Click here to download the transcript.

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

Greetings, everyone. This is Sam Collins, the coding and billing expert for acupuncture for you, for the profession, for the American Acupuncture Council, and of course, for my AAC network members. Let’s talk about, have you really decided, how do I determine

Have you ever thought of what the costs are? As most acupuncturists, you’ve probably dealt mostly with cash and you’re charging one fee no matter what you’re doing. I want to start to do something that allows you to make more money in your practice by identifying your services and creating a true value to them.

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I can’t tell you how often I’ve had acupuncturists come to me and say, Charging a fee that is well below what people will accept. By example, if someone is willing to pay you 70 for a service, but you only charge 35, how much are they going to pay? 35 is what you charge. And I say this really from an insurance standpoint, because if an insurance is willing to pay you 70, but you only charge 30, they’re going to pay you 30.

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So have you ever really taken some time to look through your fee schedule to understand the value and what we’re going to focus in on what’s called relative value units. So let’s go to the slides. Let’s talk about that. Every single service. In CPT, any service you can provide as a licensed acupuncturist to a patient, that service has a value.

And that value is just to compare one service to another. By example, if one service has a value of 1 and another service has a value of 1. 5, It tells you the one that’s 1. 5 would be 50 percent higher than the other. So what I want you to do with this is start to really use just your fee for acupuncture.

If you tell me what you’re charging for your first set, I will tell you what the relative price should be for everything else you should do. And I’m going to implore my network members, in particular those that are viewing this, Make sure if you haven’t reached out to me this year to do so we can go through with you on a one on one Zoom on Establishing and understanding a fee schedule that’s specific to your area.

There isn’t generic across the United States It depends on your area. So I’d like to start this though with all of you taking a look at what is your current charge? Have you ever really thought what do I charge for stuff? I want you to write this down. What is your charge? For the first set, an additional set of acupuncture.

We’ll just choose manual for now. Keep it simple. What is your charge for a 99203? A simple mid level new patient exam. As well as 97124. Just simple massage. Nothing fancy. So acupuncture. mid level new patient exam and massage. How did you choose the fees? How do you know what one should be to another? What we’re going to focus in on is the relationship of one to the other.

Now, what we’re going to start with is what is your fee for 97810? Now you may think how do I come up with that? There’s things to do there. And again, network members can contact me about that, but I’m going to just keep it simple. What do you currently charge? If you tell me what you charge for a 97810, I will tell you what the other fees will be and what an insurance will pay.

Give me what an insurance pays for one code, and I’ll tell you what they’ll pay for any. Now I want to keep in mind, a lot of your managed care contracts don’t necessarily follow this. But, this is one of the reasons I don’t like managed care, but things that don’t. By example, workers comp, personal injury.

Even the VA follows this because I will tell you the VA and Medicare rates are much higher than what you would get from American Specialty Health in a lot of these. So I want something that’s going to make sense. So what this is about though is understanding the value of services. So on this page I’ve given some examples of the relative value units for common codes and you’ll see right in the middle I’ve included the acupuncture codes.

And you’ll notice 97810, 97811 all have relative values from one to the other. To make this the simplest way to think of it, if you charge 138 for the first set, I’m just making it an obvious example, what should be the cost of a second set? 80. Now you may think, wow, that’s a big, yeah, there is more than a 50 percent difference.

between the first set and the additional set. The first set includes more of the initial part of the visit, all the exam part. That’s why it’s a little bit more. And I’m going to warn everyone, this has gone up 20 percent this year. If you’re not aware, and you’ve probably seen it within the VA for those that are billing, there is a 20 percent increase in the relative value.

RVU’s updated substantially because I think they really looked at the cost. and value of acupuncture in relation to other services. So 97810 and 97813 both increased 20%. So if you have not increased your value of 97810, I’m going to let you know you’re losing money. Now, the value differences of 11 and 97814 did not change, but those two increased substantially.

By example, on a Medicare slash VA patient, That is literally 10 to $15 more per code. And remember that’s based on a $40 rate. The $40 rate for 9 8 9 4 0, which was fairly common, is now 50 plus in most areas. So start to look at that. But what this also does though, is give the relative values of other services by example.

Notice simple heat, infrared heat, 9 7 0 2 6. It has a value of 0.2. So if you think in relation to a 9, 7, 8, 1 0, you’re gonna think my goodness. That’s literally around 15 percent of that. So if you want to know the relative value of a heat lamp, it’s about 15 percent of the price of your acupuncture, which means that’s why it’s worth like 10.

I, in addition here, though, I have other codes, 99203, 3. 37. Now here’s something to look at notice 97810 is 1. 38. 99203 is 3. 37. Now, this is not exact, but what we all see here, that’s close to, if not quite, three times that rate. I’d say about 2. 6. What you want to start to think of is, what should be my price of a mid level new patient exam?

Two and a half to maybe 2. 75? Of the value of the acupuncture code. So if I’m charging, say 60 for a 97810, my price for a 99203 is going to be 160, 170, somewhere in that range. What I find often is a great deal of undervaluing. of the services. So here’s how we’re going to do this. Let’s talk about what you charge.

Let’s just make it simple. What if we were to charge 75 for a first set of acupuncture? I’m just using this as a random number, so that’s what your fee is. Great. I take 75 and I divide it by its relative value. So I take 75, divide by 1. 38, and it gives me this conversion, which is 54. This conversion number then is what we multiply any other code by.

To tell me it’s relative price. So if my first set of acupuncture is 75, notice the additional set 5434 times 0. 79 means 42. Now I’d probably round that up to probably 43, but needless to say, you can see here. Oh, okay. It’s not going to be the same price. I’ll give an example. I had an office that was charging 60 for every set, and they were paying in full for each one.

They’re thinking, this is great, Sam. You know what that told me? If they’re willing to pay you 60 for an additional set, do you think you have undervalued the primary set? You bet you have. So I want you realizing that this swings both ways, that you really want to start to have a reason behind the fees.

And again, with network members, I want to push you that. Let’s start to set this up, because here’s what I’ve learned. Most acupuncturists bill roughly 8 to maybe 10 codes on a regular basis. Exam codes, acupuncture codes, a handful of therapies. I find of that, usually more than half are undervalued. Which means Half of the codes you bill, you’re getting less money than you should.

So by example, look at the exam price. Now again, remember I said it’s about 2 point whatever above, but notice 54. 34, 183. So again, not quite three times, but you can see the range. But notice for massage. Massage has a higher value than the additional cent. Hence why that one is going to be 49. 99 or again I’d round up to 50.

Now to show you how this works, here is the fee schedule for Arizona. And I just picked Arizona. Obviously this is going across the U. S. and I have network members everywhere. Network members contact me, we’ll go over what’s in your state. But this is always a good starting place. This is the Medicare rates.

for the state of Arizona. And every state has this same breakdown. Now what I’m showing here though is the Medicare rates notice for the acupuncture codes, exam codes, but let’s do the math here to show you how RVUs work. Notice the value in Arizona Medicare is 43. 86. By the way, last year that was like 35.

It’s gone up substantially. So I take 43. 86, I divide by 1. 38. It gives me a conversion of 31. 78. I then take that number, 31. 78, multiplied by any other codes RVU to give me the price. Now notice how this works. 31. 78 times 79 is 25. 10. Do you notice the fee for 97810? 25. 17. I know it’s off a few pennies, but you get it’s in that range.

