Samuel A. Collins Director, A.A.C Information Network - - PowerPoint PPT Presentation

Samuel A. Collins Director, A.A.C Information Network www.aacinfonetwork.com E mail sam@aacinfonetwork.com

Our goal and commitment is to strengthen and grow the acupuncture profession by providing education, tools, and support that continually improve the productivity, profitability, and well-being of the alternative health community as a whole

Patient’s are not always required to work remotely

But when they do, I codeZ56.3 Stressful work schedule

Acupuncture Practice Survival

• People - Patients
• Needs vs Wants?
• Culture Shift
• Come To Me Economy

10 Patient Types

1. Standard 2. PPO (preferred provider organization) 3. HMO –EPO (health maintenance organization) 4. HSA FSA (health-flex spending accounts) 5. Automobile (Personal Injury) 6. Workers’ Compensation 7. VA 8. Medicaid 9. Medicare

• 10. Cash

Wha hat Is Insur t Is Insurance? ance?

• Health Insurance?
• Sick Insurance
• Not preventative in design
• It aids in paying for services does not

pay in full in most instances

Insur Insurance ance

• Insurance aids in payment and rarely

covers 100%

• New patients
• Someone may be more apt to try

acupuncture

• You are not required to bill insurance

10 Patient Types

1. Standard 2. PPO (preferred provider organization) 3. HMO –EPO (health maintenance organization) 4. HSA FSA (health-flex spending accounts) 5. Automobile (Personal Injury) 6. Workers’ Compensation 7. VA 8. Medicaid 9. Medicare

• 10. Cash

Patients

Discounts

• Waiving
• Hardships

Data suggest that Americans are increasingly willing to pay out-

• f-pocket for acupuncture, chiropractic, or massage care that isn't

covered by health insurance, reports a new study led by the National Center for Complementary and Integrative Health.

APTA

• Higher copayments decreased the likelihood
• f a patient seeing a physical therapist as first
• provider. Patients with a copayment over $30

were 29% less likely to see a physical therapist first than were patients with no copayment. This association was not evident for chiropractic.

Pre-Paid Plans

• “As a general rule, any pre-paid plan which involves the assumption
• f risk may be the business of insurance. The person or organization

intending to offer any pre-paid plan, whether it is a plan of prepayment for a certain number of visits, or a certain period of time, may be required to conform with the provisions of the Insurance Code and Health & Safety Code.”

• Avoid offering a plan that would qualify as an insurance product.
• As long as the prepaid plan simply stipulates how many visits a

patient receives, as opposed to a list of covered services one might need over a specific period of time.

Packages and Plans “Modern Acupuncture”

Fee for service (visits) not time Refund policy for unused No expiration

• There is no requirement to bill insurance

unless you are a provider of the plan

• You can choose to bill one plan and not the
• ther

Original Medicare

• Original Medicare includes Medicare

Part A (Hospital Insurance) and Part B (Medical Insurance).

• Drug coverage, requires a separate

Part D plan.

• You can use any doctor or hospital

that takes Medicare, anywhere in the U.S.

• To help out-of-pocket costs in Original

Medicare (20% coinsurance), beneficiaries can purchase supplemental coverage

Medicare Advantage (also known as Part C)

• Medicare Advantage is an “all in one”

alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

• Plans may have lower out-of- pocket costs

than Original Medicare

• In most cases, you’ll need to use doctors

who are in the plan’s network.

• Most plans offer extra benefits that

Original Medicare doesn’t cover— like vision, hearing, dental, and acupuncture

RVU MC WC-CA 97810 1.05 $40.96 $53.09 97811 0.80 $30.81 $33.06 97813 1.17 $45.82 $59.40 97814 0.96 $37.37 $38.54 99202 2.14

$85.03

$110.24 99203 3.03

$119.87

$155.41 99212 1.28

$51.28

$66.47 99213 2.11

$83.73

$108.55 97026 0.18 $7.20 $9.33 97110 0.87 $34.50 $44.78 97124 0.83 $33.43 $43.34 97140 0.80 $31.63 $41.00 97530 1.12 $45.16 $58.55 97016 0.35 $13.85

97810 53.09 / 1.05 = 50.56 97813 50.56 x 1.17 = $59.15 99203 50.56 x 3.03 = $153.19 97110 50.56 x 0.87 = $43.98

• Veterans’ out of pocket costs for this care is $0 no

copays, cost-shares, or deductibles. Providers will be paid for all authorized care according to their contract or agreement

• Physical medicine services 97010-97799 must be

appended with modifier GP

• 97810-97814
• 97110, 97112, 97530
• 97124, 97140
• 97016
• 97139
• 99201-99215

Standard Episode of Care

VA Fee Schedule

• Fee schedule follows Medicare fee schedule
• Acupuncture as of January 21, 2020 is covered

and now is limited to Medicare fees

• Medicare fees have variances per region
• Acupuncture is a Tier 2 provider and is paid at

85%

• 2021 update 10-1-2020
• 72,616 Codes
• 490 Additions
• 58 Deletions
• 47 Revisions

2021 ICD10 Update

• R51 deleted
• NewR51.0 Headache with orthostatic

component, not elsewhere classified

• NewR51.9 Headache, unspecified

R51.9 Approximate Synonyms

• Cervicogenic headache
• Chronic facial pain
• Chronic mixed headache

syndrome

• Chronic pain in face
• Craniofacial pain
• Daily headache
• Facial pain
• Facial pain, chronic
• Headache, cervicogenic

(from the neck)

• Headache, chronic daily
• Headache, mixed
• Headache, occipital
• Headache, sinus
• Occipital headache
• Pain in face
• Sinus headache
• Sinus pain

• Headaches
• Hip or knee pain associated with OA
• Other extremity pain associated with OA or

mechanical irritation

• Other pain syndromes involving the joints and

associated soft tissues

• Back and neck pain
• Nausea with pregnancy, surgery, or

chemotherapy

COVID-19

• U07.1 2019-nCoV acute respiratory

disease

• Z03.818, Encounter for observation for

suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19

TELEMEDICINE

• It is a common misconception that providers (particularly ancillary and

complementary providers) cannot be reimbursed for telemedicine appointments, or that it is possible but only at a reduced rate.

• The reality is that many commercial payers are required by state law to reimburse

for telemedicine – often at the same rate as a comparable in-person service. Some payers in states without reimbursement mandates are covering telemedicine anyway.

• Though telemedicine would not be typically a covered service, depending on the

carrier policy or provider contract stipulations, some private carriers may reimburse for telemedicine services during this period if allowed under the state scope of practice

• Typically not used for hands on providers like chiropractors and acupuncturists as

the on-line or phone interaction typically leads to a visit where the on-line would be bundled to the hands-on visit.

Telemed elemedicine D icine Definition efinition

• The provider uses an interactive audio and video

telecommunications system that permits real-time communication between the distant site and the patient at home.

What Are The Codes?

• Evaluation and Management 99201-99215
• Can be a new patient or established

02 99214 95

Place of service for these codes is 02 95 Modifier Modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”

What about therapies - Medicare

• Medicare temporary addition to telemedicine
• Medicare added the following codes for reimbursement via telehealth

97110 therapeutic exercise, 97112 neuromuscular reeducation, 97116 gait training and 97535 for & ADL instruction.

• UHC and VA

2021 Year of Time & the Ox

go online, pay, and ask a question the day you sign-up! www.aacinfonetwork.com/network BILLING Questions CALL the EXPERT

SAM COLLINS