I Could Use Help On..

Please Note! Due to the high volume of irritating spam and slow-down of participation here, we are no longer accepting new comments, questions, or subjects on this Forum. We are keeping all the subjects and comments for review as there is a lot of good stuff here relating to practice-building subjects. So, dig deep! Thanks to everyone who participated here but it is time to move on to bigger projects educating the public about acupuncture! Matt Bauer

24-Jan-2012 07:44 PM

Matthew Bauer

Posts: 211

Matthew Bauer

Hello everybody. I could use your help so that I can better prioritize my efforts moving forward. Please share those issues you could use the most help on in building your practice here. This can be on anything from how to treat patients with complex conditions to advice on finding a good location for your office. By sharing those issues that are giving you problems building your practice, you can not only get direct advice but you will also be helping to build this database of advice and information that others can benefit from. Don't be bashful - ask away.   

 

29-Jan-2012 10:04 PM

Not Available

Posts: 10



Dan Clark

I am Dan Clark.  I found this website through elotus.  I have been in practice for 10 years and recently moved my practice to Alpine, UT.  I am still trying to put all the puzzles together.  The biggest key for me is what and when to educate patients during the course of the their treatments.  I have just purchased your book and am anxious to read it but I wanted to get my feet wet here and get things started.  

 

02-Feb-2012 11:45 AM

Matthew Bauer

Posts: 211



Matthew Bauer - Hi Dan. Thank you so much for your post and buying my book. Sorry for the delay in replying to you but this is a brand new thing I am trying to get going with this Forum and we are still working the bugs out. As for when to give what information to you patients, I strongly encourage explaining acupuncture as a therapy that stimulates the body's own resources, helping the body to better heal (or manage) itself. You usually do not have to go into too much detail about this unless they ask you. I sometimes say that acupuncture greases the wheels of the body's self-healing mechanism's. This is a good way to frame it. We may not understand all of those mechanisms but we don't have to. All we need to do is supply the grease  - help the body do a better job of its own self-healing efforts. We then hope this extra healing effort will make a difference in their health issue. We just need to see what happens in the initial series of 5-6 treatments. 

I hope this helps you some but please write back with more specific questions. I will respond in a much more timely manner this time!  Best  - Matt Bauer




 

10-Feb-2012 11:00 AM

Not Available

Posts: 10

Matt,

 

I got your book.  I am still in the process of reading it.  I have enjoyed reading it thus far and look forward to applying the principles.  


Dan Clark
 

10-Feb-2012 11:41 AM

Matthew Bauer

Posts: 211


Matthew Bauer

Hey Dan  - Thanks for purchasing my book and please share any questions or comments you may have about it here. That is what I hope this Forum will turn into  - a way for me to offer advice especially on questions related to what I put out there in my book.

 

Best  - Matt

 

 

16-Feb-2012 08:50 AM

Not Available

Posts: 10

Do you have forms available for us to purchase or make available?  I am doing a 30 minute consultation today.  I am just starting off on a blank piece of paper to get an idea of current symptoms. 

Dan Clark
 

16-Feb-2012 09:48 AM

Matthew Bauer

Posts: 211


Matthew Bauer - Hey Dan. I was not sure if you were referring to a basic patient intake form or a more specialized form used for interviewing the patient once they have filled out the intake form? I could fax you a copy of our intake form and I will look to get that available for downloading on this site. As for the interview, I don't have a set form. It would probably be a good idea to have one but I have done this so long I have my routine down.

The main thing I suggest you try to capture is to first ask about their CURRENT symptoms. You want to get a short description of the symptoms they now have at least within the last week or two. You want to get an idea of the INTENSITY of their symptoms as well as the FREQUENCY and and thing that makes it BETTER or WORSE. Once you have that, you can get the history of it especially looking for information on when the symptoms FIRST STARTED and ant CHANGES in the pattern of symptoms that have taken place.

The problem is that even if you have very specific questions to ask that could be answered with short, concise answers, people are not usually good at this. they will wander in thier answers to your questions. It is kind of like a detective asking questions of witnesses of a crime scene - they don't know how to collect their thoughts very well. That makes using a set form a bit difficult but it is a good idea to try to have one.

Let me know if you need an intake form or if you have other questions or suggestions.  - Best  - Matt Bayer 

 

16-Feb-2012 11:10 AM

Not Available

Posts: 10

I would like to look at your intake form.  my fax number is 801-763-9056. 

Dan Clark
 

16-Feb-2012 11:54 AM

Matthew Bauer

Posts: 211



Matthew Bauer We sent that over. Let me know if you have any questions and thanks for using the Forum.  Matt
 

16-Feb-2012 12:05 PM

Not Available

Posts: 10

Matt,

 

Thanks for faxing the intake form.  So you use a health history form as well?  