Notice 3178 times 3. 37 for 99203, 10710. Notice 99203, 10695. Again, within 15 cents. 3178 times 0. 92, the value of a massage, 2923. Notice the value of massage. So you may want to start to realize that, oh, this is exactly how insurances do look at fees, particularly when it comes to personal injury and non managed care.

Now here’s what’s further interesting. My general rule is An office probably wants to be maybe twice the Medicare rates as a typical fee. Now, I’m not saying necessarily that high But that’s a starting point. I would say maybe even 1. 5 But here’s where I bring this up in Arizona for workers compensation and let’s face it.

Would anyone say? Oh, yes, the workers compensation fee the mandated fee is the highest fee in the state No, it’s not but notice the conversion in Arizona is 68 So instead of being 3178, it’s 68. So think of it 97810 has a value of 1. 19. If 68 is your first, or you’re going to use 68 conversion, the worker’s comp rate is going to be, oh wait, 68 times 1.

19 is about 120 percent of that. You’re thinking that first set then is going to be around 80. Yeah, what would the additional set be? 68 times 79 or 80 percent of that take off about 13. Again, right about 52 or 53. Please be careful of undervaluing. If you are billing 50, And a carrier is willing to pay 80, but you bill 50, you’re going to get 50.

So be mindful that if someone ever says, how did you come up with a fee schedule? Have a real reason Not based on what my friends have been doing. We don’t know what your friends are doing. We’re right. Your mom told you that Did you ever get away with it when you said that’s what Johnny did, mom.

Mom’s not going for that. We don’t care what Johnny does, what we do at my house. So network members, I’m mom right now. I want to know, what are you charging? We can go through it. Make sure you set up a zoom for that. I want you to really start to realize, make a competent fee schedule, not a guessing fee schedule.

And that’s what too many of you do. And that’s why a lot of acupuncture struggle. I want to end that struggle. By setting up a good sound fee schedule now bear in mind when you sign a contract With an insurance company you’re accepting the pay less. That’s why they like you to sign up By example, if you sign up with UnitedHealthcare, what do you get?

About 60 a visit. What if you don’t sign up with UnitedHealthcare, what do you get generally? About 100. Same might apply with Cigna. Now ones that are HMOs, maybe we want to, but others you may want to rethink it. So to help you do that, what I’d like you to do is take a moment, and this is, this is not just for my network members, obviously this is for everyone, Use this QR code.

Go in here. You’re going to send us some information of what is your fee for 97810, where they’re going to send you back the calculations of the codes that we just showed you based on your fee for 97810. See if it makes sense, but I’m going to warn everyone. Be careful if you have not increased the value of your 97810 this year, you have flat out lost money because it went up 20%.

That doesn’t mean all managed care, but for everything else. As always, we want to make sure that your practice does well. Network members especially, I’m going to emphasize, if we haven’t done our meeting this year on fee schedules, get in contact with me. Let’s get moving. For everyone else, make this a good starting point.

Maybe I’ll see you in the fall for a seminar to make sure you really can make sense of it. Or how about this? Join the network. Make me part of your staff. Let’s work one on one. As always, everyone, I’m going to say thank you for taking some time with me. We always want you to be successful because your strength is ours.

Take care all.

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Let’s talk about what is going on with UnitedHealthcare. I’m sure many of you have received or have seen the letter that indicated about what changes you have to make.

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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.

Hey, greetings everyone. It’s Sam Collins, the coding and billing expert. American Acupuncture Council and specifically the American Acupuncture Council network members. And I’m really appealing out to you as well. Not just that we’re not sending it to everyone, but I wanted to keep you updated on what’s new and changing.

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As we always promise, we want to make sure you get the information first, have the right information, can use it. I know a lot of you have probably gotten the UnitedHealthcare information about, we have to build differently and put the GA modifier. I wanted to help attempt to make this simpler, more easy to understand, and kind of.

Boil it down a little bit. So let’s go to the slides. Let’s talk about what is going on with UnitedHealthcare. I’m sure many of you have received or have seen the letter that indicated about what changes you have to make. I want to make it even that much simpler. Here’s what’s happening. Beginning February 1st.

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So starting this month, they want all acupuncture providers must bill UnitedHealthcare for all services they’re providing, even if the services aren’t covered. Now, for the most part, let’s be realistic. Probably you’re billing out mostly acupuncture. There isn’t a lot of services that you’re doing that aren’t covered.

But let’s just say there are services that you’re doing that’s not covered. They’re saying now they want it to be billed. So they want these non covered services to be billed, even if they’re not payable. And this will make an added step from what you normally have been doing. Now, keep in mind, the added step is just you’re going to add it.

The reality is, the No Surprises Act, as a lot of you are familiar with, which has been a couple of years, requires that all providers make patients aware of what their costs are. I think acupuncturists have always done an excellent job of that because that’s the number one question every has is how much is it going to cost?

So what this means is you’re going to make sure not only to do that with patients, make sure what they know, the cost are what’s covered and not covered. But more importantly, what’s not covered. We have to make sure the patient’s aware, like by example, if you’re doing cupping or moxibustion, you want to make sure to let them know, okay, this cupping service is not covered.

And therefore, it’s 25, whatever you charge. So again, think of it now, if it’s a therapy, therapies are for the most part covered, so it’s going to be the services that are not covered. Remember, contract and so forth will come into place. If you’re contracted and it’s bundled, it will be. So again, this is going to be services that they normally do.

Do not cover and the patient will be liable for it’s not going to be very many, but there may be instances where this come up. Realistically, this is should be something you’re already doing. Of course, every patient should be aware of, okay, if your insurance is going to cover, what is it going to cover, but also what is it not going to cover?

So therefore the patient understands what they’re having to pay. That’s again, part of your financial agreement. I hope you’re all already doing that to some extent. Now, what does this mean for non covered services though? I’m going to tell you for the most part, I’m going to look at things that are unusual.

Obviously, massage, manual therapy, exercise, heat, those are all covered. But services that aren’t covered, I’m going to put in cupping and moxibustion as being the most likely. Those are ones we’re going to have to outline. Now, by chance, let’s say the policy doesn’t cover therapies. They’re not bundled, then you would include therapies as well.

But for the most part, I’d say they’re covering therapy. So again, non covered services. And what does this apply? And this is where people are confused because it says commercial plans. So you’re wondering what’s a commercial plan? You know what a commercial plan is one that a person buys or they get through their job for the most part, you know, they get as part of their employment.

The only place that doesn’t apply is ones that are called self insured that are just managed by United healthcare. These would be. big giant employers, you know, large union groups and so forth, which aren’t that typical though. Obviously, if you work with a lot of people in those, you might run and cross it, but it’s going to be generally the commercial plans.

One patient’s purchase themselves, get through their job and Medicare advantage plans, but it doesn’t include if it’s self insured. So it is worth asking when you’re verifying. Is this a self insured plan? Because if it is, then you don’t have to do any of this. Again, I don’t see this as very hard. What do we need to do?

We need, oh, did I hit the wrong button here? I apologize. What we need to do is to make sure a few things. Number one, when verifying UnitedHealthcare, inquire if the plan is a commercial or Medicare Advantage. If it is, we have to do this. Now, again, I’m going to emphasize, this should be something you’re already doing.

You should already be making the patients aware of cost and what services aren’t covered But this is now something they want a little bit more detail for them You’re going to complete a financial understanding with the patient with an estimate of cost which means your cost So let’s say you charge 25 for cupping you would indicate this cupping service is not covered and you would indicate something as simple as It’s not covered because it’s not part of your plan.

