And one of the things that I get commonly, whether it’s a network member or someone coming to a seminar or someone reaching out from acupuncture today is how do I manage acupuncture with time services?

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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.

Greetings, everyone. This is Samuel Collins. You’re coding and billing expert for acupuncture in the American Acupuncture Council with another episode. Let’s solve problems. Let’s make sure you have the right things documented. And one of the things that I get commonly, whether it’s a network member or someone coming to a seminar or someone reaching out from acupuncture today is how do I manage acupuncture with time services?

How does that mesh if I’m doing a manual therapy or a massage? How does that time incorporate with acupuncture? It’s actually not as complicated as you think. However, it’s something that I’ve learned because I teach in a lot of schools. Acupuncturists aren’t learning. So we wanna give you a better learning curve now to do this properly.

So let’s go to the slides. Acupuncture and timed therapies. How do we manage ’em? What’s the proper way to document these time therapies along with acupuncture? And what are the minimum times, because obviously you’re all familiar with the 15 minutes, so what does that really mean? So let’s talk about what are these 15 minute services and time services.

Obviously we know we have acupuncture. We have the four codes for acupuncture. The two first ones obviously for manual acupuncture. The ladder two are for electro acupuncture, and each of the codes indicate that you spend 15 minutes. Now remember that 15 minutes is 15 minutes with the patient. in the room.

So by example, when you go in the room to greet someone, realize your time starts. So one of the things I find acupuncturists often miss out on is the true understanding of the value of time. The time is not just the point of inserting the needles, but it’s all the things required to do such as, Hey, Mr.

Jones, how are you feeling today? So that 15 minutes is incorporated into the acupuncture codes and is a requirement for each set. Now what about therapy services? Now, I picked a few here that I say are maybe a little more common. I won’t say these are the only ones, but I picked electric, stem, ultrasound, auricular electricity to accu points, exercise, massage, manual therapy.

As I would say, these are generally the more common ones that are timed. They’re more than these, but, and you may be doing additional ones, but the big issue is how do I make sure the time for those. Meet and adjust with the time for acupuncture. If I’m doing them together, what are the minimums here? And this is the concern that we run into a lot of problems with that.

Someone will not document enough time. I generically will tell you, acupuncturists spend more time with their patients than most other providers, whether are chiro. PT or medical doctor for sure. I think acupuncture spend a lot of time because the way that you work, the type of services you provide. So let’s talk about how does acupuncture work.

Now, this is actually a page out of the C P T, and I’m just using that to make sure everyone can see. It’s not just us stating it, but in C P T, it indicates that there must be 15 minutes of time that’s face-to-face with the patient. Now, face-to-face doesn’t mean touching. Sometimes people think contact means, do I have to be contacting the patient?

No, it just means. You’re in the room. So literally once you go in, it counts. So I wanted to make sure you can see it from that standpoint, but let’s take a look at it as it’s written out. Each code indicates pretty much the same thing. It says acupuncture. Of course that means needling with one or more needles and then says without electric stent, because these are manual and it says 15 minutes of personal, one-on-one contact.

So that simply means we’re in the room with the patient having contact with them. For the acupuncture service, which includes the pre, the during, and even the after. So the first set says 15 plus needles. Notice the additional set or additional sets says the same thing. Each additional 15 minutes of personal one-on-one contact with reinsertion of needles are really an additional insertion of a needle.

So bottom line is 15 minutes plus insertion. Equals each set. Now that goes with whether it’s manual or electrical. The only difference of electro acupuncture codes, 9 78, 13 and 14 is that at some point the needles have electricity attached. So you’re doing some type of device where you’re con contacting the needles and having electricity throughout.

Bottom line. It’s just simply 15 minutes per set. Pretty straightforward, but sometimes people have a hard time understanding. What does the 15 minutes constitute? We’ll get into that because let’s look at what other codes are. 15 minutes. Now, this is a list of all of the common physical medicine codes.

