We just posted a new page to the website: Practice Dashboard. This is a relatively advanced topic for most acupuncturists, but we really believe if you use this, it can help take your practice to the next level. But be warned, if you are not fairly advanced with Microsoft Excel, it will be difficult. And we are just not able to provide technical support. But definitely worth checking out: Practice Dashboard.
I had a nice little email exchange with one of our readers and she graciously allowed me to reprint it here (I have done a few edits):
Do you offer private consultation? How do I find out more? Graduating from SWAC in July… business planning now. here is one of my questions, that I plan to post on forum once I get my password.
QUESTION: Have you ever seen a coding system like this before… is it really recognized, is it LEGAL? Continue reading
I’ve discussed Aetna before…their covering only specific conditions, etc. but I’ve never talked about how “unlimited visit” policies work. For starters, there are hurdles to jump to get “unlimited visits.” Typically with Aetna, after a patient has 25 visits of a particular kind (even when the patient has unlimited visits), they will stop paying and request records and conduct a medical review. I was dumbfounded this week when I was told this on a patient who had just started coming in. Although we saw this patient back in 2005, he hadn’t been back in until now, 2012; 7 years. I was convinced that this was a mistake. On the 2nd phonecall, where the same information was repeated, I had to wonder if this was a correct recital of their policy – this was the patients 25th OVERALL acupuncture visit from 2005-2012…they said that it didn’t matter that the patient hadn’t been in for 7 years, after 25 visits they conduct a review, period. I, of course, argued that this was absurd since it had been 7 YEARS but they assured me this was the policy. As I knew this policy to be, benefits are annual (or benefit year) but in this case, calendar year. If the patient hit 25 visits in 2012, I would be expecting this review. But to add up all visits ever had…even those that span NEW PATIENT timeframes, because by definition he was a new patient, they still wanted this info. I’ve submitted it and will see how this goes, I just think it is absolutely ridiculous…I think the same policy would apply if the patient sees another acupuncturists…..it’s acupuncture visits TOTAL that they will be looking at. So, the moral of the story is that “unlimited visits” is something you will always have to fight for, after 25 visits, and sometimes sooner than you might think.
As many medicare beneficiaries opt out of straight medicare to go with an alternative insurance, acupuncture benefits are more and more creeping into what is covered. Let me back up for those of you unfamiliar with medicare plans….
First of all, medicare does NOT cover acupuncture. When you become medicare aged, you have the option of keeping straight medicare OR opting out of it, and going with another insurance in it’s place. So, whatever monies the government pays for a person for medicare, they instead pay the health insurance. Many insurance companies now have Senior plans which can replace traditional medicare. In doing so, some may now offer acupuncture coverage. For along time, most did not. But starting this year, more have added acupuncture as a benefit. As always , call and verify a persons coverage.
In many other cases, however, and this is where it can get confusing, someone has a SUPPLEMENTAL insurance. This means that they have medicare and a secondary insurance, 9 times out of 10 it ONLY covers what medicare allows, pays the patients deductibles and co-pays, etc. Since medicare doesn’t cover acupuncture, neither would a supplemental. So, this would be the first question on a call to a medicare aged patient’s insurance, IS THIS SUPPLEMENTAL TO MEDICARE or is this policy in lieu of medicare benefits and, if so, are there acupuncture benefits.
I thought it was important to mention this, I know it can be confusing, but I’ve seen more insurance covering acupuncture for patients aged 65 and older and so I wanted to put that out there. I’m expecting questions regarding this…
There were some changes made a few months ago as to how claims are filled out specific to California Worker’s Comp billing only. Relative to a CMS1500 claim form, box 1a no longer has the claim #, instead it has the patient’s social security # or, if unknown, 9-9’s (do not enter dashes in either case). In box 4, goes the name of the employer. This actually makes sense because they are the insured, the patient is the beneficiary. Of course you would check the box 8 status as OTHER. Then, in box 11 is where you put the claim # for the work comp case. If you have have an authorization #, you should always enter it in box 23. Then, on the newest claim form version in box 24j, you will see a top and a bottom; the top is shaded, the bottom is not. In the top box now goes the TAXONOMY code for acupuncture, this is: zz 171100000x and in the box beneath it, next to NPI, goes your NPI number. If you belong to a group, you would use your individual NPI here and then the group NPI in box 33a below. These are the only changes to how the claim form is completed, all other instructions we’ve given in the book on how to complete a claim , etc. still apply except for what was indicated above. Happy billing!