Your plan may not consider it medically necessary, but anything like that, the bottom line is make the patient aware it’s not covered and they’re paying out of pocket because in order to hold them liable, the plan now is saying their requirements to do that. It says there identify if any. If any are not covered and include a statement.

So some services are going to be covered. Your acupuncture is covered, but services that are not identified and simply again, state it’s not covered or may not be covered. What you’re doing is making clear. You’re not promising them that it’s going to get paid. It is non covered. Now this brings up, what if you’re doing acupuncture and the acupuncture is not covered, you would do the same for that.

I don’t believe we’re billing too many like that, but just in case, then what you’re going to do is bill for those services. Now in the past. We’re pretty much never required to bill for services. They weren’t going to cover. They’re just liable to the patient now What they’re wanting is that we do bill those services to the insurance What we have to do uniquely though is bill it and then put modifier G a so that’s G as an apple Or excuse me G as in George a as an apple and what you’re doing with that is simply indicating that the patient has signed a waiver meaning that financial agreement where they’ve agreed They’re responsible.

What this is really doing is putting in place that patients are never going to be surprised They know what it’s going to cost in addition the insurance now when you bill in this way They’re going to send the EOB back to the patient indicating what they’ve paid for But that service such as cupping like nine seven zero three nine or one three nine would indicate as patient Responsibility and at the fee you’ve charged and remember that fee is the fee you want to charge It’s up to you.

That’s your cash rate. Whatever your fee is and the patient’s paying. That’s all you’re putting there So is this a little bit of a hassle? Yeah, I think so Um, it’s only a hassle in that we need to bill it. Everything else is the same You still have to inform patients you’re doing a service not covered You start to make sure they understand the cost of it.

Now the only difference is that we also have to put it on the claim and when we do so just put it with the GA. So let’s say it’s a therapy this this plan doesn’t cover a therapy. Okay, we would indicate that therapy with modifier GA. Keep in mind it’s not required for services they pay for. This is only for services they’re not going to be paying for.

So they’ll process it and then they’ll indicate patient responsibility. So let’s kind of get back at synopsis here. Let’s go, what’s going on? UnitedHealthcare commercial policies for acupuncture. You are now to make sure a patient is fully aware of services that they’re going to cover, but also not cover.

That’s not different. We’re to make them aware of the cost of the services, whether they it’s covered or non covered, which is also not different. So therefore that’s all going to be the same. That’s something I think acupuncturists do a good job of. Haven’t you always made sure your patients know the cost?

This is just making sure it’s memorialized, if you will, the patient signing it. And now we’re going to bill it. With a GA, if it’s a non covered service. So just a GA. Now you might be saying, well, what type of form do I have to have? It’s going to be a pretty straightforward, simple financial agreement.

Where you would indicate, these are the services we’re being provided. This is the amounts. And here’s the cost. And also indicate if it’s non covered. Now if you’re a network member with me, AAC Network, just contact me. We do have some samples. If you’re not a member, I apologize, but that’s not available to you.

That’s why we do the service. At least you’re getting the information. But for those that are members. get in contact with. We have a couple of examples. It’s not that complicated, but want a straightforward statement that the patients know it’s not covered. Here’s the point. It protects us. Therefore, a patient can’t come and say, I thought it was gonna pay.

You’re gonna point out. No, we said that at the beginning, and so I think it eliminates a lot of that issue. However, there is an extra step. Yes, you’re gonna now have to put everything on the claim. Part of what United Healthcare is stating they want to see the services that are being provided. What my hope is is that they start noticing that, wow, this cupping service is popular, moxibustion, maybe it should be something that we’re covering.

At least that’s what I would think. So, that’s the change. Non covered services, make sure patients are aware they’re not covered, the cost, put them on the bill. Patient still responsible. Nothing crazier than that. Again, if you’re a network member, get in contact with me. If you’re not a network member, the whole reason I’m doing this is to get this out to our network members, though it’s going to everyone contact me, let’s get you started on into the network.

We’ll give you a lot more help. In addition to that, though, we can give you a day to day help as well as forms and other things. We’re here to help. So for all of you, I greet you and say thank you for listening for a few minutes. I hope to see you at a future program as well. Take care.

 

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I always want to keep you updated first of the year on what’s changing, what’s new, and there’s been things that are changing for this year regarding telemedicine.

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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 there friends, it’s Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and most importantly, you as a profession and as an individual provider. As always, we want to make sure you have the most current information to make sure your practice is thriving. And actually just making more money, if you will, or continuing to make more money is our hope.

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I always want to keep you updated first of the year on what’s changing, what’s new, and there’s been things that are changing for this year regarding telemedicine. Now, I know you’re thinking, is telemedicine something that we do a lot of? Maybe not, but I want to point out there’s going to be a place for it.

So I think it’s important to know what these new codes are. So let’s go to the slides. Let’s talk about telemedicine for 2025, because there was a whole new brand set of brand new set of codes in the old system. And when I say old system for 2024 earlier, when we built telemedicine, it was always for. E&amp; M codes.

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And then we build with a modifier 25. That has changed. For this year, they’ve updated. But let’s make sure first that we define what telemedicine is. Let’s make a clear definition. Telemedicine means that the provider uses interactive audio video telecommunications between you and the patient, which means literally a live visit.

It’s just audio video. That’s all just live. So in other words, it is a face to face visit. It’s just a face to face visit done online. I think that’s very viable in this day and age. And I think, though, that really started during the pandemic. I think it’s really stuck because we’re going to move that way anyway.

Think of how often with a medical provider, This is going to save a ton of time because how many of us have been to a medical provider? They don’t touch you. They just sit on the other side of the room. Shoot We should have done that audio video better for everyone. That potentially could fit for us as well in certain circumstances But do remember it’s live audio video and here’s probably the bigger Sticking point for many of you because you’re thinking oh good.

I’m gonna do herbal consults across the nation I’m going to, I’ll slow down. You have to have price, proper licensure. And it says here, make sure you are licensed both in the state where you are located, obviously, but also where the patient is located. So by example, if you’re in California and you’re trying to do a telemedicine visit for someone in Texas or New York or someplace else in California.

You not as a licensed acupuncturist. Now, this is irregardless of if you’re billing insurance, frankly, because you cannot practice in a state you’re not licensed. If you’re saying you want to do some type of herbal consult outside of your state, you’re not doing it as an acupuncturist, you’re doing it as an individual, which means you have no protection.

You’re not, you don’t have malpractice, something goes wrong, it’s on you. I’d be very careful of that. The key factor here is, I think if you’re going to do this, do it for patients that are here because Maybe they have difficulty coming in. Maybe your first visit is going to take an hour because there’s so much information you’re going to do a long consult with them.

Telemedicine might bridge that, so that way when they come in the office, you can get right to it. And or, maybe they don’t have that much time. What about a patient that goes I can’t get off work until this time, I can’t be there. Okay, let’s do some of it, telemedicine. So here’s what’s changed for 2025.

We have some brand new codes and you’ll see these codes. It’s 9800 through 98007. And what these are for. is telemedicine, but you’ll notice they are E&amp; M codes. You’ll notice it says, Synchronous audio video visit for the evaluation management of a new patient, which requires a medically appropriate history and examination.

Straightforward in nature. That’s literally the same thing as an E&amp; M code, except it says synchronous. So in other words, think of these just like E&amp; M codes. 9 8 0 0 0 will be a 9 9 2 0 2, the next one a 4, 0 5. And so much the same way, and I think the easiest way to see these is it’s going to be based on time.