Dan Clark
 

16-Feb-2012 12:20 PM

Not Available

Posts: 10

I am on chapter 17.  Do you mind sharing with us what you charge for non-covered or covered services like cupping, massage, gua sha?  What do you charge for covered services such as heat therapy

Dan Clark
 

16-Feb-2012 08:36 PM

Matthew Bauer

Posts: 211



Matthew Bauer -

In that chapter, I am trying to debunk the misinformation so often spread that insurance plans pay so little for acupuncture that acupuncturists who spend much time with their patients cannot afford to give quality care. I tried to point out that there is flexibility when working with insurance that would allow a practitioner to charge additional fees for additional services like cupping, heat therapy, etc. When my office bills insurance for those types of services, we usually charge around $25-$30 dollars.  I, personally, do not usually charge for those services as non-covered services for most of my patients because I have a higher volume practice and don’t spend as much time doing those things as others might and my fee structure would make it difficult for me to do so. The main point I was trying to make in that chapter is that those who have their practices set-up to charge higher fees can still use insurance to get close to their normal fees if they choose.

More than anything, practitioners need to learn how to make their services work clinically and financially for both their patients and themselves. Many acupuncturists try to charge too much for their services then end-up treating their patients too infrequently due to the cost and then their patient satisfaction rates suffer. This hinders the growth of practices. Many would be better off charging less and building to a higher volume of patients. More patients mean more referrals that help to grow the practice over time. Of course, you can take the lower fees/higher patient volumes too far and that is why I call the model I promote the “Middle Way” – trying to find the right balance between charges and patient load.

I hope that helps but keep the questions coming if you have more.  Matt

 

16-Feb-2012 08:37 PM

Matthew Bauer

Posts: 211



Matthew Bauer No just the history information on that intake that I may then flesh-out during the interview.  Matt
 

23-Feb-2012 12:05 PM

Not Available

Posts: 10

I am trying piece all the information together.   I have read most of the book.  I have enjoyed your book and am looking forward to making a transition to the "Middle Way".  Could you give me an idea of the paperwork that you have patients fill out when they come in for consultation?  So you also do an examination or first visit once they come in for consultation? 

Dan Clark
 

23-Feb-2012 01:35 PM

Matthew Bauer

Posts: 211



Matthew Bauer -

Hi Dan – Our intake form asks for the basics such as name, birth date, address, phone numbers, e-mail address, and so forth. We also ask the reason for seeking treatment in bold type yet people often skip this line. When we asked the date that the symptoms or symptoms started. We ask if they have insurance that they believe covers acupuncture and if so we need a copy of their insurance card to verify coverage. There is a box to circle areas of pain that lists different body parts and then a 0 to 10 pain scale the ask how often the symptoms are present, their general health, if they can perform daily activities, and if they're under the care of a physician. Then there's a checkbox for past and present problems about 25 or 30 of them and then a place for them to sign at the bottom.

 

In addition to that we have patience that have insurance sign a paper that both allows us to build insurance directly and have the insurance pay as strictly and also has the patient egg knowledge that if their insurance does not cover the services they realize that they are responsible to pay for those services. Sometimes people balk at that form but we let them know we will be doing everything we can to verify their insurance but that form is mainly there for those rare instances when we are treating someone and their insurance runs out like if they lose their job and they don't tell us.

 

After I do the initial consultation, if the patient decides they want to go through with starting treatment, that is what I would do my initial examination just before I start the treatment.

 

I hope that helps and I would encourage you to go back and reread some of the sections of my book as you go along and feel free to keep the questions coming.

 

28-Feb-2012 11:28 AM

Not Available

Posts: 10

So you mind sharing the insurance form that people need to sign? Dan Clark
 

29-Feb-2012 02:30 PM

Matthew Bauer

Posts: 211

Matthew Bauer

Hey Dan  - I will fax the forms to you as I would have to pay my web person to get them on this site. If more people ask for them, I will bite the bullet and do that. 

ALSO - I was using a voice recognition software to save time and just realized some of the typos I had in earlier posts. Embarrassing! I will get that corrected as soon as I figure how to correct things like that. Still learning this system 

Best  - Matt

Best  - Matthew 

 

01-Mar-2012 11:33 AM

Not Available

Posts: 10

Matt,

Thanks for all of your help.  I look forward to putting everything together.  

 

Thanks,

Dan Clark

 

 

19-Jun-2012 02:54 AM

Michal

Posts: 1

I have recently purchased your two books and just finished reading Making Acupuncture Pay.  Thank you very much for writing such a helpful book. You have really provided very useful advice and I appreciate your generosity in sharing your experience (you can see my book review on Amazon.com).

I received half of my training in the US and the other abroad where I now practice.  I have been practicing for several months now and have had very low patient volume.  I hope to implement some of the suggestions in your book, but I also realize it takes time.  On a positive note,  I realize that I have been able to help a pretty good percentage of my patients.  I have even had one of those "miracle" type cases as you describe.

