than an eight and never feel fully trapped into it. You’re going to let someone know here’s what your coverage covers. Here’s what we need to do. Here’s the difference provide what is necessary for your patients. So if you need to do four sets, do four, but if you’re in United health care, you will be limited to three.

So be conscientious of following through and understanding different plans and understand what your rights. In the sense when you’re in network or out of network, remember when you’re out of network, it’s up to you to charge what you feel is reasonable and the patients can choose or not choose to get it.

But bottom line is you are not limited unless you belong to something. When you belong to something like the VA, oh, they can say three are United. And so I will say the medically unlikely edits is there. If you go to a massage there. And they want to do two hours, but the plan only pays for who’s going to pay for the additional hour.

We, as the patient or the patient would, so same idea here. What I want you to take away from this is do what’s medically necessary, do what your patient needs, but just be careful understanding when you belong to a plan, there can be limits. And that limit is three to give you a little history of it.

Pre 2019, it was actually for manual. And three for electro and post 2019, they removed it and went down to three. Now the good news to that is I would suggest that many patients, I know me and myself as a patient, I’ve often not gotten much more than a 30 minute, maybe 45 minute. I’ve never had an hour treatment and I’m not saying anything wrong, but I think most patients can respond.

So we want to treat what’s adequate and be careful if you’re doing an hour. And here would be my question to you. Does the patient really need the hour? Are you just doing extra because you’re not busy enough and I’d sometimes be careful of that. Be careful of having a patient that you overdue, just because you feel like you want to throw everything at it.

Be. Be mindful, be helpful. What’s your patients they’re looking for is a response to care whether it’s going to take 30 minutes or an hour. So don’t put yourself in the realm of limiting, but also bear in mind. What is my cost benefit ratio? And remember, benefits are continuing to increase. Take a look.

And the benefit of 2022, it says Aetna will add acupuncture as a standard benefit in new and renewing commercial health plans in 2022. So everyone who has a commercial Aetna plan will be covered. Now, this doesn’t mean some of the federal ones, but all the commercial ones will cover, which means greater access.

Now will Aetna limits you to three sets? I’ve not seen them. I will say Optum United. But not Anthem and Aetna bear in mind, again, medical necessity. What comes down to, we want patients, we want access, give them the best help and understand do what is medically necessary. We’re always here to help remember the American Acupuncture Council, specifically the Network, not the insurance side.

The network is here to help you. I can become part of your own. Where you can call me, email me, fax me. We even do monthly zoom meetings. Take a look at our site, take a look. It’s very reasonable and as well as always gives you access, have an expert on your staff. Always reach out to us, go to our site. And I’m going to say to all of you.

Thank you. Continue success. Peace. Be with you, my friends catch you next time. Oh, and don’t forget, they’re going to bring it up on the screen. There is another show this Friday, and it’s going to be Michelle Gellis please tune in. We’re always here to help take care of everyone. Seeing that.

 

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How Do You Promote Your Practice?

 

 

And let’s focus on what are we doing to promote our practice? What changes have we made? What changes will we make?

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 and the American Acupuncture Council Network. Giving it another episode to try to always, as we do uplift you uplift the profession. This time, we’re going to go off topic for at least where I generally go, which is going to be coding and billing.

And let’s focus on what are we doing to promote our practice? What changes have we made? What changes will we make? What are we doing to really make sure that we’re getting people to understand what we do, how we do it and how we can help them always think of what is the barrier to care. Some of it is just lack of communication.

And I want you to think of it like this. Think of companies that have went belly up and I’ll think of one that comes to mind, which is the store Sears. Why did they do that? Well, someone at Sears didn’t have enough foresight when Amazon came in and started selling things online. Wasn’t that actually what Sears was, think about that.

What is Sears could adopt and adapt that say, Hey, we do the same thing. Wouldn’t they still be around. So I want to think the same thing about our profession, where we’re going to go, what we’re going to do to promote what we do, make sure people understand because of course acupuncture works well, but until we get more people to try it, it’s never going to be as big as we would like it to be because we obviously want to touch as many people as possible.

So let’s go to the.

Do. And there’s so many ways to think of it, but I want to kind of simplify it a bit. Let’s not make this too complicated. However, I use this to say, how are we perceived? You know, think of these pictures. What do your friends think you do? Your mom thinks you’re inserting a big needle. Western medicine has negative views.

What do people really do? Still take pills, but at the end of the day, look at that. Is that the concept are people that are not seeing a shit understand when they get acupuncture care. Think of how many people you’ve seen, who probably were skeptical before they tried your care. Wasn’t even sure it was going to work.

And then we’re like, oh my God, I can’t believe. Think of how often that miracle happens. When people walk into an acupuncture office, they’ve been to so many places. So how do we make sure to attract more people? I start with, what does the public know about what we do? And I’m saying this generically as our profession, but mostly about ourselves.

So I want you to think of ask your friends, ask your family, if you will, what do I. What do I treat? And I don’t want you to bias them. I want you to literally find out what do they really think about what we do. I want you to have an honest answer because we run in circles among other acupunctures. So we hear this all the time and we think this is out there.

And maybe it’s not asking your family, your parents, just friends. Okay. Acquaintances, people, you just meet casually. I fly. You know, for seminars. And one of the things I learned to strike up a conversation is, Hey, have you ever been to an acupuncturist? And the majority are no. And of course it’s an opportunity though, to discuss what we do, how we do it, and we’ve got to promote that part of it, but I want to know what are they thinking?

And you always want to know. That’s the perception we have, what are we doing to mold that perception make a different, but what I want you to do is really see what’s out there. What do people really understand? What we do, frankly, ask some strangers, see what’s going on. How do they go to the doctor by the way, you know, when they go in and do they pay cash, think of in your own practice, are you a mostly cash practice that can work really well, but think of yourself, do you go in to another doctor and pay cash?

So are you potentially limiting patients? Because we have to know what does the public know about what we do? Does it. Well, what happens if someone does an internet search for acupuncture? What does that say? Well, this is one from the Mayo clinic that talks about and inserts needles to reduce pain. So a lot of people say, well, it’s a pain relief, but is that all that you do?

I think there’s so much more. So what if someone who has fibromyalgia says, oh, I don’t have pain. I have fibromyalgia. I know that may sound counterintuitive. But it is sometimes how people think now on that same website, what they talk about, maybe it’s main to relieve pain, but it does get into things like nausea, vomiting, labor, pain, back pain, but you’ll notice it’s a very stringent on pain.

Now notice it does say menstrual cramps. That’s Mayo clinic. How about house? It says it’s an effective for a variety of conditions, but it’s not for everyone. If you choose an active person discuss with your doctor first, he has a practitioner licensed with proper training. So notice it just gives a vague, well, it treats sorta some stuff.

So again, is that really giving people anything about what we do think of your way? If someone went to your website, what did attract them for the type of condition they have? So let’s take a look. What else can you find on the internet? If you search, what does acupuncture do? The national institutes of health.

Of course, you’ve all seen this nausea, addiction, headache. So this goes a little bit beyond, but here’s one thing I would take a look at. If you’re someone who specializes in treating women with menstrual cramps or medical. Could I find you, if I were to Google acupuncture, treating menopause, would you come up?

Would it come up in the city? Remember internet searches are based on information that’s on your site. If the information is not there, it doesn’t appear. Do you have any type of blogs or newsletters that might give a little bit more what they call it? SEO. So people can get to your site. There’s a lot of things out there, but does it say it for you?

Well, here’s one from a company called Evercore and Evercore is behind the scenes on a lot of Anthem policies, as well as United health care. And you’ll notice here, it lists a lot of things that are way different notice asthma cancer, pain puncture. Might you have something that would promote and say, no, this could be helpful.