If you’ve been to a seminar with me, if you’re part of our network, of course you have access to this. And all this is a simple list of therapies you’re gonna notice in the upper left side is gonna be the unattended therapy supervised. The constant attendance, the therapeutic procedures plus the acupuncture, even dry needling listed nonetheless.

Let’s talk about specifically what are the timed services? Timed services are the ones that indicate time. You’ll notice the first ones that say supervise like. Infrared heat or something, they don’t have time, so these don’t matter. Those you just do or don’t do. There’s no minimum or maximum.

However, where you see ’em say constant attendance, you’ll notice now each of these indicate 15 minutes with each. So much like acupuncture. That means you have to spend 15 minutes with the patient. Now that doesn’t mean necessarily that your hands on though it could be, but it means you’re with the patient as the therapy is being provided to monitor the efficacy of it, if you will.

Now, commonly it could be electric stem, handheld type, not a type where you put pads on where you hold it by hand. Here’s that code I mentioned, the electric stimulation of auricular, acupuncture, literally electrical impulses to the surface of the year. at acupuncture points but not needling.

Those all indicate 15 minutes. In addition. In 15 minutes are the common ones that you’re gonna do. And of course I think most acupuncturists, and I shouldn’t say most, but many do incorporate therapies as part of their practice and may do some body work with a patient, whether it’s twink, haw and so forth, certainly gonna be applied to it.

And those notice all indicate 15 minutes. So what this is focusing on is making sure do I have the time? and understand the timing of it. I just taught a class last week to students at Emperors College, a college acupuncture college in Southern California, and I was surprised to see how most of them were getting ready to graduate and really had not learned anything about time.

So it’s one of the reasons their instructor had me come in, because it’s one thing to learn to be a really good acupuncturist, but we do have to understand the business end of it. How do I document this? And I don’t care if you’re not billing insurance. , you still have to document the services you’ve provided.

So let’s talk about the acupuncture time. What does it mean? What does it mean to do time in general? Now, what you’re seeing here is actually taken directly from cms. As well. And when CMS means Medicare as well as the American Physical Therapy Association, the ama, and all the adaptation of this, and it talks about counting time, and I want you to notice when time is not just time touching the patient, but notice it says time of therapy includes.

Assessment and management time, medical record review, physician contact while the patient is present. And so what it means is when you’re in the room and you’re looking at the notes and you’re getting ready to start part of it, thinking, okay, last time I did this and I’m doing, you’re gonna count all that time.

So what I’d like you to do is start thinking of when you go into the room, Either you’re starting acupuncture, so the time starts then, or maybe you’re gonna be doing a therapy. It starts when you contact the person. So this means the things you do before the service, that’s part of it, if you will. In addition, of course, it includes the hands-on treatment time, obviously, but then it’s also post-service work.

Notice that includes things like assessment of treatment effectiveness, after you’ve done making sure the patient’s feeling okay, sitting upright, making sure they don’t have any needle sickness. All those things would be included. But notice it also says, Communication. So you know those few minutes you might spend with a patient at the end of the visit communicating some things about their therapy that would be included.

I wanna be careful. It’s not overstate post-service time, but it’s certainly part of it. Here’s why we have to make sure we’re accounting for it, because I know the codes save 15 minutes. But the codes have what we refer to as an eight minute rule. Now the state minute rule is put out through C m S and adopted by every insurance, and it talks about the time required for a time service is actually not 15 minutes.

The time is actually as little as eight for one unit. It means you’re doing more than half. So the bottom line is if you were to do acupuncture or a therapy for as little as eight minutes, it could be billable, assuming there’s only one unit or set. Now, here’s where things get slightly tricky, but not too hard to understand.

Notice it breaks it down one unit. Of services. Now, I’ll even say one set, cause I like to think of acupuncture and sets. Notice one unit is as little as eight minutes, but notice it goes all the way up to 22 minutes. So if you’re doing a set of acupuncture or a therapy anywhere from eight minutes up to 22 minutes, that is simply one unit.