I would like your advice on handling calls from new prospective patients.  I have noticed that too many do not make an appointment by the end of the call.  I can't say an exact percentage, but it has happened enough times to make me wonder how I can improve.  My hunch is that I am spending too much time on the phone with these patients.  I usually ask a lot of detailed questions about their chief complaint, and they then usually ask all sorts of questions.  Of course it would be better for all of this to happen at the time of the appointment, after they see that I am a professional and nice practitioner who really wants to help.  How did you handle these calls before you had a receptionist? 


Michal
 

01-Feb-2013 08:34 AM

Robinette Acu

Posts: 4


I would like to give some talks at businesses during their "lunch and learn" sessions, and I'm coming up with a list of topics.  Can you recommend any topics that the general public may be interested in?  Not quite sure how to structure it so that it is useful and informative.

 

05-Feb-2013 02:40 PM

Not Available

Posts: 2

Hello, my name is Rikki and I am newly graduated acupuncturist in the state of Colorado. I had the honor of visiting your office with my SCU class last summer and learned so much. I purchased and read your book at that time which helped me decided to open my own small 2 room office with the "middle way" fee base. Now it is time to get patients in the door. I have been open a month and with all the money I've spent to get here I am short on any cash for advertising. I am also delving into a very diluted population (23 acupuncturist in a small town of county of 14k). So while I have the benefit of acceptance on my side, I have been racking my brain to think of a way to advertise in a way that would make me stand out. I try to hand out my biz cards daily and I have a website/social media, brochures, flyers around town and will be in the next phone book. I feel like the next step will be to visit doctors offices and the like. So my question is this, how can I stand out, as a new practitioner in a small town already crowded with options? Thank you!


 

05-Feb-2013 05:24 PM

Not Available

Posts: 2

This is great thank you! I am happier to start with a letter to doctors, that seems more efficient. I will use your template in your book! As for a specialty I do not have any special training but I do have a background as a dancer so that is a great place to start. During internship I seemed to be drawn to mental/emotional complaints and so I have visited with a few psychologists/psychiatrists in town. I also really love the retirement home idea and will start to source contacts on that. I was hesitant to offer a specialty because I didn't want a patient to not call based on that limitation. It is a funny position to be in but I see your point. Thank you so much, just finding where to begin is half the battle!

 

05-Feb-2013 06:52 PM

Matthew Bauer

Posts: 211

Hey Rikki –  The tricky part is that you don’t want to limit yourself with a specialty but you want to distinguish yourself also. Geriatrics is a good one for this because although it is a type of specialty it involves all different types of medical conditions. Pediatrics is another very good one. Parents are looking for drug free natural therapy and Moms also spread the word well. Either way – you should be able to let people know you have a general practice with a “special interest” in this or that and have it both ways. And PLEASE start working on explaining what you do is boost the body’s own ability to heal/manage itself. This makes what we do sensible to people and explains why by being able to do this one skill, you have the ability to treat such a wide range of problems. By explaining acupuncture in this most straightforward, easy to understand manner, you can start to distinguish yourself as someone that does not need mysticism to explain yourself.  



Matthew Bauer
 

06-Feb-2013 02:07 PM

Not Available

Posts: 2

Thank you I agree with how to say and what to present to patients on what acupuncture does. Education is so important. My next question is: Should I offer the Dr/PT contacts a free treatment so they can "see for themselves" my style?

 

06-Feb-2013 03:12 PM

Matthew Bauer

Posts: 211

Yes. It can be a good idea to offer a free treatment to a MD or PT but you don’t want to coming-off as desperate.  You are a trained professional introducing yourself but you practice a type of therapy that is not well understood so you are offering a treatment to help them better understand just how your therapy and you, yourself work. If you are using thin gauge needles and a gentle technique (as I recommend) then you could approach the free treatment offer by stating something to the effect that you appreciate that many people don’t understand acupuncture well and that concerns over it being painful are common. You want to assure them that you use the most modern, ultra-thin needles and a very gentle technique that you would be happy to demonstrate for them or a member of their staff.

This and the advice I gave about how to specialize without really specializing is another example of what I mean about the “Middle Way” – finding the right balance between going too far in one direction or another.

Keep the questions coming and please note that I thought it best to move this discussion to a new thread “ I Just Opened My Practice – Help!” This thread title should make it easier for others to follow and I so appreciate you sharing your efforts so others can follow. That is what I hope others will start to do so we can build a resource database of common questions/problems. 



Matthew Bauer
 

28-Feb-2013 02:00 PM

Not Available

Posts: 0


Matthew --

I just wrote you another post and then I came across this response on another topic.  When do you schedule these initial free consultations?  Do you book these as you would book any other appointment?  Do you book them as initial consults in order to have the 30minutes to give?  Do you find that many people take advantage of this?  What percentage would you say end up booking a follow-up appointment?  Do you limit how many of these free consults you provide in any given period?

Thanks again for your book.  I purchased a copy a few months ago read through it and recently misplaced it!  I found it so informative I just purchased another copy this week on Amazon! 