I have a couple of doctors in the state of Washington. That’s. They work with a couple of psychologists and psychiatrists, but that’s all they treat by the way it’s paid by insurance. But again, that’s something that they promote because most people would golf. It can treat that. I mean, what if you’re an infertility expert?

What if somebody is looking for that, would they be able to find you, is your, are you telling them what you really do? Let’s look at another carrier. How about American specialty health? And of course, I know everyone has a little bit of problem because they should pay more, but let’s talk about how does American specialty health cover?

Well, they talk about kind of, neuromusculoskeletal kind of what I call the chiropractic end of it. So it talks about headaches, hip pain, neck pain, back pain, and so on. So again, that promotion is there for that, but is it promoting. What, if someone were looking for this, what is it saying? Is this information on your site?

If you take this plan, here’s the conditions that we cover and we can help you. I mean, obviously marketing is done by every company. A RP uses acupuncture to market their product. Take a look. Here’s an ad for them. Medicare will cover here’s another one for a company called clever care. This is a TV.

They’re using acupuncture to cover. Now what about this? It says Medicare advantage. Is there anything that you’ve done? So if someone has Medicare advantage, they know they can come and see you. Is there anything as they pass by Medicare advantage here, take a look at this one. This is the United healthcare one.

And think of the promotion here. They’re literally using you to promote their business, but are we utilizing it to promote ourselves? Can you imagine if you have a zero copay acupuncture visit, do you think that’s very hard for some of the. Probably not now we would have to accept payment in full from these plans, but I’ll tell you they’re about a hundred dollars a visit and they cover much more than you think here’s their acupuncture coverage for this Medicare part C policy.

And you’ll notice that it says acupuncture, routine codes, but not all inclusive. And it’s not only including acupuncture, but what does it include? Therapies, things that you do, whether it’s massage exercise. Uh, myofascial release or manual therapy wash off 20, not so much more. Do people know that we do this?

Can it be something that might attract them? Always think of what is going to attract someone. What is going to make them know that what you can do can help them. Here’s another one from good morning America, where they talked about prescription for wellness and it indicates acupuncture. And. How about something like that on your side to make sure people know, okay, we do herbs.

Someone may be looking for that, tell them what do you do, herbs for? What can help? How does it help? And I’m not saying write some long drawn out article, but there’s a little bit of information that at least is introductory. So someone can go, oh, I think I want to try that. So here’s what I want you to do.

If you’re thinking of marketing, what do you mean. Start thinking, what is my thing that I do? How do I know people are going to find me if I do it? So here’s a couple of interesting offices that I think has done something in a positive way. The one on the left is an acupuncture office that they’re in a medical building.

And when you walk by their office, this is the sign. And look at all the things she’s talking about. Fatigue, stress, tension, anxiety. When someone’s walking by. They treat anxiety, they treat arthritis and notice it. Doesn’t just say pain. Now. Pain is many times the origin of most of these, but people often think, well, no, I have fibromyalgia.

I have TMJ. We want to let them know. Yes, we can treat it. Notice that even talks about veteran’s benefits. Look at the one on the right chronic pain, neck and shoulder stress, depression, insomnia tendonitis, Bell’s palsy, nasal analogies, weight control PMs. You want to think of who am I attracting? If you do a lot of sports medicine, guess what you should be talking about?

I do sports medicine. There, isn’t a professional team. That’s a professional sports team that doesn’t use and promote acupuncture. I know several acupuncturist who work directly with the teams and that’s their whole job. But again, are we promoting that this P do people know that they can come to us for it?

Often think of if someone says, what does acupuncture going to do for me? They may not. Because they’re going to have a condition that they’ve never heard, it’s going to be helpful. So I want you to thinking, when a person sees your website or your office, what do they see? What do they know? Will you be able to help them?

So what does it say? Does it talk about you where you went to school? Does it talk about your philosophy? Does it talk about the conditions? Would I be more important is a little bit of that. What have been some of your success stories of people you’ve helped? How you’ve helped them change? Think of that someone searching, like, if you think of it, if you did a Google search in your area and said acupuncture for menopause, would there be anything from your office that will come up?

If you put information like that on your website, guess what Google does. They pull that information and then that’s how someone would be directed to it. I want you to think, how does it attract. What is someone looking for? And remember, it’s not something that you need to write a lot, but something that’s going to go.

Oh, okay. Cause think of most ads don’t take that long. Does it really communicate to their needs? I mean, think of what is your specialty? What are the things that you treat? I have an office. He does only infertility. So I guess what’s prominent on it’s infancy. And he’s very busy because he’s had good success.

Everyone wants to come in because if you have a 50% increase and people getting pregnant, who doesn’t want to spend that extra money considering they’re spending 20,000, all, all the other things. So think of it this way. What is the barrier? I think one of the barriers of care is just people not knowing, but it’s often fear.

So is there anything on your site that talks about the gentle approach and that you won’t feel anything? Think the other barrier can help you. What does communicating to the patient about how it helps them kind of put it from the patient’s standpoint, if you were looking, would, you know, what’s helpful and of course, money, I think that’s often the biggest barrier.

So you want to start to think of, are there things that you’ve done on your site to show people you make it affordable? I always use cars as a way of showing you how we make things look before. When you see some of these fancy car commercials, particularly the mercury with Matthew McConaughey, do you know, they never tell you that car actually costs $80,000, because if they told you that you’d never want to buy it, but if they say, oh, you can lease it for 4 99, that seems affordable.

So also think of, are you having anything in there that helps the patient understand? Do you offer payment plans? Do you offer any other types of discounts do even take insurance and I’m not saying you have to, but you got to think of this. Someone has insured. And they want to come to you what they know.

So for instance, when you belong to any insurance or you accept insurance, I would certainly want to put it on my side. I want people to know, yes, we do take blue cross blue shield or Aetna. And I’m not saying you have to, but you got to think of if someone’s looking, how are they going to find us? And that leads me to something that the American physical therapy association talked about last year.

Now, as a seminar person, I teach seminars not only to acupuncturist, but to chiropractors, physical therapists and medical. And at one of the programs, and one of the things that the American physical therapy association literally said was this many of us look at the way chiropractors have branded themselves in the last few decades and feel a twinge of resentment.

Why can’t that be us? So think of it for a moment. Do chiropractors do a lot of marketing? Do they let people know if you’re in a car accident, you can see me. By example, if you treat the auto injuries, does anyone know you treat them? If you treat VA patients, does anyone know. Is there any way for you to find that out if I look at your site, because if I’m looking and I can’t find it.

It doesn’t mean anything to me, I’m going to move elsewhere. So realize that even these professional associations are beginning to realize that they have to do more, to do their own branding acupuncture. Let’s take control of the message. Let’s take control to put out there whether or not this stuff is covered by insurance.

I do not care because is there a value to what you do? Remember something my mom always said is this people buy what they want. And beg for what they need. Acupuncture is something people want not necessarily needed. And I hope you notice with the connotation. I mean, something that they value they’ll do think of how many people go, oh, I gotta pay that bill.

But what I really want these shoes in a way, that’s what we want to be. Someone who I know there’s enough value there. And trust me, the value can be high. What if someone’s had migraines taking medication that’s not helping. And they come in for a handful of visits to. And they’re gone. Is any of that information somewhere for people to see you allow the patient to do a testimonial?

I certainly would think of it. There’s a great opportunity here that I think all of us haven’t really taken heat of. You have control. Think of how much easier it is with the way you can market now with internet based. Forget Facebook. No, one’s looking at that anymore. Even Instagram too short. I mean, Tik TOK, forget it.

It’s just simply your site. People are doing searches. Are there any acupuncturist in this area that treats what I have or takes my insurance. So I want you to think of who are these patients going to be? If you have a mostly cash practice, talk about it, tell them why you do it. You’re making it affordable.