A second unit or time factor doesn’t begin until you’re eight minutes into the next service, which means now it’s gone to 23 minutes. So notice 15 plus eight, always the eight minute part. So it goes in that pattern all the way through. Notice two units or sets would be as little as 23 minutes. Three would be 38, 2 meaning 15, 15, 30 plus eight, and so on.

It goes all the way through. Now, that’s not too hard to see. However, it becomes an issue when, what if I’m doing two services, obviously, like acupuncture, I might just do ’em, look and go, okay, I did that, but what about a time service? And this is where things get confusing. . Where does that time count?

And again, I wanna make an emphasis here for your acupuncture time because I think many of you forget what constitutes it. It’s not just picking points and inserting needles and removing, but it includes all these things in red. Include a review of history. When you walk in the room and say, Hey, Mr. Jones, how are you feeling?

That’s when the time starts. It includes day-to-day evaluation, pulse points. Tongue, maybe range of motion, whatever you do. Obviously, cleaning your hands, choosing and cleaning the points, inserting, manipulating the needles, removal and disposal. Wow, all of that’s included exactly as well as completing the chart notes.

So clearly there’s a lot of time. If it’s an activity that’s related to acupuncture, it certainly counts what doesn’t count, and I underlined this at the end, the time the needles are retained is excluded. So be careful. You know how you might have a person rest on needles for 10 or 15 minutes? I. Perfect.

I know when I go to the acupuncturist, generally when she inserts needles for about 10 or 15 minutes, usually says, Hey Sam, I’m gonna leave you here and let you cook for a little bit, if you will. And then she’ll let me lay there for 10, 15 minutes, relax, and then come back in. That time does not count.

Now what if you did stay in the room though? What if you stayed in the room and every few minutes you stimulated the needles or you’re looking for patient response whether to insert more? That will count and it would count if it as an additional set once you would insert more needles along with that time.

The key factor here though that’s complicated is that I can only use one time code at a time. I can’t do two time codes and I have to meet the minimums. And what I think probably makes it simple to think of whether you’re doing acupuncture by itself or acupuncture with a therapy time is cumulative. So it’s not a separate time for additional services.

It’s an included time. So even though you might be doing two different things, massage and acupuncture, The minimum time to build a unit of each means you must spend 23 minutes total with no one of them lesser than eight minutes. So one thing to keep in mind though is let’s document this. This is not hard.

You spend a lot of time. You know what I’d like you to start doing. Tell me what time you entered the room, what time you left. , if there’s a particular therapy, tell me what time you started, the efforts of that and what time it was completed. But do keep in mind time documentation is only two ways it can be done.

You can either tell me how many minutes you spent. That’s easy enough. I spent 15, 18, and so on. Or you can say I went from nine 30 to 9 45. Now where I would be careful, I find often when people state minutes, their minutes are off in an average, and you may be undervaluing it. . My preference would be to actually tell me start and stop times.

Now either is acceptable. Just be careful of shorting yourself. You ever have that where someone says, Hey, how long does it take to get to whatever particular location? They go, oh man, it takes 10 minutes. Then you go to get there and it takes 25. You’re like, what? They’re telling you often 10 minutes to make an enticing, but also to say, Hey, if it’s perfect traffic, maybe I want to know exactly, so let’s make sure we’re documenting it right by telling me how much time.

Whether it’s total minutes or from and two, what’s unacceptable, and this is where you have to be careful. Don’t state doing one unit. You can state that, but then you have to define one unit by how much time, don’t indicate a range. You can’t say, Hey, I spent somewhere between six and 18 minutes. It has to be a certain number.

It can’t be a range. It also can’t be, Hey, I just did it times two. What do you mean by times two? , and then of course, not just indicating any time by just saying, Hey, I circled acupuncture. A set massage. That would not be adequate. So by example, let’s take a look at this. If I’m doing acupuncture and I spend 10 minutes on the first set, that would be billable.

I circled to say that would be one set. What if I add an additional set in there for another 10 minutes? Would that be billable? What’s the amount of time that we spent? 10 plus 10 of course is 20. What does that mean? Only one set is billable. Now obviously it’s too short. Now you’re gonna say, but Sam, it went over eight minutes.