Johanne

 

28-Feb-2013 03:27 PM

Matthew Bauer

Posts: 211

Hi Johanne – Please check on the second page of these Forum topics under the Appointment Times topic. I think I answered those questions in that thread (and maybe one other thread, too) but if you still have any more questions please follow up on those. Best   

Matthew Bauer

 

17-May-2013 07:35 PM

Not Available

Posts: 2

As a recent grad, I am familiar with some popular herb brands such as Sun Ten, Evergreen, Blue Poppy and KPC. But can you speak about the safety and efficacy of the lesser known, made in China herbal formulas?

 

11-Jun-2013 08:19 PM

Toreador

Posts: 1

Hello 

I just finished your webinar and it provided a lot of helpful information, so thank you for that. I am just restarting in practice after many years lost at sea then two years abroad. So a big goal for me at this point is getting people in the door, seeking out speaking opportunities, getting credentialed with insurance providers, and cultivating relationships with referral sources.

One thing that has been suggested to me is to do a Groupon type deal. Do you or any visitors to this forum have any thoughts about or experience with this as a strategy?

Thanks. 

"Joy is the Flower of true health" - Japanese Proverb
 

12-Jun-2013 11:14 AM

Matthew Bauer

Posts: 211

I am happy to hear you found the webinar helpful and welcome back to the needle-poking profession! I have mixed feeling about Groupon for Acupuncturists for a few reasons. The first is the possible legal problem. There has long been the sentiment that those providing medical services should not engage in any advertising that works as an enticement to use those services. In other words, it is considered unethical and may even be illegal in some states to entice people to use medical services with any “special, limited-time” offers – the idea being that if people need medical services, they should use them only for medical need not because of special deals. That being said, I know Acupuncturists use Groupon and similar marketing and I don’t think anyone is going after them for it.  

The bigger issue here, I believe, is what I stressed in my seminar – that the biggest education/marketing challenge Acupuncturists face in the West is convincing the public that we are intelligent, caring professionals. If you can find a way to use something like Groupon to get that message across – fine. I think such marketing tends to cheapen the role we hope to play as health care providers but maybe someone can figure out how to use that medium without doing that.

Lastly, I guess I would say it depends on the clientele you are going for. If you are in a busy city and are appealing to a younger crowd, maybe everything I said above is not important. If you are specializing in “acupuncture face-lifts”, Groupon would be a great fit. Whatever you decide, I advise that you keep the goal of establishing yourself as an intelligent, caring professional as the ultimate goal of your marketing efforts as that will do more to bring down walls of anxiety and uncertainty the public has about Acupuncturists than anything else.  



Matthew Bauer
 

12-Jun-2013 11:36 PM

Toreador

Posts: 1

I thank you for your considered response. This was very much along the lines of my own personal thinking about it. It's that fine line of opening up access and shooting one's self and the profession in the foot. I've ordered your book and I'm looking forward to more of what you have to say. Also I noticed on the forum you were talking about intake forms, I don't have a good intake form these days. I'm working on one, but if you're sharing it, I'd like to take a look. Thank you again. 


"Joy is the Flower of true health" - Japanese Proverb
 

29-Jun-2013 07:07 AM

acupete

Posts: 12


Hi Matt,


Great to be on here. I'm currently focusing on developing a PIPELINE. Not the Keystone kind, but rather those doctors, physical trainers, pharmacists, hostesses, salespeople and so on. I find whenever I consistently connect with others in my travels, there is invariably someone who is genuinely interested in acupuncture. Not always a referral necessarily but always an opportunity to educate. Sometimes a patient comes from this, sometimes not, but I'm a big believer in "Polish here and it shines over there."


All the Best!

Peter C Doyle
 

01-Jul-2013 08:16 AM

Matthew Bauer

Posts: 211

Hi Pete - happy to see we got your registration glitch worked-out so you can post here. I tell you, there is a tremendous interest in acupuncture out there but no one is working hard at addressing this from a profession-wide prospective. That leaves it all up to us to do individually and it is true that working proactively at this may not always seem like it produces results but this type of marketing/education approach can build interest over time. Keep polishing and posting!


Matthew Bauer
 

01-Jul-2013 08:55 AM

acupete

Posts: 12

I hear that. Still trying to find out what they discussed on the AAAOM conference call. Michael forwarded the agenda....


Peter C Doyle
 

21-Oct-2013 10:48 PM

Not Available

Posts: 5

Hi Matt, I am currently practicing in WA State. I do not currently take insurance but am considering starting that process with the changes that are coming to heath insurance with Obamacare. I send a super bill electronically using Office Ally for all the clients that request it.

My questions for you are 1) do you think I need to make this change to my practice if I am already successful? I guess I am concerned that once insurance covers more services patients will be more intent on finding covered providers (understandable!). 2) Where do I start? I am licensed here but am not NCCAOM certified, do I need to be to be a preferred provider? 3) I see almost all pregnant people. A lot of labor prep treatments, can I bill for that?

I just downloaded the first few chapters of your book and will buy very soon if I find it helpful. Do you expect any changes to the book with the changes in health care?