What if you offer pro pays or prepays? And then of course you have all these insurances. So in my opinion, there’s 12 ways to get. And I want to highlight a few of these. I mean, if you’re treating personal injury, workers’ comp VA Medicare parts seen. It’s why I bolded and underlined I’m in a Medicare part C policy.

It can be fantastic if you didn’t watch last month’s show with me, take a look. There’s some great opportunities. Here’s the thing. You need people that need your care and watch your care. And that’s where your practice will grow. Because one thing that I can always say is acupuncture does really work very well.

Once someone is. But what’s that barrier. Do I know that you can help me? How do I pay for it? That’s what mostly people are thinking. So we want to make sure we set ourselves up that yes, this is how you can come to us. Here’s how we can help. You always know there’s ways of promoting that. Like even on our website, the American acupuncture council network, here’s something last month we talked about Aetna.

Now has all of their commercial plans, not necessarily federal, but all commercial plans now have acupuncture benefits. Wow. What if you’re in the state of Massachusetts that you don’t even need to have a diagnosis? You can treat anything under their plan and there’s 12 visits. But what I want to know is does anyone know that besides you take a good look at how you’ve marketed and branded yourself when you meet someone, do they know you’re an acupoint.

Do they see someone that’s a professional, trust me, getting out in the public, having people know you is one of the best ways for people to come in because it’s people they trust and bottom line people, they help. So think of it. What have I done? Create a plan. Start to put a few things out and track what attracted people when they come in how’d you find me, then you’re going to start to learn what works.

Remember every business does that. Don’t be serious. They’re going to be people who promote and do better than others. Why? Because they have taken some, I guess, old fashioned put the nose to the grindstone and just tried some things, maybe what works for you is not for someone else, but there’s always something.

What I want to say to you is acupuncture has a great opportunity. The access that you have now to people and the understanding the growth potential is infinite. Think of addiction. Think of the VA and all the things that are there, but does anyone find you and I’ll leave it with that? What about a VA patient?

If you’re doing VA, if a veteran was looking for someone, what they find you don’t leave it to happen. Hopefully, we’ll take a little bit of this and do a little bit at a time. I’m not saying you have to be perfect, but it’s trial and error. What I’ll say to everyone is get out and help yourself. We’re always here to help you.

The American acupuncture council is your partner. We want to make sure you’re doing well. Anything that you need, if you need help with coding, billing, documentation, medical necessity, you want to verify that your notes are fine. Not getting. Come to us, we offer two services to do that. Just go to our website.

If you need further help go to our website, we’re always going to be there. Don’t be afraid to call or email. I’m going to say to all of you. Thank you very much. Here’s our phone number and information there. Ultimately, we’re here for you now. Pay attention Friday, coming up is the host will be Shelly Goldstein.

I’m going to say until next time everyone. This is Sam Collins, your coding and billing expert. I’m here for you. Go out and be a good acupuncturist..

 

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No Surprise Billing in the Acupuncture Setting

 

So today’s program is going to hit a chord. I think for many of you, because you’ve probably heard a lot about this and you aren’t yet. Does it apply to me? Does it not apply? Does it really matter? And of course it does. But we have to make sure that we don’t create something where we’re creating too much emphasis on one thing and not understanding the big picture.

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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 Network and the American Acupuncture Council malpractice carrier. With another episode of, to the point to make sure your practice continues to grow and thrive and understand what’s changing and updating to make sure you’re always having the best success that you can have.

So today’s program is going to hit a chord. I think for many of you, because you’ve probably heard a lot about this and you aren’t yet. Does it apply to me? Does it not apply? Does it really matter? And of course it does. But we have to make sure that we don’t create something where we’re creating too much emphasis on one thing and not understanding the big picture.

And that of course is the no surprises act. So please let’s go to the slides. Everyone. Let’s take a look at what’s going on with this no surprises act. This has actually been something that’s been out for a while. It just became implemented January 1st. And really what it’s intended to do is to protect patients from an unexpected or undisclosed medical bills.

And I want you to think of the big picture. Think of how many times you’ve heard of this. That’s gone to a hospital when they’re there. Maybe they get a surgery and it turns out the anesthesiologist is not in their network. And lo and behold, now they get this bill out of network for thousands of dollars.

They had no idea. That’s really the onus behind this. So again, I always report to you to take a look. There’s my name, there’s our website and my email to make sure you’ve got all the right information. But here’s what I want bust. The hyperbole, you’ve all been exposed to this. And if you’re using Dr.

Google, you’ve probably been exposed to it. People love to put out stuff and not really understand it. Think of all the different things you’ve heard about vaccines that turned out to not be true as far as mandate. The other thing about this is the same thing with the no surprises act. And I always say be careful, gave away the exaggerations of a hyperbole.

And I would say use something that’s called Aquaman’s re. If you’ve never heard of that concept that often says that there are very complex questions and often the best answer is the simplest. And I’ll say, this is no different. So starting January 1st, this no surprises act was designed to protect individuals from very high out of network bills or just high bills without them being aware of it.

That’s all this is about. So you have to think from an acupuncture standpoint, aren’t you probably doing all this. Chances are you are cause aren’t you already doing some type of financial agreement with your patient. So this is essentially the design, these big bills. The law requires that providers give a good faith estimate.

You’ll hear this term. It’s an estimate. I probably don’t think in some cases you’re going to be able to give an exact, but at least a range, by the way, that range could be within $400. So you can imagine how many of you have a visit? That’s 400. So I don’t think it’s going to really fall outside of that, but I want to think of just what’s better for us is to make sure patients understand what’s going on.

Obviously, there’s going to be two things that are a barrier or a patient coming for care. Number one, they don’t know about what you do or afraid of it. Unknowing. Isn’t going to work, but number two is cost. And so the better we are at aligning what our costs are in the patient, understand that the better off we’re going to be.

So if you think of it, aren’t you already doing a financial agreement, making the patients aware of what your charges are and what their out of network or excuse me, out of pocket costs might be whether you’re in or out of network. So what I’ll say to most of you. Chances are you are already doing all the things you need to do for the no surprises act albeit maybe a little bit differently, but for the most part already accomplishing that.

So who has to do this? The, who is people with health insurance, many of your patients, whether they use insurance or not, or pay cash, we have to make them aware. So if they’re using your health insurance for. Or not, it’s simply making sure a patient’s aware of what are the expectations of costs. And this is where things can get a little tricky because if you’re in network or out of network, that’s certainly can make a big difference.

So here’s what I, to suspect that you’re doing at our hope you’re doing how about some simple language in a financial agreement that something like. Many insurance policies do cover acupuncture care, but this office makes no representation that yours does. We’re never promising think of a medical office.

They never tell you, we guarantee your insurance is going to cover, or that we take it. They’re saying that we will take some or offer it. And it says here insurance policies may vary greatly in terms of deductible and percentage of coverage. You’ve seen. Yeah, the plan says it pays 80%, but of course, 80% of what, not necessarily what you’ve built.

So here’s what we tell them because of the variance from one insurance policy to another, we require that you, the patient be personally responsible for the payment of your deductibles, as well as any unpaid balances in this office. And we’ll do our best to verify your insurance and bill in a timely manner.

But ultimately let’s always remember who is the contract, really with an insurance it’s between the patient. And the insurance company. Not necessarily the doctor and Lusher and network. So you want to be very clear if you’re out of network, we want to be clear as to what your charges are because the insurance is going to pay.

Some of it. Patient pays the rest. When you’re in network may be a little easier, but obviously you’re getting less money. What if you have a $10 copay? That would be pretty strictly. So we have to do it for the patients, give them information, but who else? Us as providers, we give that information and we have to make sure we understand our differences.

When we are in network, it’s mostly a fixed co-pay and we’re going to write off by example, let’s say you’re billing an American specialty health plan, and maybe the patient has a $20 deductible, or excuse me, a $20 copay. That’s automatically what they’re going to pay. Other stuff is written off. You remember, regardless of what you do, right?