Yes it did, but it didn’t meet the time for the second unit. What if I spent a little bit more time? Let’s take an example. What if I did acupuncture for 12 minutes face-to-face, and then the additional set I did for 12 minutes again that will be 24. Which means above the 23 minutes and I could build both sets.

In theory you could do 11 minutes on one and 12 minutes on the other. What I wanna focus on here is just be careful that you do have to add the time for cumulative amounts. So for tunes to be billed, we have to have that minimum. Which brings me to what we started with was talking about therapy.

What about time therapy when it comes to acupuncture? Now, if I’m doing infrared heat, doesn’t matter because infrared heat doesn’t have a time value. You either use it or you don’t use it. However. Let’s take an example here of acupuncture and you did 15 minutes on the first set, 10 minutes on the second, which I would say isn’t unusual.

Obviously the first set may take a little bit more time. I do want you to keep in mind though, the second set does include if you’re face-to-face, finishing the notes. So if I did 15 plus 10, good. Now I did another 10 minutes of massage. It meets the eight minutes, but let’s total this up. 15 plus 10 is 35 minutes total.

If I did 35 minutes, how many units are set can I bill? Based on the eight minute rule, what’s the min minimum time for three is 38. So this would mean this would not be billable for the massage. I would build a two sets of acupuncture. Now, you may ask Sam, why are you gonna build a two sets of acupuncture?

They have a higher value, so I would pick the ones with the highest value, but we cannot bill all three. If I were to bill all three, I would have to have spent somewhere either three more minutes on this set. Three more minutes on this, or three more minutes on the first one. The total time. has to equal 38, so be very careful.

This is where I see people run into problems. They forget to look at the cumulative nature. Think of it simply, if you were to do massage only for 35 minutes, could you bill that for three units? No, not enough. So it doesn’t matter that it would just be one service or multiple, but let’s take an example using the same idea.

We did 15 minutes of the first set, 10 minutes on the second, and then 15 minutes fully of massage. What’s the total time there? The total time is 40 minutes. This means all three services can be billed because the minimum time of eight minutes was hit for each, and the cumulative time was over 38 minutes.

So what I’d like you to think of is just start getting in the habit of these time services and units to do them in this way. Please, I hope you’re not looking going, oh, this is too complicated. It’s not at all. You’re just documenting the services you have done. And I want you to think of this way.

Documentation should be a way that someone can look back. and go what was performed on that visit, and I’m talking a complete risk management of this. What if a patient were to say, I don’t think you did all the services, or was, making an issue of money. This would be the way to make sure you’re gonna say no.

It’s all there. I would love for us to be in the habit of it. Frankly, I’m frustrated for some acupuncturists because your time is something you do a lot of with your patient, but because of your lack of documentation, when notes get reviewed or people make an issue, , we cannot defend it. So let’s just start putting the time down.

You’re spending it. Let’s meet it. So eight minutes minimum for 1 23 for two. Get in the habit of that, whether it’s acupuncture or therapies, will make your life simple. Now, keep in mind, Acupuncturists aren’t doing a ton of services. You know why most people go to an acupuncturist? To get acupuncture.

But isn’t it good sometimes to get some additional services? I know when I’ve gone, I’m a big lover of cupping. I find that’s really helped me with some shoulder issues. But also there are times where they’ve done some gua or deep tissue work, and I would say there’s ways that acupuncture stood that others don’t, that you might be doing slightly differently and maybe have a better outcome.

Don’t be afraid of additional services. Just simply document them. We wanna make sure you’re getting the patient the best care, but I also wanna make sure you’re getting reimbursed. That’s what we do at the American Acupuncture Council Network. We’re here to make sure your offices continue to thrive and make more money.

If you would love to have an expert to be on your staff, you know you can hire me for less than a dollar a day. You can zoom with me. We can do one-on-ones where we go over your fee schedule, audit your files, make sure everything’s compliant with the big issue of not so much compliance but reimbursement.