A 15 minute audio video visit, 9 8 0 0 0. 30 minutes, the 0 1. 45 minutes, 02, 60 minutes, 03. And I do think you want to caution that it’s not always going to be about medical decision making, though it could be, which exams mostly are. But if you’re doing a telemedicine with a patient and it takes an hour because of all the information, is it appropriate to use 98003?

Absolutely it is. So don’t be afraid to use it, but document it the same way. You’re going to document I spent one hour over audio video. Tell me the system you use. Tell me the date and time, but you don’t record it. You don’t have to save it somewhere. And it’s going to be all the information you take.

And it’s going to be the same stuff you would take down if they were sitting in front of you. Their history. And maybe some of the evaluation. Now when I say history, realize that’s going to include past history, family history, review of systems, all that stuff. But can it include some exam things? I think at least some.

Could you do potentially a tongue evaluation over audio video, get it close enough to the tongue? Probably. I’d be worried about color a little bit, depending on the cameras, but I think we’re okay. Could you certainly do a range of motion? I think so. Now, could you do tongue and pulse and body palpation?

No, but I think this visit often is going to be one based on a lot of counseling, a lot of history and information. So these are new patients. And these are established patients. They work the same way, just about time. I think time is the more likely use. Here’s the difficulty. How much has this happened in your practice in the last year?

If you’re saying none, it’s probably going to happen none this year, because I think we have to promulgate this. I would say, let’s say you have a patient, they’ve had a car accident, they’re coming in from a medical referral, and you talk with them and you say, hey, we’re going to have to block an hour. for this.

And the patient, Oh, I don’t have an hour. I don’t have an hour until I can come two weeks from now. I don’t want to wait two weeks. Let’s do an audio video. Let’s start there. Now you may wonder what is the value of these? They’re much like the value of a regular E. N. M. They’re slightly less. And by the way, next month we’ll do a program.

The program I do will be on our views. So we’ll go over that. But I’m gonna tell you, it’s roughly 80 percent of what you would build your normal E. N. M. S. There’s no modifier necessary because there’s no treatment. It’s just this visit and what if a visit where the patient’s calling and just goes, you know what?

I need to discuss with you. I’ve got these issues. This visit could be counseling. These could fit. I would just be mindful. Make sure it’s a plan that covers exams. Here’s one of the problems we’re having for acupuncturists. A lot of the plans that you have joined as a provider, you wind up getting into a contract that says we don’t cover exams.

Now, that doesn’t mean you shouldn’t do them. They’re just saying they bundle it and don’t pay it separately. I know a lot of you know what I’m talking about. That’s an upcoming show as well. Anyway, what my point is that be careful. If they’re not covering an E&amp; M code, they’re not going to cover this.

So it’s got to be a plan that covers an E&amp; M, but I do think this is reasonable in some instances. Realistically though, let’s talk about acupuncture. While I love the availability of this service and the potential to use it, I think there’s a place for it. Is that the way we really want to treat someone?

Is that how we’re going to make them better? Let’s face it, in acupuncture, what you do is hands on. You get in the room, you put in needles, because without needles, you can’t talk me into feeling better. Sorry, give me some advice. But the reality is it’s the acupuncture, it’s what you do, but this can be a bridge.

So focus really on the acupuncture part, but this bridge might work for some, I can tell you major carriers, Anthem, Cigna United Healthcare, they will cover this. Just, again, go back to wait a minute, what does my contract say if I’m part of ASH? Maybe not. Now, there’s also new codes for 2025 for telephone calls.

Now, I say telephone calls, actually, what these are called are synchronous audio visits. Now, the reason I say telephone calls is because I’m old. Young people think, no, I don’t need a phone. You can do it through lots of devices. And so realize, though, it does mean just audio only. Now, these work in the same way as the old phone call codes.

And let me be clear. Remember those old codes for phone calls that you had? 99441 and so on? Those are gone. They don’t exist. But let me be conscientious when it comes to a phone call. Phone calls aren’t very typical. Because phone calls are difficult. A phone call that results in a person coming in for a visit or has been seen within the previous 7 days.

is one that they’re not going to cover. And so make sure we understand that. But they are straightforward. 15 minutes, 30 minutes, 45 minutes, or an hour. Okay? That’s a new patient. We have telephone audio visit here for established patients. You know where this probably works though? You have a patient you’ve treated.

It was two weeks ago. They call you and go, oh my god, it’s killing me. And you spend 30 minutes on the phone and they can’t come for the next month because they’re going to go out of town. That could work. Now notice the scenario I gave because if the result of this phone call is a visit is being appointed, then it becomes part of the visit.

So phone calls aren’t going to be well paid because let’s face it, no one’s going to call. You’re going to go, Oh, just do these acupressure points. I’m not saying you won’t do that. Chances are you want to get them in for a visit. So I point this out because it’s important to know, because you’re going to hear people saying there’s codes changed.

And it’s true, but we have to look at what’s the viability of use for us as providers. Is it really viable? And I would say for most of these, in this sense, probably not. It even applies to this new one, which is called a virtual check in. I had someone the other day as acupuncturist, that’s why I decided to do this.

I want to use this code because the patients are sending me emails. A check in is not an email. A check in is when you have an electronic health record system. That’s protected HIPAA compliant, where the patient logs into their account and then checks in with you with some information that maybe you’re communicating back and forth.

You can tell now, that’s probably not viable. One, I don’t know of a system that’s out there for us that does that. Some medical ones do, but the ones for accus, I don’t see that too often. I’m not saying if you have one that does, great. The problem is going to be, notice it says, provided within the previous seven days or procedure within the next 24 hours.

So in other words, if the result of this is again, treatment. Or, was within seven days of a prior visit? Does not count. So being mindful here, when it comes to use of these, do they really match? Because chances are when someone does a check in or a phone call, what is it going to result in? The person coming in for a visit.

So let’s be careful of being overzealous, but focus in on what we do well. What is the reason that people come to you to receive acupuncture if you could talk them into feeling good? You would have done that already or they wouldn’t need to see you It’s the acupuncture where I think this is helpful is to understand that there can be a bridge Particularly the audio video one that helps the phone call thing or you know The audio only is what I think it helps to get them in the office in that few minutes of counseling though You’re not billing for it directly Indirectly, it’s creating that good patient doctor relationship.

They trust you and you’re giving them solid information. The good news is, your practice continues to thrive. Next month when we go over RVUs, I’m not sure you’re aware, do you know your fees for the first set raised 20%? And that’s where I want to make a focus. So as always, we want to be the place where you get the right information.

The American Acupuncture Council has a very vested interest in all of you. Please make sure you continue to practice well, but I also want to make sure you’re profitable. If you’re not already, go to our website for the network. Take a look there. We’ve got a lot of information to always keep you updated because as always, your success is ours.

Until I see you next time, be well, my friends.

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Click here to download the transcript.

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

Happy New Year and greetings to my friends and colleagues. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and more notably, you and the profession. I’m here to help you to make sure that you get information that keeps you up to date and moving and there’s nothing better to get knowing what’s going on than let’s get ready for 2025.

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So let’s go to the slides. Let’s talk about are you ready? for 2025? Are you really setting yourself up? Realize this is that first week, so everyone’s back in. Let’s get things ready. Let’s be proactive, not reactive. So the first thing I will tell you to do, you want to start thinking if you’re doing any insurance, but for that matter, even cash, we’ll get into it.