You could do lots of services, but they’re going to include just that fixed per diem price. So it’s very, in fact, straightforward. This is what the patient will pay. This is what we get now, conversely, where it gets a little bit more complicated though, is what about out of network? And this is what I want to warn you is that so many offices do this improperly.

You’re probably setting yourself up for something that they would consider anti-kickback or a kickback as well as a false claim when you’re out of network and building insured. The patient has to pay what the insurance didn’t pay. We often use the term co-insurance because co-pay, we generally mean a fixed amount.

Co-insurance we mean, what is leftover? So here there’s no contractual write-off so let’s take an example. We build an in-network plan, a hundred dollars, but because we’re in network, that patient has a $10 copay and the insurance pays $40. So we collect 50 with $50 being written off because we have a contract with that.

Now let’s take another patient. We’re out of network. We build the same $100. The plan let’s say still pays $40. Great. It pays 40, but now because we build a hundred we’re to collect $60 and I know many of you go no, I don’t collect that. I’ll write it off. There’s the kickback you’re giving the patient again.

Of $60. They didn’t pay. Cause why are they not paying what others have to pay? So in other words, you can’t have it just because your insurance is not as good. You pay less unless you’re in network. So if no contractual, write-offs kind of what you, bill is what you have to collect. So be careful of that being a kickback, like by example, if you just told a patient, oh, you have a deductible, no big deal.

I won’t collect it. That’s a gift. And we can’t give gifts for a patient for, to become a patient with us. So I will always come back to say, if you’re willing to build it, you have to be willing to collect it. So be careful of setting your fees off of your best paying insurance or your worse, because if you have one insurance paying that much, what about the patients that doesn’t, they have to pay the difference, which means for many of you, if you’re doing that, you might as well join and be in that.

Because you’re writing it off anyway, you might as well do it legal. So here’s the difference. We have to make the patients aware of that. So as the provider, we have to do to make sure they’re aware of what those amounts are. Don’t overcomplicate it, but it’s really just the out of network of the patient.

Now, if you’re in network fairly simple, because you just telling them what that price is, and I’ll give you some examples of what these forms might look like. But what I want you to keep in mind is what you’re charging. You have to be able to make sure patients understand those. Maybe what their insurance might pay at least a portion, and then they’re going to pay the balance.

So if I’m billing $400 per visit, I can’t guarantee what the insurance is going to cover. Do I have to make the patient aware they could be liable for $400? They couldn’t be. So again, be careful don’t set your fees off of your highest. Now who else has to deal with this? It’s not just us or the patient, but the insurance company, the payer, and here’s some really good rules that they have to follow that I’m sure some of you have run into problems with.

They have to verify who’s in and out of network. How many times have you seen someone coming to your office to say, oh, I found your name on my network and it’s something you dropped out of months ago or years ago. So now they have a duty to make sure that list is updated every 90 days. And it has to be updated within two days of notice, which means many of you are going to get an additional request from insurance companies very regularly, probably every three months to make sure you’re still willing to be in network because those lists have to be up to date because if the insurance company improperly puts your name on that list and that patient comes in the patient, won’t be liable to you.

But, That insurance company, because your name was on the list. They misinformed the patient. So it puts a lot back onto that insurance company, which I liked because how often are we left on the side when we’ve dropped out or we’re not part of it. And yet they try to say that we are, it also emphasizes this, that insurance companies have to be more transparent as the amount that they’re going to allow her pay.

How frustrating is it? You bill 75, 1 insurance pays 41 pays 30, maybe one pays the full 75. How do we know that? Partly once you, bill, you can obviously keep a log of what different plans pay, but otherwise the first time [00:10:00] out, how would you know? And so this is where you have to warn the patient, that I cannot guarantee what your insurance is going to cover.

You can certainly estimate it, but you’re not guaranteed. So potentially they can, oh, the entire amount. Now insurance companies should be more transparent to give that information. There should be more access to online portals or information about what they allow. I would even in fact, have the patient call and say, what do you allow for acupuncture blue cross blue shield of Illinois through their Availity platform.

And I’m sure others are going to follow the same thing. There’s a tool available. If you’re a network you can plug in your codes and your. They’ll tell you what they allow that way. There’s going to be no guessing. What’s there now. Bear in mind. If you go back to ELBs, you’ve received, it’s probably easy to figure out what’s been paid, but it’d be nice to really more real world information about what they’re allowing get rid of that mystery.

Why is there always a mystery of what they’re willing to do all. For the payers, there’s going to be a way to dispute. So it says here out of network physicians, [00:11:00] clinicians, and facilities, wherever process, available to challenge inadequate out of network payment. So you ever seen this ridiculousness, you are billing a fee that everyone pays you and all of a sudden this insurance says, oh no, the usual customary for your.

Is 50% below that. Wait a minute. What means that they can do that? If they’re charging, what is fair and reasonable now, again, if you’re in network, they can make that provision, but out of network, no. So there’s going to be an independent dispute resolution and independent body that will oversee that.

And I think is going to make this a little bit more reasonable that these companies can’t come out and just say this is what we’re going to pay. Take it over. Unless you’re a network. So it gives a little more power for us and the patients to push back on some of these ridiculous low fees that they allow.

So in summary, here’s what I want you to do. Establish a fair and reasonable fees schedule. I did a program about, oh, just right before December, about how to use RV use, but I’m going to. Hire me as an expert, we have a service called the network at the American acupuncture council network, where I [00:12:00] help you just with that to make sure your fees are in line out guarantee.

Most of you have 50% of your codes that are probably not correct. So let’s establish a fair and. Clarify who you are or not in network with them. When people come in, you can be upfront with them. I don’t belong to Aetna, but I do belong to blue cross. Maybe in addition, disclose your fees. Now, what you can do is you can put a big list of all your codes and fees, but that doesn’t really help because that’s not what the patient is getting.

So you want to do something that identifies with this patient is receiving so they know what they’re paying. Can you imagine if you just went to a hospital? And they had a big charge list of everything they might do. How would you figure out what you’re getting done? So you want to be more specific? So the patient has a good choice to know.

Oh, okay, great. I’m going to get this care because I know I can afford it or I will pay for it or here’s what I would rather do. I would rather not treat someone and not get paid, then treat them and not get them. You get my point. That’s happened to all of us at some time, be clear with their [00:13:00] out-of-pockets eight or out of network with a financial understanding or agreement that way.

No, one’s had a mystery and you’re thinking we’ll see them. This no surprise act is what I’ve already done is try to give a patient information about what their costs are. That’s exactly what. What I will say, avoid the hyperbole of when people get all excited, you gotta do new forms. You gotta do this and that.

No, don’t post it on your website. You don’t know what they’re coming in for. Wait until they’re there and use something like this. So you notice this is a simple form that just goes into the same thing. I said, many insurance policies do cover acupuncture, but take a look at where the blue arrow is. It says our services may not be covered by insurance.

Our office and providers are not in network with any insurance. And do not accept insurance assignments, meaning we’re expecting you to pay up bill your own insurance, or you wait for the check. You will be billed the cost for your care and will be responsible for that amount and any difference that the insurance pays great, but that’s not going to be on.

We then indicated in red that the patient says, I [00:14:00] understand, and I will have the financial responsibility applicable to healthcare services provided by an out of network provider. Remember, don’t make them think that you’re in network when you’re out. And then a breakdown here are the services that are going to provide.

Now you notice I made a little spreadsheet here of common services. You might just have something you just fill in the. Of what you’re doing and the fee is, so that way they could know and notice I put an estimated payment. Yep. But is that something you’re going to absolutely guarantee?

No, it’s an estimate. And remember you have a $400 threshold, so it’s pretty easy for us. So the big picture for me is I want a person to be comfortable with their care that they can afford it and remember affording it is not always as complicated. Think of this. How many times have you seen a car that they advertise on TV?