Your practice is going to continue to thrive because of your ability to run it as a business. Allow us to help you do that. Take a look at the American Acupuncture Council Network. We’re here to help. Until next time, everyone, I wish the best, continue to be that good person to all your patients. I’m counting on you.

 

 

 

Let’s talk about what’s going on for the new year and just beyond that and continue with the topic on dealing with how do we deal with 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.

Greetings to all my friends, colleagues, and people that just follow along. I’m glad that you’re with me. Let’s talk about what’s going on for the new year and just beyond that and continue with the topic on dealing with how do we deal with fees? What about updates? Should we change it first the year?

What should I charge? And this is something I go through in a lot of detail in our seminars, but I wanna give you a chance to kinda get feel for it. So let’s talk about your 2023 fees and what’s happened with RVUs and should we be maximizing payments? Let’s get to the slides and let’s focus in on that cause I wanna give you some tools that will help you start to understand what should be my fees.

What’s reasonable, and I will say the fee you choose is what you choose, but I want it to be from some knowledge, not just because of I think that’s what it’s worth, but the true value. So I want you to think of it from a standpoint of what do patients look at, mean, for the most part, Beyond the factors of, are you gonna help me?

And we’ll do a separate show on that. Let’s talk about what the biggest common question is for most patients are. What does it cost? How much is it? That’s what everyone wants to know. Cause they’re looking, Hey, can I afford it? Is it reasonable? So we’ve gotta remember, how much should I charge? What?

What is my fee? Where did I come up with it? Am I going by what my friend said? And let’s face. Do your friends know what they’re talking about? Have they really set up a fee schedule based on any knowledge other than going this is what I saw someone else do? You remember what your mom said about what others do, so let’s do with a little bit more of knowledge.

We think of it from this way. You should chart what is reasonable. What’s fair? I often think, what would you pay? That’s a good way to look and go what would I pay? What is the value of this service? What is a half hour? What is an hour value of time for this type or level of service? Always think the value people will always buy based on value.

If you think of it, have you ever chosen a medical provider of any type because they were. , did you look? Oh, who’s the cheapest office visit? Not at all, I think. I don’t think that’s how anyone ever chooses now. Certainly. . It could be prohibitive if it’s too expensive, but certainly we all want quality in the best providers.

So always be careful. Is cheap always better? No, it’s the value of the service. The better you service, you give, the more expectations. Those expectations being met are what I want. We all know if we go to a 99 cents store, What are we, the expectations of the goods there compared to a higher end retailer?

So should we change this? Does it change yearly? Is it something we should update in a sense? I think it should at an ex to an extent. Just bear in mind, I know some of you’re thinking, but Sam, I belong to Ash, or I belong to this plan, and do they update yearly? They generally don’t. However, I’m gonna give you a little tip, particularly for those of you who are members of my.

Or the American Acupuncture Council Insurance Information Network. Remember, one of the things we do with you yearly is to focus in on your fees. Let’s make a look at what are you charging, what is fair, and it should go up. And if you have some of these managed care plans, are you aware of the techniques and things you can do to get an increase in your fees with them?

There are things you should be doing cuz it’s not stagnant unless you allow it to be stagnant. But let’s talk about it from this standpoint. What is usual customer and reasonable? In other words, what is the. Customer reasonable price for your area. What are people charging? It’s what’s charged by most doctors or any healthcare providers, other acupuncturists in your area.

And remember, you wanna look at it. It’s not just your fees. But it’s the fees of other types of providers. What is the medical doctor down the street charging, say for an exam or a therapy? Certainly the things that we do that are similar might and should be within that same range. I want it to fall within a range with other doctors, not necessarily just acupuncturist.

That’s gonna be part of it, but certainly what is fair and reasonable. . Now, where I think most people never look though is the understanding of the value of each service. So what I’d like to do with you today is focus in on understanding of the value, and we use something called RVU or relative value units.

And what these are standard units of a comparison of one service to another and the value comparatively. So in simplest way, let’s say a service is worth one and another service is worth. , what would that tell you? Oh, the one that’s worth one is double the price or value. The one that’s worth 0.5 or the other one is 50% less.