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Are you prepared? For insurance, I would say prepare for understanding What’s going on for plans in 2025? Is anything changing? It’s time to go back through to see what’s new for certain plans. Now, keep in mind, if I have one person that works for a company and has insurance A, another patient that comes in from the same company with the same insurance, I don’t have to go through all of that if I do one thorough way of going through that policy on one person, so long as everyone has the same policy.

So the first thing I want to look at is, What’s going on with deductibles? Has there been any changes for 2025? Did it increase, decrease, stay the same? By example, though acupuncturists don’t directly bill Medicare, you’re involved now. The Medicare rates, of course, did make a nice increase. We’ll get into that.

But the Medicare deductible did go up 17 to 257, which means if Medicare went up, might other plans. Yeah, that’s a hit and miss, but check. One thing I’ll point out though, that a lot of times acupuncturists are not familiar with, however, is that deductibles may roll over, meaning that they will not have a new deductible at first of the year if that person saw a doctor in the last quarter, and what this means is, let’s say by example, you don’t go to the doctor at all.

You’re a patient, and in December you go to the doctor, you have a $1,000 deductible, you have to go and you meet that deductible. Then January 1st sits and you’re like, oh my God. I gotta pay the deductible again? I just they don’t punish someone in that way. Most plans will have some type of rollover for a person who’s seen the doctor within the last part of the year.

So it’s worth checking. Often that may not be the case, but it’s worth looking into. So I would check to make sure. Most importantly, We want to know deductible so we can make patients aware of what they’re going to pay. And keep in mind, we also want to check on not just deductible, but what’s happened with any coverage.

Has there been any changes to the benefits? Is the acupuncture benefits better, worse, or the same? By example, a lot of people have said, Sam, I heard that the Medicare Advantage Plans were getting rid of acupuncture. They were not. So long as the person has the standard one that has what we call gosh, I gotta think of the term, but it’s where you’re going to have just a acupuncture benefits that are there all the time.

Realize all plans under Medicare have the regular benefits, meaning, MD supervision, but for those that have routine acupuncture, it will cover for pain management. Look to see if any of that’s changed. Many of them may or may not have it, so always check. Don’t assume. Regular Medicare did not update.

You will still need for regular Medicare Part B medical supervision. Do check though, because this is something that’s occurring with some of these Medicare Advantage plans and others, is the requirements for pre authorization. Many of the Medicare Advantage plans continue to have it, but the ones under United, at least some of the plans, and others under Humana, will require pre authorization, which means they all allow you to do the first visit, but then you have to request more after that.

Not that it’s that hard, it’s all online, but it’s just something to know. You don’t want to bill out assuming it’s being paid and they later say, oh it requires pre authorization, because often they will not do a retro authorization. So do check to make sure what are the coverages, what are the changes, are the number of visits the same.

Are they combined with anything? Is there any limits? And this is something to keep in mind. The limits to acupuncture benefits under insurance are limited to what are they covering under the diagnosis they allow. By example, Cigna has probably a 500 code list of things they cover. Aetna has a list that’s about 25.

So you can see clearly one more that’s going to have a little bit more or possibly more. So know what those plans cover. Don’t assume. Some plans will cover fertility. You want to check to make sure it does it. And here’s my point. Get as much information about beforehand so we can make sure that we understand what’s going on with what are we going to bill and how we’re going to be paid.

Because one thing to look at is what’s going on for fee schedules for this year. And I want to talk about just your common CPT codes. I don’t care about things you don’t do. Most acupuncturists, of course, are going to do exam codes, E&amp; M codes. Acupuncture, of course. And then maybe a handful of therapies.

What I care about are those codes. Here’s some really good news. The relative values For the first set of acupuncture, both manual and electrical have increased substantially. For most of you, if you’re billing the VA, this literally means you’re getting about a 20 percent increase in that allowed rate.

That’s pretty significant, which means that may roll over into other plans because plans that use Medicare, which include VA, Personal Injury Work Comp, et cetera, will be increasing. Now, the downside to this, of course, It’s not going to affect your ASH. It’s not going to affect your Optums. Now, if you’re part of ASH, certainly if you’ve been in a while and you’re a tier six, I will be looking for, have I done a protocol to ask for a raise?

That’s something to be thinking of, but do take a look and think of, wait a minute, how much it’s increased. Now be careful. Relative values tell you what to charge from one code compared to the other. So I want everyone to start a little bit differently. Literally, you’re going to see a large increase. in the first set.

If you want to get more details of that, I’m going to tell you. Come to our seminars with the American Acupuncture Council right at the end of the month. Keep you updated there. If you’re a network member with me, just get in contact with me. I’ll get you set up. But really, this is a significant difference for you, particularly when it comes to things that are related.

VA, of course, but everything else related, which is going to be and so forth, which means prepared to understand. W for this year? What type do we have in place? Make are always aware of your think of what’s the numbe ask beyond if you can hel

Make sure you get something new for the year. Now, if someone’s on an ongoing care plan, they started in December, I’m not concerned, but someone coming in new this year, always have them sign a new and updated financial agreement so there’s no surprise. That’s why we have the No Surprise Act. Make sure they’re aware of what their costs are going to be for what services are covered.

And maybe some services that are non covered. By example, on some ASH plans, they don’t cover massage, which the patient can be charged for. Therefore, we got to make sure they’re aware of it. The bottom line is, just like for you, if you go someplace, you want to know the cost, make sure your patients are aware of their cost as well.

Which means, are you doing anything financially with How do you set up properly for a cash discount? Outside of California and Minnesota you got to be very careful. They allow some big differences but for most states you can make a 5 to 15 percent so if your rates raise up that should be the same thing for cash.

But what about prepays? I do think prepays should be something that every office offers. I’m not going to say it’s absolute that every patient’s going to want one, but I’m going to tell you some patients are. And it’s a good way of creating another revenue stream because people can see it as affordable.

And remember, prepays allow you to discount more than a 5 to 15%. Now what about your assignment of benefits? Remember, patients need to sign a new assignment in the new year. They want one up to date. If you’ve not seen someone in a long time even, Make sure they’re signing a new assignment. What is the assignment?

That just tells the insurance company, pay the doctor. This is something many of you may have gotten letters asking you about that for the VA. Not a big deal. Should always be on file. I would just make it at first of the year. As patients come in, they sign a new assignment January 1. Which means we’re always offering compliance.

Our compliance when it comes to HIPAA. What have you looked there for a while? Have you seen, is my privacy notice up to date? Does it have everything that I do? Which by example, Almost everything is open. What if you say, Hey, I want to make phone calls to remind you about appointments. There’s nothing wrong with that, but in order to do because that may not be private, the patient has to give permission that, oh yes, you can call and leave a message, because that line may or may not be private.

So keep that in mind that if I’ve not done anything to update, have I looked at it? Do I have all the things in place? Do I have business associate agreements? Who am I working with, whether it’s a billing service or an electronic record company? Are they all HIPAA compliant? They should be, but make sure you’ve got things in place protecting ourselves.

Now, what about your office policies? Things that you do in the office. There’s nothing wrong with updating those. And I would say two things to look at. Do you have a no show policy? Some offices like to have those. If a person doesn’t show up, do they get charged? Outside of the VA, you may do so do keep in mind, if you have a no show fee, make sure the patients are made aware beforehand.