Do they ever tell you the total price of the car? They never do. They always say, oh, it’s 4 99 a month. So here, we’re going to do the same thing. We’re going to tell them what the total fee is. And if that’s something that kind of rebuffs them, then you can talk to them about, Hey, no problem. We work out payment schedules for you.

We’ll debit your card. [00:15:00] Anything to just make it more palatable, but at least this way, no, one’s going to be surprised by how much. So this would be a good way of dealing with when you’re out of network, which frankly, I recommend now, what if you are in network though, here’s a different. It says here the same thing at the top, we’re going to bill, but notice it says our office and providers are in network with your insurance and put the client name.

We then talk about balance billing, which there’s none. So that’s why in the red section, you’ll notice it specifically talks about copay, which is fixed and maybe what’s excluded by example, many of you who belong to American specialty health, you understand that they do not cover massage or manual therapy.

So as a consequence, you can inform the patient that’s not a covered by. And they would be liable for those amounts, but you have to tell them beforehand. So do be conscientious of making sure when you’re making these types of estimates, that patients are clearly aware of what they’re going to pay.

That’s all there is to it. Is that really that complicated? I don’t think so. It’s just a matter of thinking just like yourself as a. What would you want [00:16:00] to know what the costs are that way, how you can afford it? And if you feel it’s unaffordable, now we, as providers can work out something for them to do that.

Now, if you’ve never noticed, if you go to our website, the American acupuncture council network, you’ll notice we have a new section. Have you ever been there? Have you seen all the information about. We’re putting out information on vaccine mandates, whether it is or isn’t no, it’s different a little bit for each state, not ma not nationally, but notice about four weeks ago, we put things up on the no surprise billing.

So one of the ways you can always get engaged and we’re here to help is by just going to our news. Our goal is to make sure you have a practice that is thriving, that’s doing better. How do you do that by having the correct information to make sure you’re getting paid? That’s our ultimate goal. So if you really want some day to day help, we offer a service, we call our network or hotline where literally you hire me as part of your staff or part of your.

And then you work with me directly by phone fax, email, even zoom, all types of issues, anything coding, billing, [00:17:00] documentation. We’re always here to help you. The American acupuncture council network. Here’s our site and our phone number. If you have any questions or concerns that never be afraid to reach out to us, we are your teammate and we want to make sure you’re doing well.

So I wish you all the best now coming up next week for the live program will be Jeff Grossman. I look forward to seeing you all at a future seminar until. Be well, take care of yourself. Take care of your family. Thank you everyone. Okay.

 

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New Year, New Fees?

 

 

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 for you giving you another episode with, to the point from the American Acupuncture Council and malpractice carrier on keeping you up to date, what’s changing. What’s new as the coding and billing expert always want to make.

You’re on top of everything that’s going on and what the changes are going to be for next year. So let’s get started with understanding fees. So let’s go to the slides, what I want to make sure there’s a good understanding of is how do I determine fees? And so you’re going to see what I have here, the RVU update, which stands for relative value units and how that affects your fee schedule, what changes you can make at the beginning of the.

And how your fees are going to be paid. Well, let’s talk about what are our fees. When you hear this term, you see our, or usual customary and reasonable, what does that mean? Well, it’s the amount that’s paid for medical services based on your geographic area. In other words, what is usually in customarily pay kind of like houses, what’s the usual and customary for your neighborhood.

It’s based on what the houses sell for. So in that sense, that’s usually the fee that’s charged for a doctor for a service and falls within the rains that others charge within the area. It is a service deemed necessary to their current condition. But what is the usual fee? Now keep in mind that usual fee has some variances.

Are you on the upper end or Lauren? I hope that we’re somewhere in the middle because here’s my concern. Let’s say you’re charging $50 for a service. That someone, including insurance companies are willing to pay $75 for if you’re only billing it at 50, of course, what are they going to pay you 50, even though they would pay at 75.

So I want to give you some tools that help you to establish a better way of understanding your fee. What let’s understand, what is the model we deal with? There’s a course in the insurance model. And that’s the reasonable customer feed that insurance has say are the acceptable range. And of course there’s a lot of variation to that.

And of course, as you can expect, if you belong to an insurance, like say you joined blue cross or blue shield or Ash, that’s going to be a set fee, which is probably not usual and customary, but the trade-off is I joined. And hopefully you get more patients, but you take far less money, not something we’re really that tickled with and less volume can be there.

So I look at it more from the patient value. What is the service worth that a patient is willing to pay for? And this is where we have to provide the value of the service. So someone’s willing to pay. And I think this is the model that acupuncture really thrives in the American physical therapy association has indicated that they find that as soon as people have a $30.

They start losing about a third of their patients. Do you know that’s not true for acupuncturists? So I’m always a little nervous that we sometimes undercharged for what we’re doing, because we’re afraid of that amount being something that’s going to scare the patient off, but what you have to think of, what’s the value and want you to think of as an acupuncturist, think of the value for a moment.

How many of you have been to a medical. And when you went in, you’re in pain and when you left, you felt better. And I’m not saying this as a negative in a way against medical doctors, but that’s not the way they treat. Think of how many times you have a patient come in. Maybe they have a headache or back pain, and they’re not even sure acupuncture is going to work.

But then after the visit, they’re like, oh my God, I can’t believe I’m not in pain. I’m 50% better than. There’s a lot of value there. So I want us to start to think of the value of the service and how we establish rates and using something called the relative value units. The relative value unit is a value determined actually by the federal government on the cost of each medical service.

Every CPT code has a relative value. Now what this relative value does, it allows you to compare the value of one service to another. So by example, if there’s a service that has a value of one. And another service that has a value of two. That would mean that service that’s a value of two would be twice the cost.

And so one of the things I want to do with this is take the RV use to help us begin, to establish a reasonable fee for the services we provide. The development of this started way back in the eighties and Harvard, and it continues to be updated every year by CMS. In fact, it is updated already for 2022, and I’ll give you a preview of that coming up.

So here’s what I’d like. You all to do. Take a moment. And tell me, what is your fee for these four codes now, obviously you don’t have to tell me, but I’d like you to think or write them down. What do I charge for the first set of manual acupuncture? What’s my fee for the second set or additional set. How about a mid-level new patient exam?

What do you charge for that? And then what do you charge for massage? What I’m trying to point out is if I can tell you the value of any one of these servers. Based on the relative value. I can tell you what the value is for another. In fact, that’s how insurance companies decide to pay for certain services is based on the relative value of each.

So let’s take a look at what is relative value. You’re going to see here a whole page of relative values. And I put all the common codes. If you’ve been to a seminar with me, you’ve seen this, but this is the update for 2020. What you’ll see immediately is that there’s been an increase. If you notice that I put the arrow around it, you’ll notice the relative value for now.

4 9, 7, 8 1 0 is 1.16. Whereas last year was 1.06. That’s about a 10% increase. So if someone says to you, Hey, acupuncturists are having an increase in fees. Actually that’s true. And it’s based on the relative values have been increased relative value though, just compare one service to the other. So the easiest way to think of this is if you look at the relative value of 9, 7, 8, 1 0, you notice as a value of 1.16, and then the value of 9, 7, 8 1 0 is 0.87.

Now, when you look at that, you’ll go, what does that mean, Sam? Well, I’ll make it real simple this way. What if you charge and again, this may be a little high. What if you. $116 for your first set. What would be the price of the second set? $87. That’s the idea. So if you can tell me what you charge for one code, and if that code is accepted and paid by a payer, I can tell you what they’re going to pay for everything else.

Now, the good news is you don’t really have to look at that many codes. I know this list is a little. But I want you to think of what services are you billing on a regular basis? That’s all we need to look at. Don’t worry about all of them. So how would I do this? You’re going to see her on the right. I did some calculations.