I have taken the insurance seminar given by AAC, they basically advised to not contract with insurance companies if you can survive without it!

Thanks so much, Jasmine
 

22-Oct-2013 08:59 PM

Not Available

Posts: 5



Thanks for your reply. I just bought the kindle version of your book. Eating it up!

To answer your questions yes it is true that some insurance companies here are not taking new providers, but some are, depends on the company.

And yes by labor prep treatments I mean getting women ready for their upcoming birth. I also see a lot of morning sickness, pregnancy aches and pains, postpartum issues like depression and milk supply. I also see babies and kids. I am a midwife and I work in a birth center, so I am surrounded by bellies. I just had my own baby and am just getting going again after maternity leave so wanting to shake things up and really delve into what my goals are, how much money I want to make, what kind of practice I want to have. I found just at the right time!

And you may have answered this in your second paragraph, but is it generally a requirement to be NCCAOM certified to become a preferred provider? Or is that what you were referring to when you said it varies state by state?
 

23-Oct-2013 05:30 PM

Matthew Bauer

Posts: 211

That is so great that you work in a birthing center. I sometimes use the example of acupuncture helping lactation issues as something many Acupuncturists would never even think about yet it tends to work so well!  I hope you would consider sharing some of your experiences with the work you do as your background gives you insights many Acupuncturists could benefit from.

As for NCCAOM certification being required by insurance companies,  I think that all they would require would be whatever the State requires for licensing. If NCCAOM certification is not required to practice in Washington State, I don't see how a insurance company could require it.

Let me know how things go for you and maybe we could communicate sometime about things you have learned being a Midwife LAc. working in a birthing center.  


Matthew Bauer
 

27-Nov-2013 10:32 AM

Not Available

Posts: 1


Jasmine, I also practice in WA state. If you already consider yourself successful then i wouldn't bother to credential with the networks here. We are actually seeing less coverage for acu under the ACA with more utilization management making it harder to actually access the benefits. If it ain't broke, don't fix it!

The one exception may be the premera network, which is one of the few still open worth dealing with. Their plans have 12 visits covered at around $65 per visit. They also have 50% out of network benefits so your current system may work just fine for those patients, with the difference between the unreimbursed amount and their coinsurance percentage only being $15-20 anyway. But if you need new patients if may be worth getting into their provider directory.

I wouldn't bother with any of the other networks as they will just make life more difficult at this point, and some, such as aetna actually pay more out of network than in network in some cases.

The specialty focus of your practice is often not an eligible ICD9 code for acupuncture benefits so those patients won't likely have coveregae through other LAc's anyway.
 

27-Nov-2013 04:40 PM

Matthew Bauer

Posts: 211

Thanks for offering your advice. It really helps to have people who have direct experience offer their thoughts.  


Matthew Bauer
 

27-Nov-2013 05:22 PM

Not Available

Posts: 1


You bet. Hope I didn't step on toes by jumping in to reply to Jasmine's questions. One central concept in her questions is worth delving into more, though, and the middle path material offers a nice venue for discussion. I'm thinking of the concept of competitive vs creative business development.

The notion that "I better take insurance to be successful because if I don't the patients will go see someone else" warrants some self-inspection to assess the underlying motive.

If it is fear-based then is it really a sustainable solution that is congruent with your ideals? However, if it is a rational option based on an objective business plan and model then it lends to more creativity in my mind as a potential tool to help build and grow, rather than something that may end up constricting and conflicting. Doing it just because everyone else seems to be isn't a good enough reason in my mind.

Like you, Matt, I am curious to see how the ACA plays out over the next couple of years. It is too soon to base a whole business model or major business decisions upon it I think. Things are certainly in flux, however. Ultimately, if we charge a fair price and our patients get good results, it's just a matter of time and persistence to grow a stable practice. If you already have a stable practice, then I'd be hesitant to change too much based on a whole new set of unknowns mixed with fear. But maybe I'm projecting!

Great forum Matt, and great model you propose. As a Singer and CA wallflower the Middle Path feels congruent with my innards and offers a nicely half-full cup of optimism and hope for all facing the daunting task of growing a practice.

Cheers!


 

27-Nov-2013 09:59 PM

Not Available

Posts: 5

Thanks for the information! Your perspective is helpful and affirming of what I am already feeling. I don't want to enter into a working relationship with insurance out of fear. The fact is I do currently have enough clients because I am choosing to work part time while my baby is young. But I do wonder down the the road if i will still feel busy enough with wanting to work more and because of changes to health care, more people having insurance and more service being covered. Most of my colleagues take insurance and they mostly have complaints about it, which I find disheartening. When they describe not getting paid, not getting responses, having clients that get upset because things aren't covered I think it sounds like more headache then its worth unless you really needed the clients. Another issue I hear with other acupuncturist that work in pregnancy is that they feel they are being dishonest when they do their billing because often women come in for non covered services and they use a code for back pain or something similar even though that isn't really the reason they came in (although so many pregnant women have back pain). I would be uncomfortable not being totally honest. Great discussion and thank you for giving me more to think about.
 

