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

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

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- of-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 of 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 of 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.

Fee for service (visits) not time Packages and Plans Refund policy for unused “Modern Acupuncture” 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 other

Medicare Advantage Original Medicare (also known as Part C) • • Original Medicare includes Medicare Medicare Advantage is an “all in one” alternative to Original Medicare. These Part A (Hospital Insurance) and Part B “bundled” plans include Part A, Part B, and (Medical Insurance). usually Part D. • Drug coverage, requires a separate • Plans may have lower out-of- pocket costs Part D plan. than Original Medicare • You can use any doctor or hospital • In most cases, you’ll need to use doctors that takes Medicare, anywhere in the who are in the plan’s network. U.S. • Most plans offer extra benefits that • Original Medicare doesn’t cover— like To help out-of-pocket costs in Original vision, hearing, dental, and acupuncture Medicare (20% coinsurance), beneficiaries can purchase supplemental coverage

RVU MC WC-CA 97810 1.05 $40.96 $53.09 97810 53.09 / 1.05 = 50.56 97811 0.80 $30.81 $33.06 97813 1.17 $45.82 $59.40 97814 0.96 $37.37 $38.54 97813 50.56 x 1.17 = $59.15 $85.03 99202 2.14 $110.24 99203 50.56 x 3.03 = $153.19 $119.87 99203 3.03 $155.41 $51.28 99212 1.28 $66.47 $83.73 99213 2.11 $108.55 97110 50.56 x 0.87 = $43.98 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

• 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

Standard Episode of Care • 97810-97814 • 97110, 97112, 97530 • 97124, 97140 • 97016 • 97139 • 99201-99215

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 New R51.0 Headache with orthostatic • component, not elsewhere classified New R51.9 Headache, unspecified •

R51.9 Approximate Synonyms Headache, cervicogenic • Cervicogenic headache • (from the neck) Chronic facial pain • Headache, chronic daily • Chronic mixed headache • Headache, mixed • syndrome Headache, occipital • Chronic pain in face • Headache, sinus • Craniofacial pain • Occipital headache • Daily headache • Pain in face • Facial pain • Sinus headache • Facial pain, chronic • 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

Place of service for these codes is 02 02 99214 95 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

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