Now don’t be put off by the math part of this. It’s not complicated. All you have to do is tell me, what do you charge for 9 7, 8 1 0. So now I want you all to think of that. I asked you a moment ago. What do you charge for 9, 7, 8. You’ll notice I put a charge of 65. Now you might say, well, Sam, how’d you come up with 65.

I’m just saying that’s a typical fee for a lot of acupuncturist for the first set. So let’s just say 65 was your fear is your fee to figure out the fee for every other service you don’t guess and go, well, I guess I’ll charge $10 less. Here’s what we do. We take our. And we divide it by the services relative value.

So you’ll notice that I take 65 divided by 1.16, and it gives me 56 0 3. Now 5,603 is actually not the price of something. It’s the conversion. I then take that number and take any other codes relative value. Multiply to tell me the fee of that service. So by example, you’ll notice here 9, 7, 8 1 1 has a value of 0.8, seven.

So I’d take 56 0 3 times 0.87. It gives me 48 75. So that means if my price for a 9 8 9 7 8 1 0 is 65. What should be my price for a 9 7 8 1 1? Well, I would round up to 49, but I think you get my point that way you make sure you’re not cheating yourself. And I’ve seen a lot of providers do this. They’ll build a first set of 60.

And the second set of 50, 65. Now, of course, that’s your option. You can do that, but he won’t be my concern. What if the insurance company pays you in full for the second set? What does that tell you? You’ve done with the primary code you’re billing way below. So I can do this backwards as well. If they allow 65 for the one, one, I do the same calculation the other way, and I do it the same for every service.

So think of it in simplest terms, the difference between the first set and the second set is about 30%. So if your first sets a hundred seconds, that would be 70 or in this case 65 to 48, 75 or 49. Well, the same applies with any of their code. Like you might say, well, what do I charge? Or what should I charge for an exam?

Well, you notice the relative value for 9, 9, 2 0 3 is 3.2. So I take 56 0 3 times 3.29, and it gives me 180 4 33. Now the reality here is if you look at 1.16 to 3.29, it’s not quite three times the amount, but you can see it’s pretty close. So really what you want to think of is that the price of. Exam should be three times the price of your acupuncture service based on the relative value of the service.

Now, how these relative values work, they determined that the amount of work that’s involved with each service, and that includes not only the work involved with the service, but the type of provider, what your malpractice costs are and so forth. So again, 180 4, based on a $65 price or about three times the amount would be pretty reasonable.

Well, what about other services? Have you ever built, you know, let’s say. How would I figure out my price for massage? Well, massage value now is 0.8, eight. So I’d take 56 0 3 times 0.88, and gives me 49 30. What I want to make sure is that my prices for my services match each other. I’ve seen offices, bill out some pretty large amounts for one code at a very low amount for the other code.

And my question is why are you doing. What was the purpose? Now, if you can say to me, well, Sam, I did that because I just don’t want to charge my patients as much. And you have a good reason, I’ll say, okay, because maybe that fits your neighborhood, but if you’re doing it because you don’t know, like by example, what if you charge 50, 65 for the first set and you charge only $30 for massage?

Well, you. But if someone’s willing to pay 65 for a first set based on relative value the exam, or excuse me, the price for massage would be about 50. So start to really go through these coasts and start to see that. And here’s the beauty. It increased for acupuncture. So, I’m not sure you’ve heard this or not yet, but the prices for acupuncture related to rates associated with Medicare rates, or anyone will go up next year.

Now let’s not get too excited. The rate increase is about six to 7%, but that’s well above cost of living. So, yay. Finally, we’ve got an increase. Do you know? No other profession got an increase. If you go through all the fees, actually chiropractors, medical doctors, physical therapists, all got about a three to 4% return.

Acupuncture got a 6% increase. And I think mostly because the relative values are becoming more apparent. So you’ll notice the relative value for 2021 was quite a bit less now, 1 0 6 to 1.16, you think? Well that’s 10%. Oh, no. Because remember that’s again, already up at that level. So again, probably about six or 7% to give an example of what I’d like you to do though.

Now, if you’ve been to a seminar with me, you’ve seen this RVU sheet and if you’ve never been come to a seminar or join our network, so you can get this type of information, but here’s what I’d like you to do. You don’t need to do every code, but start coming up with a competent, reasonable fee schedule.

Cause I don’t want you to. But I certainly don’t want you to undercharge. And what I find for most offices, frankly, you bill about five or six services regularly. And I would say the average acupuncturist has three to four of those that have the wrong value, which means 50% or more of the code you bill are undervalued, which means you’re just losing 50% of your income.

So what I’d like you to do is go through, do this for your ENM codes and not every code you don’t bill, all of them, acupuncture codes, probably heat like infrared or other ones. Bodyworker massage, pretty typical as well. And maybe a little bit of exercise. Now you might say, well, Hey Sam, I do some other services.

Fine. Do those as well, but realize you’re not going to do a bunch of these. And what I would like you to do with this is begin to break down the cost. So here’s an example, and this is just for California, Southern California, specifically for Los Angeles and orange county. Now this is something we do for our network members in seminar attendees every year is we give you the updated.

For Medicare, which of course means the VA. And you’ll notice there’s been an increase notice 9, 7, 8 1 0 last year was $40 and 7 cents. Now it’s 42 67. Now, is that enough to go? Oh my God, we’ve got a lot more money. No, but a 6% increase if you’re generating a hundred thousand dollars a year. Just on acupuncture codes.

That should be an additional 6,000. So you can see here a nice little jump. Now, remember these are just for the California rates. Every state, every county has their own rates. And again, if you’re a network member with me, or if you’re coming to an upcoming seminar, you will have access to all these. So, you know, the rates that way, you’re making sure that you’re getting paid the right amounts, because my concern is, if you build below these rates, what are they.

That rate. So you want to start to understand what is the value of my service, but let’s go beyond that a little bit. Here’s what I’d really like. You all to do, take a moment to create a spreadsheet, like what you’re seeing here. And you’ll notice what I’ve done is I just put some common codes for acupuncture from exams, through acupuncture, massage.

What I do with one column is put the RV use and then maybe the next column might be what’s your time of service discount. Maybe that’s your price for cash, you know, maybe. You know, five or 10% below what you normally bill, but then you have your regular rate, just regular. What I, bill insurance then of course, what I’d like you to do is go through from payers that have paid you in the last six months or a year and put down those amounts.

What does Aetna pay? Blue cross blue shield. Cigna. I guarantee you all have that. One of the things I do with network members is to go through this and say, Hey, look, let’s start creating a competent sheet. The realization. You don’t bill as many codes as you think. So you don’t have to do a lot, but go through that way.

But what if it isn’t a patient comes to you and they ask you because of course the next year we have the no surprise billing. Okay. What does my plan pay? Well, you can go to your chart and go, oh, your plan is going to pay XYZ dollars. And this is going to be your balance. What it also does though. It’s a chance for you to look to go, which of these are good or bad because as your practice begins to go into next year, what is your plan?

To really begin to maximize your office. One of the plans I would do is let’s do a survey of what is the better paying plans that we may deal with and how much are they paying now? By example, Medicare work comp are all standard fees. Most states have standard fees for that. So you can already put that in and at the very least I’d want you doing that.

So here’s an example with RV use. You can do a lot to determine your care. So by example, if you’re in the state of. The work comp rate in Texas, what they do is take this value 61 17 and they multiplied by any RVU. So by example, I can tell you exactly what the fee is for work comp in Texas for 9 7, 8 1 6.

Remember, it’s 1.16. So it’s 16% above this, or roughly close to about 67, maybe $68. Or how about if you’re in the state of Utah? What they do is use a conversion, but two different ones. If it’s an ENM code, they convert with a 56 conversion or 52 for other codes. So realize that the Medicare conversion is roughly $37 plus or minus depending on your county.