29-Nov-2013 11:20 AM

acupete

Posts: 12


Can you talk about selecting points.

Peter C Doyle
 

03-Dec-2013 08:19 AM

Matthew Bauer

Posts: 211

Thanks for your question on point selection, Pete. I started a new thread by that name in the Forum and a Facebook posting to begin to address it.  


Matthew Bauer
 

07-Jan-2014 03:21 PM

Leah

Posts: 12

Thank you so much for your prompt response.  I have been extremely anxious about this issue.  Now that I know how to set up my fee structure, the rest seems manageable.  I'll be sure to mention this forum to WISCA members on facebook.  I wish our state organization would provide more continuing education on insurance.  Seems better to focus on making money than just getting angry about dry needling.  I'll be sure to check out other messages in the forum and see if I have anything to add.

Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

07-Jan-2014 03:54 PM

Matthew Bauer

Posts: 211

You are welcome, Leah. And say - let your state association leadership know that I would be happy to work with them if they wanted to connect with me to work on developing resources to help their members in their practices. My mission is to help get this therapy to more people by helping Acupuncturists be more successful in their practices. It seems to me that should be the mission of any AOM membership association as well so if anyone wants my help, I am ready to give it.  

Matthew Bauer
 

07-Jan-2014 04:18 PM

Not Available

Posts: 5


Hi Matt! 

Quick question, I have heard differing opinions about when to use Evaluation and Management codes (E&M codes). Some use them every visit and some every 4-6 weeks or at the onset of a new symptom. When do you you use them?

And do you use Office Ally for electronic submitting?

Thanks! Jasmine

 

07-Jan-2014 05:43 PM

Matthew Bauer

Posts: 211


Hi Jasmine - good to hear from you. You should use E/M codes that best reflect what you are doing clinically. If you are doing a time consuming, comprehensive exam, use the code that signifies that. If you are taking the time to get a brief update and limited exam, go ahead and bill for that. If you are seeing a patient for a series of regular treatment where you don't need to take time gathering information or doing even a brief exam to proceed with treatment, then there should be no need to add an E/M code. Don't omit codes that reflect the work you are actually doing because you think they will not get paid and don't add or use codes that reflect more time than you actually spent because you think they will get paid. In other words, don't bill based on what you think will or will not be paid for. Don't try to use a formula like billing for a Brief Exam every five treatments because you think that will be allowed. Bill what you do.  

Matthew Bauer
 

07-Jan-2014 05:54 PM

Not Available

Posts: 5


Thanks Matt! That is what I figured. I think its tempting to bill for as much as you can when you don't think you are being paid enough! Its a slippery slope. 

Do you submit your insurance form electronically?

 

07-Jan-2014 08:40 PM

Matthew Bauer

Posts: 211

Opps - sorry, I forgot that part. We don't use a service like Office Ally although I have heard a lot of good things about doing that. We do their online electronic billing for our American Specialty Health claims and my wife has an electronic template HCFA 1500 form that makes things go faster for our other claims but we never made the transition to all electronic. I would encourage you to research this and maybe someone here can give you some insights. I think once you learn the ropes and get things set-up, that is the way to go.  


Matthew Bauer
 

13-Jan-2014 01:35 PM

Leah

Posts: 12

Hi Matt,

I found this to be a really good resource on figuring out E&M codes.  Reading through all of this is going to help me redesign some of my office forms so that I know that I am documenting correctly for insurance purposes.

http://emuniversity.com/NewOfficePatients.html

http://emuniversity.com/EstablishedOfficePatients.html

Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

13-Jan-2014 01:43 PM

Matthew Bauer

Posts: 211

Hi Leah  - thanks for the links. That is about as straightforward and useful advice about how to use those codes as you can find.  Best -

Matthew Bauer
 

13-Jan-2014 02:01 PM

Leah

Posts: 12

Hi Matt,

You had touched on "discount programs" in a previous response, as well as in your book.  There are some insurance companies in my area that offer this.  Do you think it is worth getting listed on their websites as a provider if there are no acupuncture benefits, only the discount?  Would this mean that the person gets two discounts?  Both the specific discount program and a TOS discount?  Thanks!


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

13-Jan-2014 02:14 PM

Matthew Bauer

Posts: 211

Hi Leah  - No, you don't give a discount on top of your TOS discount. I usually advise setting your fee a little above what your actual target fee is so that when you give a discount (TOS or under a discount program) you are closer to what you wanted to be. The benefit of being listed within a discount program is those patients are cash patients and being listed as a provider under such a program is like free advertising. 


Matthew Bauer
 

13-Jan-2014 03:03 PM

Leah

Posts: 12

I'm sorry I'm not understanding this Matt.  Let me use an example to make this more clear.  Let's say I am part of the WEA Trust Discount Program and I offer a 20% discount, and my rate for acupuncture is $75.  The person comes into the office and pays cash for the treatment.  Wouldn't the math be the following?