What about credit cards? There’s nothing wrong with obviously taking credit cards, debit cards, but can you charge extra? You can, but let’s be careful. It’s not a percentage. You could have a fee that says, if you choose to use a credit card, there’s an additional 1, 2, 5 transaction fee, depending on the amount.

Now, and what I mean by that is, you’re going to charge 5. If they’re only charging 15, that seems a little steep, but what I’m getting to is having a fee. What it has to be a separate from the charges. You can’t say the more you charge, the more of the fee, but there could just be an allowed rate.

That’s allowed so long as patients are told beforehand. Make sure, of course, too, you have consents on file. If you’ve not seen a patient in a while, if you’re seeing them from, an ongoing plan from, November, December to now, I think we’re okay, but if they’re coming in with a new care plan, they need a new consent.

Okay? Make sure also that you have the difference between covered versus non covered. Okay? The patients know what is covered, but what is not covered, I want to make sure they understand that’s going to be out of pocket. They’re going to understand that. I want to make sure if we’re doing cash or prepay, the compliance is we have things on file so that no patient comes back and says, I’m upset because I don’t feel it was fair.

Now you may think I never do insurance. I’m not worried about that. Realize. You can get complaints and other things from the board based on this if a patient makes a complaint. Put things in order. Have them to make sure all the agreements are there. And do remember, it’s always documentation, whether it’s going to be financial agreements or what you’ve done for treatment.

And again, I don’t care cash or insurance. If it is not written down, it didn’t happen. So make sure the documentation has what’s going on. A quick review of what you done. You know what a SOAP note is? The S. A review of the chief complaint. and how the patient is changing as a result of care. Is it better or worse?

In other words, it’s what they’re telling me, subjective. The objective is, what did you find? The tongue was coated. The pulse was wiry. There’s muscle spasm, loss of range of motion. And then your assessment is nothing more than your diagnosis. And then from there, your treatment. So for acupuncture, and this is the area we run into the most problems when we deal with audits.

Remember, if you have insurance through the American Acupuncture Council, you have audit protection. So if you’re audited, they’ll help defend you, but it’s hard to defend because if you don’t document what you’ve done for acupuncture, please make sure you’re documenting the time you spend face to face with the patient, as well as the points of each set.

And remember that 15 minute, or if you will, 8 minute rule that follows. If you’re doing therapies are fine. Just make sure that the therapies are documented properly. What am I doing? Where am I doing it? You can’t just check off if I did infrared heat. But tell me, oh, I did infrared heat to the lumbar spine for 15 minutes.

Again, not very complicated, if you will, but document it in a way that it can be seen when what was done. And again, if it’s timed, make sure time is there. When you’re doing an exam or E&amp; M code, are you making sure that if you’re billing a 99203 or a 202, is that clearly the value? A 202 would mean that you spend at least 15 minutes, a 203, 30, or at least one complaint or multiple complaints with strain and sprain.

Make sure that if you’re billing a code, know why. If you’ve never attended a seminar with me, I’m going to encourage you to go, what is the requirements for E&amp; M? I think a lot of times people really misunderstand that. And I’m going to emphasize time. Acupuncturists do spend a lot of time. Document it.

There’s a value to you. That’s getting you prepared for 2025. Document what you’ve done and ultimately the patient getting better. Your practice thrives off of people understanding and having access to you. The understanding Is this going to help? Then they come in and go, wow, that did. There’s a value to that.

Make sure people understand that. For me, the biggest difficulty for acupuncturists is getting yourself out there. Being prepared for 2025 would be, if I have back pain and I’m looking for an acupuncturist, how am I going to find you? Have you set up a network of people that refer? Does your website do it?

Does the signage in front of your office when I pass by, does it let me know what’s going on? Practices thrive based on, of course, patience. And we thrive based on you. We’re here to be your resource. The American Acupuncture Council, of course, more than the malpractice side, I deal with the network side.

We’re here to help you. One on one, a resource. By example, are you aware of what’s happened with the fee schedules? I’ve given you a little bit of that. What about new codes for phone calls and telemedicine. That’s changing for this year as well. It’s more than what we could do in this short time, but I just want to make you aware, be proactive, not reactive.

I look forward to all your success. I hope to see you all at a future seminar. Until then, my friends take care.

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Click here to download the transcript.

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

Greetings, my friends, members of the network, and all of you. It’s Sam Collins, your coding and billing expert for acupuncture, really, and for you in the profession. I always want to make sure you’re successful, because quite frankly, you’re not. We have a vested interest as a company. The American Acupuncture Council not only does malpractice and all that, but we do continuing education and do services to support you because we’ve learned.

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If you’re not well supported and it’s successful, you don’t need what we’re selling. So we want to make sure that we’re symbiotic. I want to begin starting for next year, getting to be proactive. So let’s go to these slides. Let’s talk about what do we need to do for 2025. And I’m saying it’s going to be proactive 2025.

And the reason I’m indicating that it’s got to be proactive is because too often acupuncturists are simply reactive. Something happened. What we’re going to do as a network director, if you will, I get a lot of information well before often you may see it. So one of the things I would encourage you to do is always be around AAC network to know what’s happening, what’s changing.

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So let’s talk about what’s going to change for next year, but how do we really become proactive to keep our practices successful and the things you want to do with that in mind, what I want you to think, start to think of is for 2025, what is going to be my practice success? How am I defining it? What does that mean?

Is it a certain number of patients I want to help? Is it a certain monetary figure I want to hit? Is it going to be getting to just simply more people? There’s lots of ways to define it. I don’t want it to always be about money, but part of me says that. I’ve learned that you really have to make sure that this is a business.

And you do have to have a business mindset. Certainly you want to care for your patients. That’s primary, but there’s got to be payment for it. My goodness, everyone can treat someone. But what if you’re not getting paid for it? How do you continue doing that? So I want you to think of how do you define your success?

What does that really mean? And when you get there, tell me what you start to realize are some of the barriers if you look at how did I define success last year? Was it going to be for this coming year? What things stopped me from getting there? What are the barriers? What can I do a little bit better?

Because if you are not growing even a little bit, your practice is failing. Because if you grow a little bit, you’re just keeping your head above water. You have to grow just to keep your head above water. Remember economy, 3%, 4%. If we’re saying inflation may be higher, so you’ve got to probably do at least 5 percent better just to be at where you were this past year.

In fact, I’ll say maybe you’re sinking a little bit. So what are these barriers? How are people coming to the office? Is the barrier one that people just are getting to you? Is the barrier because people can’t afford it? There’s all types of things, but you want us to think of how do I. One of the barriers I think often is people are not sure what you do.

So have you created something that people know if they looked at your office, what you actually treat? Too often acupuncturists will go, I do acupuncture. What does that mean to most people? Nothing. Define to them what it means for you. I can help you with headaches or sciatica or anxiety or depression or whatever it is.

Because that barrier is often they’re just not knowing. Of course, a big barrier is always going to be money. www. circlelineartschool. com So we got to start to think of how do I make sure that I create value to what I do. Notice I didn’t say cheaper. Cheaper is not always necessarily the way people choose a doctor.

I’ve never chosen a doctor because it was cheap. I’ve chosen it because I felt there was enough value. If it’s too expensive, of course, no, but be careful. Always follow something I’ve always held true. People buy. what they want and beg for what they need. You’ve got to put yourself in a portion where, yes, they need it, but they want the care.

You’ve got to make sure that you’re creating that type of value. So what is your model? Have we set up a model that where if people are looking online, they can find me? If they’re needing to, what’s my cost? Is there a way of figuring that out? Oh, that’s affordable. That seems reasonable. Are there, pay plans and things I can do?