So it’s an easy way for developing a fee schedule that’s based on, look, I know if the insurance is gonna pay me one price for this code, I can tell you what the price is for others. This RV dates back all the way to a Harvard study, and so this goes into CMS insurance companies. Work comp, personal injury, and others all use this as a method to help establish relative and fair fees across the board.

So Medicare and others. Now you’re gonna say Medicare doesn’t cover that. We’ll remember Medicare Advantage plans, but Medicare does set at least a value. So you can start to understand how do I use this to help set my own fees? So I want you thinking of what is my usual reasonable fee, but think what is.

What is re what is someone paying? What? What is someone willing to pay? And then let’s remember, can you really have dual fees for the most part? No. You can have a small discount for cash and you can go back to a previous course I did on that. But bottom line is once you establish a fee, you do have to collect it.

So I wanna be careful here. Some of you can have insurances that pay a lot of. For a code and services. I have providers in the New York area, Florida, and almost any state that can bill, and you’re gonna think, I’m kidding, that are getting two to $300 a visit just for acupuncture and maybe just two or three sets of needles.

Now that’s great. I love that. But here’s my problem. If I’m charging one patient $300, what do I have to charge other patients? $300. But what if one I. 300 to the insurance and the insurance pays the whole thing. Whoa, yay. Happy. But what if I bill another insurance and I bill 300 and it only pays a hundred?

How much does a patient owe you? $200. So you have to collect the difference. Let’s be careful. Don’t set your fees off of your wealthiest patients. at the same token. Don’t send ’em off your Ps, but somewhere in the middle of ’em what is fair and reasonable. So let’s talk about your current fee structure.

I’d like you to do a little bit of a class with me. This is what I do at our seminars and network. I’m gonna give you a little taste of it. What is your current fee for acupuncture? Just manual. 9 7810. Let’s just go with that code. What is The way to do it? What is your fee for 9 7 8 1 1. So compare the.

Okay. Let’s also look at something else though. How about a mid-level new patient exam? 9 9 2 0 3. And then how about maybe massage? Now I just picked these four codes cuz they’re common. We can certainly do any of the codes, but let’s just stick with these as a reasonable way. What do I charge?

Cuz here’s my concern. This is something I deal with all the time, whether it’s a member or someone at our seminar. , they have a fee for one code that’s fair and reasonable, but yet when they charge the other code, they charge far below. And so in other words, what if you’re billing $30 for something that some insurance or a patient is willing to pay?

64? If you bill 30, how much they gonna pay you? 30. So what if you had billed. They would’ve paid 60, but you didn’t know. And that’s what I wanna help you with is give you an idea of starting to know what these things are actually valued at. Let’s say you bought a house 20 years ago and you went to sell the house today, would you just say, Hey, I paid 150,000 for it.

I think I’m gonna charge, 200,000. I think most of us would say no. You gotta do a review of the neighborhood. What are the housing selling for? Cuz you might find out maybe the houses are selling for 500,000 know the actual value. So here’s the relative value of those four codes. 9, 7, 8, 1 0 is 1.14.

They make a, what does that really mean? You’ll see when we reference it because of 9 78, 11 is 0.86. So what I want you to really see the difference here, if you look at the difference between those two numbers, It’s about 28%, or we just round it to say 30% or 25. Either way you want to go. Let’s do it even simpler.

Let’s say, and again, this is probably too high. Let’s say you charge $114 for your first set of manual acupuncture. A little high, but okay. What would be the cost of the second set? 86. So we’re gonna use this in a way to start to establish that. If you can tell me the fee of one. , I can tell you what the fee should be of any other code based on the price of that one by giving its relative value.

So by example, notice 99 2 0 3 has a value of 3.3 th 3.33. Now, that’s not quite three times as much, but you can see it’s pretty darn close, isn’t it? And then how about massage 9 7 1 2 4. And here’s a area I see commonly acupuncturist undervalue. You’ll notice the price of massage. Has a slightly higher value than your second set.