$75 - ($75x.20) = $60 (Discount Plan)

$60 - ($60x.20) = $48 (TOS Discount)

I thought that if you have a discount (i.e. TOS), you have to apply it uniformly to everyone.  That's what makes it legal, because technically an insurance company could take advantage of the discount if they could pay at time of service.  There is just no way for them to do this.  I think you are in California, though, so may not have to deal with this.  Thanks again for your help.


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

13-Jan-2014 04:38 PM

Matthew Bauer

Posts: 211

Hi Leah  -   I first have to preface this by stating that these types of questions only really get answered by court cases and I am unaware of any cases on TOS discounts. That being said, I get so frustrated to see people like you worrying over these sorts of details as it is so unfair. Hospitals have tremendously inflated rates that they quote knowing that they will negotiate a far less rate for insurance and that if you don’t try to bill your insurance will give an even deeper discount for cash.  I recently read an article in the L.A. Times about how people are learning to just pay cash rather than putting charges through their insurance then pay the co-pay. Last year my wife went to have a bone density test and was told that it was covered under her insurance but her co-pay would be $620. She told them to cancel it as she was not going to pay that much then they told her if she just paid cash it would be $52!  A greater than 10 times increase with the co-pay! And that is not unusual especially for expensive things like surgery. The fact that insurance companies allow these huge price variations for those mainstream medical procedures and practices but us small-fry private practitioners have to worry about having a “dual pricing” system because we charge a little more for insurance is maddening.

Ok – rant over. The way I would encourage you to think about it is this: Your “normal, prevailing rate” (in the example you gave) is $75. You just happen to give a TOS discount and you also signed-up to offer a discount to those referred to you by specific health plans. You don’t give a discount on top of another discount - unless the agreement you signed says you have to give a double discount. If that agreement says you agree to give a discount off your “normal, prevailing rate” – you should be fine. $75 is your normal, prevailing rate. Some patients may get upset thinking they should have a double discount but you should be OK legally.   



Matthew Bauer
 

13-Jan-2014 04:58 PM

Leah

Posts: 12

Thanks so much for your thoughts.  I completely understand your rant as well.  The fact that I have a cash practice keeps me honest and I think cheaper in the long run, but clients don't always understand that because they are used to insurance.  It is an imperfect system that unfortunately lends itself to fraud.


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

13-Jan-2014 05:45 PM

Matthew Bauer

Posts: 211

My favorite philosopher, Chuang Tzu, argued that all systems are imperfect. He lived at an age when standardized weights and measures where first being used in China's marketplaces to insure honesty in commerce. He said that if you use weights, scales, and measures to try to insure honesty in the marketplace, then cleaver thieves will learn how to steal using weights, scales, and measures. 

Thanks for posting and good luck!

Matthew Bauer
 

17-Jan-2014 08:27 AM

Leah

Posts: 12

Hi Matt,

This may be more a question for your wife, but could you give a little more information on the nuts and bolts of your billing setup?  You mentioned that you have an electronic HCFA form--did you buy a piece of software that helps you fill one of those out easily?  What accounting software do you use?  I've used quickbooks up until this point and have an accountant, but this gets more complicated once I add insurance.

Thanks so much!


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

17-Jan-2014 08:31 AM

Leah

Posts: 12

I guess I should add that I'm thinking about creating a superbill for every patient, and then just using quickbooks to track whatever I get paid.  Of course that means I have to keep a superbill of the records, so I was thinking maybe use Practice Fusion since I like the idea of electronic record keeping at some point.  The software is free and you can generate superbills.  However, that's a lot more work to get set up.  I'm hoping maybe you have a simpler, low-tech version that would work for now.


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

17-Jan-2014 09:10 AM

Matthew Bauer

Posts: 211

My wife is out of the office today but I called to ask her about this and she told me she had bought some software that allows her to ether fill-in and print-off a HCFA form or to use a blank HCFA and then fill-in the fields and print it. She buys a big tab of blank HCFA forms from Staples and then uses the software to fill-in those form. She figures the cost of ink for creating the form by printing it is more than the cost of buying the forms. She's good! But she was not so good at remembering the name of the software. She will try to find that out when she is back in the office Monday. 


Matthew Bauer
 

17-Jan-2014 10:51 AM

acupete

Posts: 12

Leah,


Don't if I mentioned before....? I use Office Ally. Free, simple and easy.


Peter C Doyle
 

17-Jan-2014 12:46 PM

sdonelson

Posts: 1

Hi Matthew -

I've been reading your forum and working with your book for a couple of years now.  It has helped me grow my practice quickly, efficiently and productively.  Thank you!


I have some questions on packages and insurance.  I'm in the state of CO and it has extremely strict rules on insurance and cash payments.  We cannot offer TOS cash discounts.  We can though offer packages as long as we bill both insurance and cash alike.  Currently my rates are as follows:  Initial Appt: $95, Follow-up: $75, 5 treatments - $275 (55/tx), 10 treatments: $500.  I've just started billing insurance, so I'm very green and have lots of questions.