So start to really lay down that pattern for yourself to say, how do I want to start to make this work for next year? It shouldn’t be by hook or crook. Write some things down because at the end of the day, it really makes a practice successful no matter how you think of it. Even if it isn’t money, it’s about patience.

Helping people. But when they come in, how do they come in? Are they cash patients? There’s three types. Someone pays straight cash. How about a person that gets a discount if they pay cash? Or how about you offer so called prepaid plans? That kind of modern acupuncture style where it’s Multiple visits bought at a cheaper rate.

Realize that’s one of the ways that you can help it more affordable Is by doing that. If you’ve ever attended a continuing education seminar with me, we’ve talked about that. But how about members that are with me one on one? We have a network where, as you’re a member, we can get into it. How does it work for your office?

What’s specific to your state? By example, what if you’re in Montana? We have to have a escrow account. Other states, you may not. Is there any limits? But I think it’s something that we should all explore because always I think a barrier is money. Are there some ways we can help that? I think so. One of the ways and barriers is when people have insurance, let’s face it, do people go to the doctor more often?

Here’s a good thing for all of you to do. You may sit back and say, I don’t want to take any insurance. I agree. I don’t want to take any bad insurance, but I’m not going to turn away insurance that pays me. And I think that’s where you’ve got to start to think differently. Realize and ask your friends.

How many of your friends, how about yourself, have gone to the doctor and pay cash? And then, your answer is no. But then you expect everyone else to do it. Now, I’m not saying there isn’t a part of that, but I want you to realize, when you ask most people if they’ve been to the doctor and used insurance, it’s going to be 99 percent of them saying yes.

So you want to start to think of what some of these are better. Obviously people who have the good, standard, high level insurance with small deductibles, those are great. For But those aren’t common. What about PPOs? That’s the very common one, but here’s one thing to keep in mind. A PPO, do you have to join?

By example, and I’ll give you three. UnitedHealthcare through Optum Health, Cigna through a SH, and Aetna, often used through a SH or sometimes secure, don’t require an acupuncturist to be in network to be paid. You may not be aware, but when you’re out of network on these plans, even though it’s a PPO, oh wait, preferred provider, that means they can still go where they want.

Do you know they get paid more? So before you join something, check to see whether or not it’s exclusive. Non exclusive plans, I won’t join unless somehow it’s much more attractive because can you live off of a 40 visit? Maybe you can’t. What about an HMO? That’s the ones that are strict. They only can go there.

That’s that strong ASH, but is it worth it? My general rule is an insurance has got to pay at least what would be my cash rate. And if it doesn’t, I don’t think it’s worth the work. So if you belong to these, know that, okay, I can make it work because I can be efficient. It’s difficult for acupuncturists though, because unlike a physical therapist or a chiro that can use an assistant, you can’t.

Everything that’s billed you have to do. So all of a sudden now that makes that barrier tougher. So maybe that is one you shy away from. But what about health savings accounts? How many of your patients are even aware they can use their health savings accounts in an acupuncture office? Many aren’t.

And they’re going to go, oh, I didn’t know, because you didn’t tell them. Same would apply with, have you ever thought of, could I treat people in an auto accident? Outside of Florida, you can. These are great patients, they’re hurt, need your help. It pays really well, it pays the real fee schedule. By the way, have you ever thought of working with other providers, like an M.

D.? That you become their pain management person. Do you know they’re looking for you, because what do M. D. ‘s do? They refer. What about auto cases? What about workers comp? In many cases, you can be the primary provider. Have you ever checked into people being aware that they can see you? My goodness, in California, an acupuncturist is considered a physician in the work comp world.

But how about the VA? Have you ever thought could I be part of that? Is it worth it? I think so. It doesn’t cost anything to join and you get well over a hundred dollars a visit. That sounds like a really good patient with no co pays, but have you ever ventured? And even if you belong to the VA, how do people even know you treat the VA?

You see where I’m going with that? Often people go I treat VA patients. How do I know? I drive by your offices that says acupuncture. Are you doing anything on your social media? Any way of marketing? So when someone looks up, I’m hurting and I need to, care for pain and I’m in the VA, does your name pop up?

Is there anything on your site that would direct them there? Remember how Google works. It takes information and scrubs from different sites. And if your site has that information, your name is going to come up. By the way, if you were to Google acupuncture, coding and billing seminars and programs, I’m first.

My company is first. You know why? We don’t pay for it. But we have so much data out there because we want you to be successful. So make sure people are aware. Now, what if you treat Medicaid? I’m not a big fan because it doesn’t pay well in many States pays horrible, but some areas can pay better. So it’s something that’s worth looking into.

There’s some areas in New York, quite good. What about Medicare? And you’re going, oh regular Medicare Part B, still the same thing, chronic low back pain only with MD supervision, so not great. But what about Medicare Advantage policies or plans? Now, I’ve heard some people going, I heard all the plans aren’t going to have that new or the routine acupuncture.

Not true. It’s no longer automatic. You want to start to check. I will tell you what the plans are doing. I can tell you UnitedHealthcare is still going to have routine acupuncture. The only difference. is it’s going to limit it to 30 visits per year. So it will still be available, but you do always want to check.

Does a person have that benefit? So at the end of the day, it’s about patients getting in your office. And what is it? That’s the bottom line. Have you ever thought of if I join ASH, I’m getting 40 a visit. Does it make sense to me? In many instances, it may not because I want you to start to think of what does it cost to treat a patient in your office?

Have you ever actually thought of that? What does it actually cost me? I want you to do this by taking your overhead, all your related costs. By the way, I would include your student loan payments as part of that. I really would. And then you divide that by the average patient visits you get per month.

So let’s say you add up everything your rent, your, cost for gowns, needles, and so on. And that total is 4, 000. And you see about 25 patient visits a week or 100 visits per month. That means you’re getting 40 per visit. So if that were the case, let’s think of that for a second. If I’m treating an ASH patient and it’s one of this 100, you’re making 2 for that visit.

I don’t think that’s worth it. I don’t think you could survive on that. Now, if all of a sudden you go Sam, because I’m seeing ASH patients. I can see 200 patients a month. That drops to 20. Okay. But here’s the difficulty. How do I increase it 200 or double it? Keep it in mind that most acupuncturists are treating most people for 30 minutes, sometimes more.

There’s a limit to how much you can do. So you got to be careful of devaluing your service and falling into the trap of some of these plans by looking at really what you’re getting. Now, if you told me, Hey, Sam, I joined because I get 10 extra patients per month. Which means, Hey, I’m getting, 10 visits.

Maybe that’s going to be about four or 500 extra or more. Okay. I like that. It can’t be the bulk though. It’s got to be a value add, like taking up a spot that wasn’t already filled, but I’m not going to trade a high paying patient for a lower paying patient. So you really got to start to look at doing a fee schedule review.

This is 2025 proactive. When was the last time you made an increase in your rates or for that matter, have you ever looked at. Having your rates make sense. Understanding what is the actual value. What is the cost in my area? What resources do you have to figure out what is in my zip code? This is what I do for my network members.

Members of the American Acupuncture Council network service directly with me. It’s one of the things we do. We do a fee schedule review and we talk about, let’s talk about what’s going on in your zip code. I don’t care what your friends charge. Because they probably don’t know what they’re doing either.

I want to look at real charges. I want to start to look at what we call relative values to understand true fees. Because I find often acupuncturists devalue probably three quarters of the services they bill just getting less money. Because I want you to think of when was the last time an insurance company raised rates they allowed?