So that would be a starting point. And I’ll give an example. What if you’re admitted? If you’re in Michigan, what they do is they just simply take whatever the Medicare rates are and double them when it comes to personal injury. Now, one thing to be concerned with here is if you just double your rates on personal injury, that’s good because personal injury will pay you.

But what if you charge your other patients less? Remember you can have two different fees. So you’ve got to make a decision, even though I can charge double for personal injury. If you’re charging maybe only 1.5, that’s what you’re going to charge for them. What my suggestion is. Probably be at least 1.25 to 1.5 above Medicare rates.

Notice by example, the Medicare rates in for work comp in Michigan, they just take a conversion of 47 66. So this is where using RV use will help you. But take a look at this one. If you have a patient that’s with Boeing and particularly Boeing uses, and they’re employed with Boeing they’re blue cross blue shield, they sent a directive out this year.

What they pay is 175% of. So what if you got 90% of your patients with this plan and you’re billing a hundred percent of Medicare, you’re losing 75% of your money. Now keep in mind, maybe you don’t want to charge 175% because you still have a lot of patients that can’t afford that. So it’s going to balance somewhere, but my concern is, am I setting my fees off of my best insurance or best richest patients?

Or am I sending it off of my port? So I want to be somewhere in the middle there, but what I want more than anything is a competent fee schedule. If someone says, how did you determine your fees? You’re going to say, I use relative values to determine the value of my service. Tell me what an insurance will pay for one code, and I’ll tell you what they’ll pay for any other code, because relative values goes across the board.

As you can see here, by example in California, we’re comp is 1.2. And so simple way of looking Pennsylvania, 113% Florida, 200% for work comp. So lots of changes here that allows you to start to use this as a way to competently set up a fee schedule. And I’m going to suggest it’s the new year. Let’s start looking towards that.

Obviously, if you’re dealing with a VA patient, you’re going to get an automatic raise, but what if you don’t raise your rates? So what if you bill at last year’s rates, what are they going to pay you for next year? So you’ve got to make sure to bill the higher rate or bill your normal rate to make sure you’re getting the maximum amount out of it.

So here’s something I want to make sure everyone’s aware of. Do you know when we posted this, if you’re a member with us, you received an email on this Medicare fees. The deductible acupuncture fees increased six to 7%. Really good notice we posted this a month ago or thereabout. If you’ve not already go to the American acupuncture council network, Facebook.

And take a look at our Facebook page or in our site, just click on the new section. We update you there all types of things. The American acupuncture council wants to be your resource. We want to make sure that your claims get paid, because if you’re not getting. You don’t need our services. So frankly, we’re symbiotic.

We have to do a good job of helping you to make sure you have claims. We also offer a service. We call the network, take a look at our site, come to a seminar, be informed about information that’s coming out for you. Cause if you’re not informed about. You’re probably left behind. Take a look. We’ve got lots of live, meaning in-person seminars, upcoming, but also virtual.

So just pick the date that fits best for you because we have a vested interest in you. We want you to do well. That’s what we always give you this information. So I’m going to say thank you very much. Next week’s hosts are going to be Dr. Jeffrey Grossman. I wish you all a very good new year in a Merry Christmas, but also let’s plan and have a good prosperous 2022 see you next time.

 

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Are Vaccines Mandatory for Acupuncturists?

 

 

What’s happening, what’s mandatory, what’s mandatory. What’s not mandatory. What can I do? What do I have to do? And who can tell me to do it? So let’s go to the slides and let’s talk about what is mandatory and requirements for an acupuncture provider.

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 and the American Acupuncture Council Network and information network, as well as the insurance company, of course, and welcome to another edition of, to the point and how to make sure your practice is doing well. This time, the topic is not going to be on coding and billing, not this week because obviously with a lot that’s going on very timely because we’re now getting close to October is what’s going to go on with vaccines. What’s happening, what’s mandatory, what’s mandatory. What’s not mandatory. What can I do? What do I have to do? And who can tell me to do it? So let’s go to the slides and let’s talk about what is mandatory and requirements for an acupuncture provider. As far as vaccines are concerned, do I have to get one and who can tell me to get one?

So you want to think about who can mandate, well, several things. There can be a mandate by the government, whether it be the federal, it could be the state, even local. You might have a city or a county. And then of course also private businesses may do so as well. So we have to remember, let’s look at, to see who is doing it, what they’re saying we have to do, and whether or not there’s going to be compliance for it. Because one of the things that’s occurring is a lot of people have gotten misinformation about who’s doing, or when they’re saying it, who they actually are including. So let’s start work first with this misinformation and misinterpretation. So you’ll see here in July 6th, the office of the alphas of legal council mandated that they said, no, we can do vaccine mandate. So there’s nothing constitutional.

We can say, oh, well I have a private citizen, right? And so forth. Well, we have a lot of rights, but do you have to wear a seatbelt? You know, do you have to wear a motorcycle helmet in some areas? So it’s that type of thing. So be careful if someone’s saying they can’t do it, they can, we have to look at, are they mandating it for us to do it? So let’s go here and let’s talk about federally, what’s happening for Medicare. So you’re going to see here at president Biden, you know, back a few weeks ago, made this big statement about Medicare, that Medicare is mandating it and they have to in federal and everyone was up in arms like, oh my God, is it going to have to be something we have to do? Well, they made a mandate that it said, yes, the key is, does that include acupuncturist?

Who does it include? And it’s often says facilities and people wonder what’s a facility. Well, facility generally is going to be a facility that provides services within it, such as a hospital, skilled nursing, that type, not generally individual provider offices. So with that said, what about the Medicare part under the federal? Does that apply well currently, of course. And I’m sure you’re well aware. Can an acupuncturist join Medicare? No. So that means absolutely not. Now a quick note, is there a bill right now to get acupuncture, to be part of Medicare? Yes. So make sure you’re supporting it. But as of now, there is no mandate for acupuncturists to even be in Medicare. So we want to be careful. That’s not part of it. There is a mandate that for Medicare facilities and providers, hospitals, that doesn’t include individual providers fee for service providers. So let’s just say you are working in a Medicare facility like within a hospital or a big clinic there you might be.

But for most of us, we’re working in private offices. So even if we were in Medicare, we wouldn’t have to, in fact, look here, it says a spokesperson directly. And this was just a week ago. This regulation does not directly apply to physician’s offices. If these are considered regulated under the provider specific Medicare health and safety regulatory provision, generally referred to as a condition of participation. In other words, in simplest terms as an individual provider, even if you were treating Medicare patients in a private office, you do not have to have a vaccination. So the federal rule actually does not apply to everyone. Now, if you are a medical doctor working in a hospital, yes. If you’re a nurse working in a hospital, if you’re an acupuncturist working in a hospital and there’s a few of you, that could be, but so long as you’re working in a private office, absolutely not.

So that being said, let’s talk about the conclusion of this and really what it means. Acupuncture providers can’t even join Medicare. So the, the mandate really doesn’t match. The only way it would, as I mentioned, would be if you were working inside one of those facilities. So again, from the federal level, nothing to worry about as far as a federal mandate for an acupuncture provider to do a vaccination or have a vaccination. And remember when they’re saying vaccinations, they’re also referring to also staff. So let’s talk about another federal plan. I’m sure many of you have heard or seen the VA made an announcement that they’re going to require vaccinations. And so here is on July 26th, they said the department of veterans affairs, making vaccines mandatory to all VA health personnel, including physicians, dentists, podiatrists, optometrists, and even went so far as to say anyone doing veteran administration through the VA choice program.