My first is how do I bill the treatments within the package.  Do I show the original fee and then show the discount, or do I just adjust the fees to match the discounted rate?



Stacey Donelson, L.Ac.
 

18-Jan-2014 06:02 AM

sdonelson

Posts: 1

Thank you for the quick response Matthew!


Stacey Donelson, L.Ac.
 

24-Feb-2014 11:51 AM

Leah

Posts: 12

Have you had any luck with neuropathy?  I've got a new client next week who has tingling only in hands and feet.  It started 6 years ago after a bad cold.  He said he's had several consults with neurologists and the only thing they could come up with is that the virus may have settled in nerve endings and may or may not get better with time.  I've never had very good luck with neuropathy--I've already told him in my experience it can be very stubborn and take a long time to see results, but he would like to try.  Any ideas?  Thanks so much.

In other news, I'm billing my first insurance client this week!


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

24-Feb-2014 01:04 PM

Matthew Bauer

Posts: 211

Hi Leah  - good luck on your insurance patient. Let me know if you have any question on that. As for neuropathy, there is a thread on that subject in these Forums. I am putting your posting there so it should now show up on the first page. There are several pages of posting here now and I have yet to organize them into specific topics so I know it can be hard to search all of them. Anyway - please read of those posts and let me know if you have any more questions. I will say that for the hands, I like to use the points LI3,4,11 TH4,5 and SI3. As a general rule, if the patient has numbness evenly across all finger and toes, it will be harder to treat then if focused on certain digits. 

Matthew Bauer
 

25-Feb-2014 02:40 PM

Not Available

Posts: 5


Curious that he got it after a cold. Could it be viral related? It makes me think something like shingles...

 

25-Feb-2014 05:15 PM

Leah

Posts: 12

Thanks so much!  I will check that out and let you know how things go.  I'm trying to figure out how to fill out the HCFA form right now.  I'll let you know if I have any questions.  The American Acupuncture Council has a really nice website with a lot of insurance related content, including instructions and examples on the HCFA form.  It costs $70 to register, but they also send you a nice book on coding.  http://digital.aacinfonetwork.com/


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

25-Feb-2014 05:31 PM

Matthew Bauer

Posts: 211

Getting details of the pattern of the symptoms can help to diagnose the most likely causes. Did the tingling happen in all 10 fingers and toes at the same time or is that tingling equal in all 10 digits now? Those details help to understand what channels are involved. If this came on suddenly right after the bad cold, was this patient on meds for that cold like antibiotics or anything else? If so, this might be a side-effect of the meds. Please refer to my book’s chapters 6 (The Intake) to chapter 11 ( How to Get the Information you Need). This info focuses on how to deal with cases with a difficult to predict prognoses. In this type of case, you can’t say just what caused it (the virus diagnosis is just a guess) so you need to help your patient feel comfortable with proceeding with a treatment where the outcome is hard to predict. Feel free to share more details here and maybe I can give more specific advice. And thanks for sharing! 



Matthew Bauer
 

17-Mar-2014 07:22 AM

Leah

Posts: 12

I have a potential client who is looking for an acupuncturist that accepts fee-based payment from the VA.  I've had a few veterans call me over the years, but I've always referred them on because I wasn't billing insurance.  Any idea how to do this?  Thanks so much!


Leah Olson www.wholefamilyacupuncture.com "Example is not the main thing in influencing others. It is the only thing." --Albert Schweitzer
 

17-Mar-2014 10:08 AM

Matthew Bauer

Posts: 211

Sorry, but I don't have any experience with VA insurance. I will post this on the MAP Facebook page to see if perhaps someone there might be able to help.  


Matthew Bauer
 

17-Mar-2014 12:14 PM

Not Available

Posts: 0

Hi Leah,

I have just started to bill the VA, and I just got paid from my first patient. I see you are in Appleton. I am in Oshkosh, so I can give you info about where to send your billing. You do have to set up an account with them first, as they will pay you by direct deposit. This does take some time. It took a couple of months of back & forth mistakes on my part, but I did get full payment, and I was not expecting that much. If you are a member of our state acupt organization, they have a VA guide you can access and print out in their yahoo users group. If you can't access it, let me know and maybe I can find it and email one to you, or you can check out the "Guide for Providers" on the VA website.

Carol J. Hemauer

 

17-Mar-2014 02:04 PM

Matthew Bauer

Posts: 211

Thank you so much for your help here Carol. This is just the type of helping each other feedback I hope to encourage here. 


Matthew Bauer
 

06-May-2014 01:43 PM

Not Available

Posts: 7


Hi Carol,

That's very interesting to hear about the VA. Did you get paid via the CHAMPVA program? I had always gotten the impression from other acupuncturists that it was very difficult to get payment from the VA. I looked at some of the VA websites and according to what I was able to find acupuncture is specifically excluded from coverage. 

-Jonah