I can’t tell you how many times I’ll see someone charging their second set at 60 or $75 and the insurance pays it, but then they’re billing massage at 30. Why are you billing a code half the price when it’s worth basically 5% more? So I wanna start to make these make sense. Now, the good news is it’s what you wanna do.

If you said to me, Sam, I know I could charge. But I choose not to because hey, I have so many cash patients, I gotta keep the price low. I’m all in on that. I don’t have any issue there. So long as there’s a reason, don’t let the reason be. I didn’t know. Most offices in our network, once we do this fee review, always get probably a 30 to 50% increase in revenue.

Cuz truthfully, most of you are billing maybe eight or nine codes, and I’m gonna say half of those codes, if not more , you have literally the wrong value. So let’s work with this and how do we make this work? So let’s just say for example, you charged $60 for a 9, 9, 7, 8, 1, 0. That’s just your fee.

I’m not saying how I came up with it. I’m just saying, someone says, Sam, that’s my fee. I charged 60 for the first set. Great. Tell me that and I’ll tell you the price of other things. So how do we do this? We’re gonna take the $60 and divide by the code’s relative value. So you’ll notice we do 60 divide by 1.14, and it gives us a value of 52 63.

What I do with that number is I take that number and I multiply it by any other code’s, R V U to tell me the price of that service based on a $60 price of the first set. In other words, if an insurance company pays me one price for one thing, I can tell you what they’re gonna pay for something else based on relative values.

And I’ll give you examples of this coming up. Now, somebody gonna say Sam, I belong to as H. Remember as H is a per diem. , they don’t follow this. And this is of course why they like you to join. Because they can say, now we don’t have to pay you a fair fee. We’ll just tell you what we’re gonna pay.

And I’m not saying that’s necessarily horrible, but it does mean that it’s more proprietary and they can choose how much they’re gonna pay. So bottom line is, let’s do it, 52 63 multiplied by 0.86 is 45, 26. So what I want you to take away is if your first set is 60, what should be your second? , basically 45.

Now, I’d probably round up a little bit to 46, but you can see here that difference. Now, if you did the percentages, you go, wow, that is actually about 25% below. How about for an exam? And this is where I see often acupuncturists weigh under value. Notice the price of the exam is about three times as much because 52, 63 by 3.3 3, 1 75, not quite three times, but you see it’s pretty darn close.

And then of course, we look at 97, 1 24 massage at. Notice it’s 47, 36. Now, that’s not a lot more, but notice it’s higher. So think of it, if I’m billing this service at 30, would the insurance still covered? Sure, but what would’ve they paid? And so I want you to think along the lines of, let RVs help you establish a fair and reasonable schedule so that you’re not undervaluing.

Or if you decide saying, Sam, I can charge more. I choose not to. That’s. It’s a choice you made, not one. You simply were not aware of. And what I generally find is most people go, oh, I had no idea. So let’s take a look here. This is from New York. I just chose New York. Why not? It could be any state.

What you’re seeing in front of you is one of the things we provided our seminars, if you come to one of our seminars or order the recording, we give you your state’s fees and codes. And this one particularly is for New York Medicare. I’m gonna go Sam Medicare let’s remember. also is the fees for the VA and these prices often Arthur’s starting point for most insurances, which I’ll illustrate to you in just a second.

So let’s take the New York fees and we’ll just pick the second column. The second column here, I believe, is the Bronx. The first one is Manhattan. A lot of people think Manhattan’s more expensive technically. No, the Bronx is. Anyway, we’re gonna take the 45 13. That’s the charge. So we’ll take 45 13, divide by 1.14.

It comes out to 39 70. So notice if we take 39 74 and multiply by 0.86, it gives us 34 17. Now you’re gonna notice here 34 16. So that’s off by a couple of pennies, but, or a penny. But notice it’s cuz I didn’t take the numbers fully out. It would probably round down. But what I want everyone to see is, oh, those values actually make sense.