And so of course, everyone’s like, oh, what does this mean? Is this something that it’s going to be mandatory for me? And of course they had to make a clarification because everyone were all upset. Like, no, and you’ll see here. It says, and this is something the VA has posted. They are not requiring community providers, which is where acupuncturists fit. If you are working in your office as a community provider on a standard episode of care, where they refer a patient, there is no requirement for you, whether you belong to the Optum on the east coast or try west on the west coast. Now they do say they strongly recommend that you should have the vaccine, but there is no mandatory requirements. So both on the federal level of Medicare, the federal level of the VA, there is no requirement for vaccinations unless you’re working within a facility doing those services.

So by example, there are acupuncturist who work in the VA hospitals, or work in the big VA centers for those acupuncturist. If you work there, you will be vaccinated as every provider within that. Heck if you’re a janitor in those types of facilities, you are going to have to do, um, a vaccination. Well, let’s move the next step. What about state rules can states make that happen? So the first one I’ll point out here is for California. Now this is just an example of one for California. The department of health first came out and said they issued a mandatory vaccine for offices. And of course, everyone was like, what lost their mind going crazy? And I always will say, make sure that you understand the full rule read in detail. You’ll notice here. They made it mandatory. But however it says, we have exemptions which include acupuncture offices.

And in fact, this includes all types of facilities that are not covered under this order. So this means acupuncture offices. And of course all the rest of these meaning chiropractic as well as natural paths and almost every individual office occupational therapy, okay. Optometry offices, podiatry offices, physical therapy places. So in other words, it’s really, again, kind of going back to the facility areas, not the individual providers, again, facilities. So California does not have a mandatory facility for you even first days. If you work at a theme park, some people that if I’m a theme park nurse, I have to do it. So pretty much exempt except facility. So I will go back to kind of California followed the mandate of the federal government, which said facilities. However, we have to be careful. Some states are pushing it. So by example here, what about the state of New York?

Well, New York has made a mandate that says as of August 25th, their regulations include a broad vaccine mandate for New York health care facilities. So again, I want to use this term broadly and say facilities. And so here are the emergency regulations apply to each of the following types of categories in the state of New York, which is going to be general hospitals, nursing homes, okay. Diagnostic and treatment centers, including without limitation, community providers and birthing centers, again, big places. And then along with that certified home agencies and so forth, but I will highlight again, home health in person hospices, but this does not include acupuncture, adult care. So notice again, kind of the facilities area of this. That is where it applies. But while California New York don’t what about the state of Washington? Now, Washington is a bit different now you’re thinking, well, Sam, I’m not in one of those states.

What I’m going to implore you to do is make sure to check your state. There’s only a few that are, but definitely Washington is making an issue Washington as had a proclamation by the governor that on August that they’re requiring it. And within this, this means that you are mandatorily required to have vaccinations. And it has to be by October 18th. So this status includes again, acupuncture offices. It includes every employee providing healthcare. So it means everyone in your office, which means this is going to be difficult. Every one of us has to be within this. And it does mean acupuncture providers are included. So Washington’s going to be a bit tough. Now, are there exemptions you might be able to have absolutely. There can be exemptions, but it’s mostly religious exemption. So I would be careful, I would say, make sure, make sure that you verify within your state.

Cause I’m going to tell you for Washington right now, they’re pushing the issue. Now what’s going to be interesting is how are they going to enforce it? Are they going to require each licensee to send information? And they may, well, what if you don’t send it, could they suspend your license for a while? Possibly. So something I would look at well beyond the state of Washington there, again, as I mentioned, there’s exemptions, but I want to highlight Oregon is doing the same thing. Oregon is requiring it by October 18th, as well with no exemptions other than religious. So again, know your state. So if we go down just the west coast, Washington, Oregon, yes, California, no New York says no, at least for us, but you’ve got to be careful. So again, on a state level, if your state is enforcing it, please look at your licensing board, make sure, check with legal counsel to make sure am I in a position where I’m willing to fight back on this or do I just have to get the vaccination?

That’s gonna be a tough choice for some obviously, well, let’s move on to the next thing here. If the healthcare provider works in a healthcare setting, they must register request accommodations for the operator, which means, again, be careful of these exemptions. If your staff says that they can’t be there certainly could be healthcare concerns that do it. If they have a healthcare issue that doesn’t allow them, but be very careful. Am I really doing things that are vaccinated? It says if an individual does not qualify for an accommodation, they must get vaccinated. And notice it says, testing, not allow. There are some states that will say, Hey, no vaccine, but get tested. California is doing that. But of course that means for us, it doesn’t matter. Cause it’s not a requirement. But if you’re working in a facility, they would require this testing. So others are pushing back.

Well, what’s the next place. Okay. So we went from state and I get I’m an employee to look at your own state. What about local employers? Can they do it? According to legal side, a private company is allowed to mandate vaccines. You know, kind of private company mandate a lot of things, dress code, and otherwise in the United States, you’ll see here in the second box, mostly our employers and employees are at will. And this employment means you can be dismissed for anything, which could be, Hey, you relate to times this week, but if you won’t get vaccinated, so it becomes one of those ones. If local is doing it, meaning an employer, they could enforce it. Now could you try to bring a lawsuit? I’m sure you could. But in the, between of the lawsuit, would they allow you to continue working? Probably not. So I want you to be very conscientious of knowing within the rules of what is having to be done.

I’m not finding for us, that’s going to apply as much because you’re the employer. But let’s say you’re employed by someone. What if you work in an office where you’re with an MD or a chiropractor or anyone else and they mandate, Hey, we want you to have that. Well, I’ll give you an example. Take a look at this. Does Disneyland. If you work for Disney, can you have facial hair? Do you know up into 2000 at Disneyland, you could not have even a mustache. Even though Walt had a mustache, Disneyland wanted to be clean cut and no one could have facial hair. So that meant if you wanted to grow a beard, you can, you’re just not working for Disney. And so Walt had one, but up into 2000, you could have a very small trimmed mustache. Now the rule is you can have facial hair, it’s allowed, but notice what they say.

Employees are allowed to have beards as long as they’re kept shortened and trim. So what I’m bringing this up for is that always understand who has the right to do it as an individual. Do you have a right to say, I don’t want to do something. Sure. But that could mean you don’t have a right to like come into the business. For instance, could you say, I don’t want to wear clothes and go into a store or I don’t want to wear a shirt. Let’s not even go that far to just say no clothes at all. And we all know that no shoes, no shirt, no service. So the same thing applies. What I want to make sure is I hope most of you were on board with this, but I will tell you many of you have not. And I’m going to ask you, where are you getting your information?

This is the webpage of the American acupuncture council network. And I want you to see, I put it in red here talking about federal vaccine mandates do not include acupuncture offices. We’ve put in three times this. So if you haven’t already go to the American acupuncture council network page, go to the new section and sign up for our newsletter. Cause we keep you constantly updated as to what’s going on. And I want to just as a little tease, do you see that one I highlighted in blue? It says ICD 10 updates happen. October 1st include new new codes for back pain. How many of you were aware of that? So a week from Friday new codes for back pain, are you on top of that? The American acupuncture council, we’re here to be your resource, the network, especially seminars, our network service. If you don’t have a place to get this information correctly, you’re going to be lost.

Remember the internet is not your friend when it comes to this information because there’s just as much bad information come to the trusted resource, go to our site. If nothing else, at least get into the new section. Because if you don’t, we’re going to have some problems. Please make sure you’re always set to understand what’s new, what’s changed. And we’re always that resource. So be careful. Do I have to get a vaccine on a federal level? No VA level, no. Some states, yes. I gave just a few examples. So make sure, and of course, if you work for someone, it could be from them. If you need to know more information about that, we are the place to go. So what I’m going to say to all of you is thank you very much. If you want the resource go to our website, it’s just simple AC info network. We’re going to help you. We do continue education and much more than that. And for next week next, our host will be Poney Chiang. Remember the American Acupuncture Council is always your resource. And if you don’t have the right information, you’re likely not getting paid. And of course we want you to get paid. See you next time, everyone. Thanks for being with me.