In fact, I’m sure a number of you have heard about what was going on with the VA community care and doing recoupment for some billing that you’ve done for cupping.
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Greetings friends and colleagues, welcome to another episode where we’re going to give you help to get paid to make sure you’re not paying anything back. In fact, I’m sure a number of you have heard about what was going on with the VA community care and doing recoupment for some billing that you’ve done for cupping.
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So let’s go and go to the slides. Let’s talk about this. What’s going on and what’s happening. I’ve got a lot of good news and I’m really happy to share that with you. So obviously a lot of you are treating and billing for VA patients. They are great patients. They need a lot of help and it’s the one insurance that does cover cupping.
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So you can bill with cupping and we have been billing with the unlisted code having no problems. However, something came up. I had an office that came to me and said, Hey, Sam, I’ve got a problem. I received a request for recoupment for billing 97039 for cupping and the indicated dates all the way back to 2022.
And I thought, Hmm, okay, interesting. But I thought, how much are they asking for? And I kid you not. This particular office was a heavy, heavy VA office and they’re wanting close to a hundred thousand dollars back. Now you’re thinking, how can that be possible? Well, let me tell you, they treat a lot of VA patients and they paid pretty well for cupping.
That’s what they were coming back for. So there was obviously a lot of panic. Wait a minute. How can they come back? And ask for something they’ve already paid for. That was really part of what we were doing. So in the VA, they have something called the standard episode of care specific to acupuncture. And what these are, are a listing of the services that you may provide an acupuncture patient.
Without any additional authorization, this includes E& M codes, lots of therapy codes, it even includes laser now, but it also includes codes for cupping, and before was codes that listed unlisted. So this is a very current one. You’ll notice this one is dated April 9th of this year, and you’ll notice I’ve highlighted in red the codes that they are allowing, and you’ll see here the first one that’s for laser, But it’s got dry needling.
It’s got 97016. By the way, that is the code you should be using for cupping, 97016. And you notice you just go along manual therapy. And of course, all the acupuncture codes, what you’ll notice is missing. is the code for 97039, the so called unlisted code. It’s an unlisted modality, and many people had used it for cupping, and I certainly recommended it.
It paid well. It just allowed you to describe it as cupping, and we were paid for it. Now, again, you’ll notice this is the most current acupuncture authorizations. You’ll notice, again, conspicuously, there is no 97039. or even the 97139 which is again unlisted codes. Well that’s what they’re coming back for and you notice for each of them whether it’s going to be the initial care plan or the follow ups for chronic care even you’ll notice it’s missing.
However once I received this I said hold on a minute This cannot actually be correct. And the American Acupuncture Council, because of course, a lot of you are insured through them, we began to work in the background to say, this is improper. So we got the attorneys involved, myself as the coder, and we said, wait a minute.
We went back and researched and specifically the standard episodes of care that they’ve published through the, uh, VA from 2021, 2022, and 2023. did indeed list the code 97039. So being it’s part of the standard episode of care and it was allowed during all phases, whether initial continuation of care or chronic care, it was there.
So now they’re coming back saying, well, we know we published a code, but we’re saying we shouldn’t have had it and we want the money back. Well, that certainly doesn’t seem to be proper. So what we did, the American Acupuncture Council and myself is to start to have our providers respond back to them with this letter.
It says, I received a refund request for 97039. And it dated all the way back to dates of service from 2022 as being overpaid. And we’ve researched it. The schedule, the standard episode of care specifically shows from 10 18, they all allowed this code. Now I will keep in mind that they did eliminate it.
And I think this is where the problem began. Because it was eliminated in February, they said, Hey, we’re going to go back and look prior. Well, you can’t. Obviously, if you build 97039 after February 23rd, technically that would be improper. And they could recoup it, but any dates prior, it was part of the standard episode.
So, per the published guidelines of the VA, it says, repayment appears improper because the code was in the SEOC, we identified it as cupping, and per the guidelines, when there’s no specific code, Because even the code I’m recommending, 97016, doesn’t actually indicate cupping. It says vasonomatic device, which would technically be correct.
But you could use either, and they were paying it. So we’re pushing back, saying, well, there was no overpayment because the code was properly identified as an unlisted service and the dates of service for the code should have been paid. We, in fact, even went further and talked about recoupment in that when an insurance pays you for something that they later determined was paid improperly, Even if they shouldn’t have, case law says that they can’t go back for it.
And so really we pushed back in a lot of ways. So everyone panicked. I said, hold on, let’s see what’s going to happen. Well, about a week ago, actually a little over a week ago, this was Optum’s response. It says Optum’s claims department worked on a special project intended to remediate historical claims logic concerns, which impacted unlisted procedure codes.
Although our analysis of the Unlisted Procedure Codes is ongoing, the current recruitments are in the process of being voided. So all those ones they sent letters, now being voided. If they haven’t, go ahead and push back. We sincerely apologize for this inconvenience this has caused and appreciate your patience as we work to void these previous specific recruitments regarding the Unlisted Procedure Codes.
Additional communications will be coming. So in other words Oops, we made a mistake. That’s why often be careful. And that’s really why we do the network is to be there to help with this type of issue. When someone joins the network, not only do you get seminars, but you get this type of help. Quite frankly, this doctors, this office that had this issue.
Literally paid for a hundred years of the network based on what we charged, based on what was there. And realize though, network members, we’re going to get it to you first, but always know that we’re going to be here to support. If you had went to our website, which is the AAC Info Network under News, on July 25th we posted this.
So I want everyone to kind of calm down and say, wait a minute. The unlisted code should have been paid because it was part of the standard episode. From this point forward, do not use 97039. From February of this year, cannot. Now, for those of you that attended my VA seminar earlier this year, you heard this information.
You knew it was changed, but again, they can’t go back and recoup. As always, we want to be your advocate because Your success is ours. The American Acupuncture Council is really your partner. We’re always here to help. And that’s why we do the network where you can work one on one with me because members, I gave them this letter directly.
So if you’re a member. of our AAC Info Network. Now not insured, insured is your malpractice, but members of the network, if you’re still running into this issue, just reach out to me and I’ll send a letter to you. But I’m going to highlight this is going to be for members only. For others, you may have to go back and read it, but it falls in the same category.
Our goal, keep you going, keep you doing what you do well is to help people. And when people want to come after you, we’re going to be your line of protection. Until next time, everyone, this is Sam Collins.