So let’s take a look. Remember I said. 9 9 2 0 3 is gonna be roughly three times the amount. So notice if we have 45, 13. We take 34 17. Oh, I did. I didn’t do the math properly. It’s 34. 17 times 3.33. It would be 1 32. Now you’ll notice it comes out to 1 34, or excuse me, I’m say 39 74 comes out to 1 32 33. Now notice that’s 1 34.

Is that pretty close to within? So I want you to start to see the values. And by the way, you can see here the value of other services. By the way, the VA is covering these and insurances do use this. So notice if you’re doing just simple infrared heat, a hot lamp that’s worth only $8. Cuz it doesn’t have that high of a value.

But this is a simple way of you starting to look at, do my fees make sense? Let’s look at massage notice. Massage is 35 76. Notice here massage 35 48, but that is a little higher than 9, 7, 8. You may wanna look at and just say do I want to use Medicare fees as maybe a starting point? I still will say these are on the low end, but probably as a starting point in most states, you’re gonna find that what they’re gonna do is take these Medicare rates or RVs and use that to help establish fees.

So let me give you some examples. In Texas, all they do there is they take whatever the RV U is and multiply by 64, 38. Now you’ll notice that’s about double the. Notice in Utah, it’s 59 or 52. Heck, in Michigan they allow 200% of Medicare. So let’s go back to this for a moment. Let’s just say you charge 200% of Medicare.

That would mean your first set would be 90, and then the additional set would be about 70. . So again, notice that about 25% difference. So as a starting point, that may be for some of you that might be a little high though. But here’s something interesting. Notice Boeing, any person that works for Boeing and has their Blue Cross Blue Shield, they literally allow as much as 175% of Medicare.

California work comp 140% Pennsylvania one 13 or one 10 depending. Maryland has a conversion. I wanna highlight, many of you aren’t aware of your own state. This is why our network members or people come to the seminar, get that information and go, oh my goodness, I have way undervalued. Now, my point to it is I don’t really care that what you charge, if you’ve got a good reason, I wanna make sure you have what you’re charging.

There is a reason it makes. Are you undervaluing? Cuz you simply didn’t know. So I’m gonna give you an opportunity to do that. We have a calculator. This is free. So you’re gonna get your fees for those four codes based on your price. So you don’t have to do the calculation, simply take up your phone, bring it up to the screen, open your camera, and you’re gonna send a text.

To 2 0 9 7 5 1 6, and you’re gonna text to that r v. Just put rvu. And what you’re gonna get is an RVU calculator that you’re gonna put in your price for 9, 7, 8, 10, and it’ll tell you what the values would be for the other services within that. Now you might say how do I know what I should charge?

It is what you’re already charging, and that’s something you wanna look at and say is the fee that I’m charging in the first place, does it make any sense? As a general rule for. . I would say most of you should be probably one and a half times Medicare, one and a half times. Medicare, by the way, is about $60 because the price for Medicare usually for a first set is around 40 to 45.

So again, 60 would put you about right in that range, but nonetheless, start to really make sense to your fees. Don’t go another year under valuing. And let’s face it, most of you were billing probably eight to 10 codes, maybe a little. , but I’m gonna guarantee all of you probably have quite a few of those that are not right.

I’m gonna implore you to come to a seminar or use our network. I offer a service where if you join or the American Acupuncture Council does, I become part of your team. You literally, I become a staff member. So if as an acupuncturist, can you imagine you have a staff member for $693 and it includes two seminar.

Unlimited support where we do meetings like this. What is your fee schedule? Let’s audit your notes. Let’s take a look at work comp. How? How do I deal with Medicare and all these other things? We can get one-on-one. A lot of you are missing out because you just don’t have the information or you’re paying a lot of money for someone for a simple phone call.

We do much more than that, so I’d employ to take a look. I want you to be successful. Your success is ours. I teach continued education courses. Go to our website. Lots of upcoming courses. Guess what? You won’t. If you’re not successful, none of those. So we have a vested interest, myself and the American Acupuncture Council.

So I’m gonna say go out and let’s be more successful and let make me part of that team. I’ll tell you, we’ll get you to the right place. Take care everyone. Until next time.

 

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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