This may not be completely relevant to this website, but it is practice management and we do want to have some of that here. Sooo…I received this email last week:
I just enjoyed completing your Five Elements of Acupuncture Medical Ethics course online from Blue Poppy and I was confused by something you mentioned. I practice in Oregon and most practitioners I know are independent contractors who are paid a portion of the fees paid by patients, while the owner of the establishment gets the other portion. Is this unethical or just a practical business arrangement for those who chose not to own their own business? Is there a difference between a percentage paid and a flat rate per patient? I would appreciate whatever feedback you may have on this.
Thank you for the class and your insight.
I want to attempt to answer these questions. Continue reading
Starting March 1, 2012, Aetna will no longer be mailing paper EOBs! You’ll have to go on-line to print or view them yourself – otherwise, you don’t know who or what a payment is for. To do this, you’ll need to register with NaviNet at https://connect.navinet.net/enroll to gain access. Once you register, make sure to follow-up to make sure you get registered since I have had lots of problems with this myself. Aetna is also encouraging you to do EFT (direct deposit)…so very similar to ASH. Basically, they’ve jumped on board with the paperless movement. Although this is great, I still would like my EOB’s sent to me. It doesn’t appear you have an option to opt-in to still receive the EOB’s either. So, be prepared. March 1st will be here soon and it can take a couple of weeks to get registered…
I’ve had some questions from providers asking if they need to send back the “election to participate with Cigna” form that providers received in their in-box on ashlink. I will say that in order to continue seeing ANY Cigna patients as a participating provider, you must sign and return that form. Much like an Aetna plan where you are participating because of your affiliation with ASH, the same is true with Cigna. Many times payment of Aetna PPO’s is very good and the same would continue to be true for Cigna. Again, you don’t really have an option if you want to be in-network with Cigna, you must sign and send that form back in.
Also, if you’ve read my previous discussion on the Cigna-ASH debacle, I have to wonder if the signing of this form arose out of that issue; to re-establish themselves as the contractor for Cigna. I’m actually glad to see this since it removes any doubt about who handles Cigna’s contracting.
Most patient’s benefits start over at the beginning of the year. A small handful have a “benefit” year which is something other than a calendar year, typically July to June. For those that have the majority calendar year policies, this means deductibles will re-start in the new year (if you submit a claim in 2012 for dates of service in 2011, they still process with 2011 and will not go towards the 2012 deductible). Since many of you don’t deal with the details of insurance often, I will give you some reminders of what happens in the new year. First, all patient’s insurance benefits should be re-verified at the beginning of each year. In my offices, we get “update” forms just to re-verify addresses, phone #, etc. and get a NEW copy of insurance cards. Many people will tell you none of this has changed, maybe that’s true, but for those you catch who moved, etc. and have completely new information, you will be glad you went to the trouble. It’s prudent to always get new insurance cards since sometimes subtle changes occur to policies; higher deductibles, ID number changes, etc. When you call to verify insurance, make sure to use a form. We have one on the website for you to use as a template (Health Insurance Verification Form). It’s important to get all questions answered and if you simply jot down the info they tell you, as they ramble it, you may miss out on some important details.
As we approach the end of the year, there are a few things to keep in mind with regards to patient’s health insurance.
1) For many people, their deductibles may actually, finally, be met! This means they should use their benefits as much as possible while their responsibility is much less before the new year and when most people’s deductibles start over.
2) Double check where patients are in their benefits. Towards the end of the year, they may be close to maxing out their benefits. Knowing how many visits a patient has left under insurance can help avoid costly patient balances.