ASH has it in years, but what about other plans? I don’t think it’s so much worrying about how much have they raised. Some don’t, and it may stay stagnant for a while. But how many of you are aware that you’re billing below what they allow? I’ve seen this happen. An office bills something for 30.

The plan allows 50. Now, if you call them and say, do you allow 50? They won’t tell you, but there’s ways of figuring that out. But anyway, if you bill 30 and they allow 50, what are they going to pay you? 30. So I’d like you to start to take a look at understanding relative values. Have you ever reviewed your rates based on that?

This is federal government. This is not made up. This is what a service costs based on something else. So what you can do is start to tell me what some one thing cost and i’ll tell you what other things would cost based on the relative price of that one. So by example, this is how you would use relative values.

Let’s say by example, you said, Hey, Sam, I charged 60 for a 9 you know, for a set of acupuncture manual. Great. I’d say that’s fair. Is that very high? No, that’s probably about 170 percent of Medicare, give or take. So needless to say, if I charge 60 for that, what’s going to be my fee for my second set, third set?

Or what about other therapies? And this is where I find a lot of discrepancy. Okay. I’ve seen people charge the same amount for first and second set. Makes no sense. The additional set should be 50%, 15%, or excuse me, 30 percent lower than the primary set. So let’s give this example. If I bill 60 and insurance pays me 60 for the first and the second, you know what this tells me?

I’ve way undervalued the primary. Because if you bill below, they pay it to you. But if you bill above, they’ll reduce. So by example, let’s use this. If I take 60 as my fee. And again, this is if you’re saying, Hey, Sam, I know 60 is fair. It’s what I charge. Good. Let’s base everything on that. The value of a 97810 is 1.

15 relative value. So I take 60 divide by its relative value and it gives me 52. 17. Now this multiplier is what insurances do. And they take that number. And then they multiply it by the RVU of every other code. So by example, to give you a way to look at this, Medicare allows about 33 to 37, depending on your region for this.

So what we’re going to do is take 5217 multiplied by the RVU of the additional set of 0. 85 gives me 44. So notice 60. And then I would round this up, by the way, make it 45. But you’ll notice, oh yeah, Sam, that is about 30 percent different. In fact, it’s exactly 30 percent different. But here’s where I find it’s often the biggest misnomer.

Notice the exam price. Relative value is 1. 15 for 97810. Notice the relative value for 97, or excuse me, 99203, new patient mid level exam, 3. 35. Will we all agree that’s approximately three times the rate? Not quite, but close. So if it’s three times the rate, notice it’s 60 here, 174 here. Notice three times the rate.

I can’t tell you, at an office last week, that was charging 75 for this. That literally meant, yeah, you’re losing 100 when it comes to this. What about things like massage? Massage actually has a higher value than does an additional set. Not by much, but notice the value is 0. 91. So that means massage is 47 compared to the additional set of 44.

Please make your fee schedule make sense. If you’re a network member with me, it’s time to get ahold of me. Let’s do our one on one Zoom. It’s part of your service. Let’s take care of that because you weigh under value. If you’re not a member, it may be time to join and start to go, wow, I’ve really messed this up.

And I find that to be often true. Start to really look at a fee. Now, I’m not going to be against you saying, Sam, I chose this fee for a specific, if you’ve got a reason, of course, but is the reason when that’s bad business. Remember, there’s a time for you to put your business on Shark Tank. Is this really viable?

Here’s an unfortunate statistic for a lot of acupuncturists. Generally, close to 50 percent of acupuncturists within five years of graduation no longer practice. Now, I don’t think it’s for lack of understanding the business of acupuncture as far as how to treat someone, but not how to make a business out of it and create value.

Some people do that really well. My goal for any acupuncturist, by your third or fourth year of practice, you better be making 250, 000. You’re going to go, Oh, that’s not that complicated. If you start to understand where patient values are. So I want you to do these things for 2025. Please take a look at any plan changes of anything that you normally have billed out.

Start looking now. Don’t wait. Start to look now. A lot of things can be done online. What’s changing? As I mentioned, a lot of people said, I heard there’s change to the Part C plans. Please read more. Please make sure, make your patients aware that if the existing plan they have doesn’t have it, there’s probably choices for them to have a new one help them do that.

Realize that time is coming up. December, I believe, 7th is the last day for them to change, so make sure your patients are made aware. What about deductibles for next year? I know Medicare is going up to 254, and you’ll say big deal. But that means other plans may do that, but keep in mind, what about deductibles?

Sometimes deductibles, if the patient has used their insurance in the last three months, That may fall into the next year. What about Assignment of Benefits? Many of you have contacted me saying, Hey Sam, I had an Assignment of Benefits thing came from OptumHealth and TriWest regarding my VA patients.

What is an Assignment of Benefits? I don’t understand. Or they’ll use the term AOB. The Assignment of Benefits is something that you need to have current on file. It’s what directs the insurance company to pay us. It’s block 13 of the 1500 where it says please pay the undersigned provider of services. By doing that, you get the check.

If the patient’s already paid you in full, leave it blank. Why I’m bringing this up is that VA wants a new one every year. So get in the habit, new year starts, patients sign a new form. That way there’s no confusion. They understand, yes, payment’s coming to you. They should, of course, because they’re not paying directly.

But that applies, I think, to other consent forms. I know you may have had the patient sign a consent to treat, but what if it’s two years ago, a year ago, and it’s a new plan of care? Have them sign a new one. Don’t leave any risk there by not having a patient saying I didn’t sign a current one. Have it re signed for the new year.

Same would apply with financial agreements. When the new year comes, make sure people know, here’s what the cost is, here’s how we plan to do it, and here’s what we do. If you want to, we also offer a prepay plan. Or we offer some other type of discount for time of service. It’s not very large, but something that can be there.

Make sure patients are aware because that’s the barrier. What does it cost? How about credit card fees? Have you reviewed that? Look at your credit card fees. They’re often higher than people realize. Now, what can we do about that? It’s part of doing business. However, businesses are allowed. to disclose there’s going to be an additional fee for use of a credit card.

You just have to do it before you do it and tell the patient, if you choose to pay with a credit card, there’s an additional 3, 4, 5, whatever the fee you charge. That fee can’t be based upon the amount of purchase, by the way, but it simply comes down to a credit card transaction fee. I think that makes sense.

And of course, the other thing, please review your fee schedules. I’m going to suggest you may want to do it with an expert like me, but at least do it with some level of semblance of information. Realize in many states, what they’ll do is they look at the Medicare fee schedule, which by the way, will update in early 2025.

By the way, network members get in touch with me. I’ll keep you updated there. And start to look at a percentage of that. Realize that many major health insurances, such as Anthem, use 1. 75 of Medicare. And I will guarantee most of you, you might have one or two services, 1. 75 of Medicare, the rest are probably not.

So keep in mind, often I find for offices, they’re losing 10, 20, maybe 40 a visit by not understanding the value. Now you might say Sam, I belong to this plan and they cut the fee. I get that. But that’s something you signed up for. And that’s what I want you to start to think of in that review. Is it worth it?

Realize the American Acupuncture Council is here to help. This is our website, our phone number. We’re the resource to help you get paid and understand the coding and billing. We do lots of courses for continuing education and network members get those for free. So I’m going to suggest let’s make a good 2025 by having a proactive plan.

I hope to see you all soon. Take care of my friends.

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