Medical Billing Services: Top 2 Reasons You’re Not Getting Reimbursed for Code 97810

If you are an acupuncturist, you are already familiar with code 97810. The CPT-4 procedure code 97810 is a general acupuncture treatment code. This includes 15 minutes of verified time with the patient while performing treatment. Verified time means that the time increments are documented in the patient’s chart for the correct date of service. 97811 is used for each additional 15 minutes spent administering treatment. This does not include the time the patient spends laying idle on the table. For instance, if a front treatment is done without any other services, then 97810 should be billed. However, if the patient receives front and back treatment, 97810 and 97811 should be used.

Now, that we explained what procedure codes 97810 and 97811 mean, we can begin to discuss the top 2 reasons why you are not getting reimbursed from Insurance companies.

Claim sent to Medicare or Medicaid

Neither Medicare nor Medicaid will reimburse for acupuncture claims. Medicare and Medicaid are excellent insurance programs for the young, poor, sick and old; however the insurance plans do not cover everything. Medicare determines medical necessity when they receive the claim. However, Medicare does not consider acupuncture, holistic medicine, alternative therapies and homeopathy to ever be medically necessary procedures. Therefore, acupuncture claims will not be paid. If your Medicare or Medicaid insurance plan does not cover acupuncture, you will be responsible for paying the full bill if you receive these services. Many acupuncturists willingly discount their prices for non-insurance patients.

Medicare also offers supplemental plans, which allows someone to gain coverage where there once was none. Medicare advantage plans may offer acupuncture, and alternative therapies. Even though, Medicare advantage plans cover acupuncture, the service will only be payable if it is determined to be medically necessary, and if the services is performed by a licensed healthcare professional who participates in Medicare. To find out if your Medicare patients have acupuncture insurance, perform Benefits Verification. An experienced and competent medical biller should know whether a claim will be paid or not before it’s transmitted to the insurance company. A thorough and documented Benefits Verification will give you the insight you need to make that determination, each and every time.

Wrong Procedure Code

There are four codes that are greatly used by acupuncturist. We have already discussed two of those codes, 97810 and 97811. However, there are two more additional codes, which is 97813 and 97814. 97813 is used when the acupuncturist uses electrical stimulation on one or more needles. Remember, this is only for the initial 15 minutes spent performing the procedure. 97814 is used for each additional 15 minutes spent using electrical stimulation on one or more needles. Oftentimes, licensed acupuncturists simply code the procedures incorrectly. That is why keeping good records is a must for acupuncturist. For instance, if a provider performs general acupuncture, and then performs acupuncture with electrical stimulation, how would you bill that visit? Many providers believe the correct way to code this visit is with 97810 and 97813. However, 97810 and 97813 is used for the initial 15 minutes. Therefore, a determination must be made about what procedure was performed first. Since, general acupuncture was performed first, we will bill 97810 for the first procedure, and 97814 for an additional 15 minutes of acupuncture with electrical stimulation. This is the correct way to bill this scenario.

Acupuncture insurance billing can be tricky for many medical billing services and in-house staff. Physicians can have over 50% of their claims denied, simply because they have not learned how to properly code procedures. However, with thorough research about acupuncture coding and how to properly use them, experienced medical billing services can help you to expect consistent reimbursement from insurance companies.

Everything You Need to Know: How to Become an Acupuncturist and/or Oriental Medical Doctor (OMD)

What has brought you to the field of Acupuncture and Oriental Medicine (OM)? Was it an experience you had? Or, maybe you are researching new alternative medicine. Whatever the answer may be, it is noticeable that the public is becoming more aware of the effectiveness of Acupuncture, Oriental Medicine and other holistic alternative medical practices. The limitations of Western Medicine has led to the awareness of alternative medicine such as OM and Acupuncture. Over 2,500 years old (much older than Western Medicine), Acupuncture and Traditional Chinese or Oriental Medicine (TCM or OCM) continues to gain public acceptance in the United States making it a fast growing professional field.

The journal, “Evidence-Based Complementary and Alternative Medicine,” reported that more people are trying acupuncture treatment. The National Health Review Survey along with the U.S. Census Bureau reported that there was an increase from 8 million Americans using acupuncture in 2002 to 14 million acupuncture patients in 2007. This is a staggering increase since only two decades ago very few (less than 1%) reported using acupuncture. This is great news for medical practitioners-to-be who are looking to expand their knowledge and the field of medical science. It is also great news for those who Western medicine were unable to treat.

ARE YOU RIGHT FOR THE JOB?

To get a slightly better understanding of how good Acupuncturist or Oriental Medicine Doctor (OMD) are like, let’s take a look at some personal traits that all effective Medical Practitioners have (or have acquired.)

1) Strong Interpersonal skills

2) Genuine interest in bettering humanity

3) Sensitivity to those who are ill

4) Ability to adhere to a medical code of ethics

5) Ability to respect cultural sensitivity

6) Ability to act with professionalism

7) Ability to respect patient confidentiality

8) Ability to counsel, be uplifting, motivating and genuinely caring

9) Honesty in regards to patient health care and health issues

Remember, it’s not about the traits you possess naturally that fully determine who you want to be in the future, but your willingness to acquire those which are necessary to do the job.

1. FIRST-HAND EXPERIENCE

If you want to study to become an Acupuncturist or an OMD, but you haven’t experienced Oriental Medical Treatment or Acupuncture, why not try it out! There’s nothing more inspirational (or eye-opening) than first-hand experience. And, you don’t need to be ill to receive acupuncture treatment. Acupuncture can be used to help bring into balance the body’s natural energy flow. After acupuncture treatments, you’ll more likely know if Acupuncture and Oriental Medicine is right for you.

2. ONE ON ONE TIME

Take time to sit down and talk with an Acupuncturist or Oriental Medical professional. He/She will more than likely be happy to assist you and answer any questions you may have regarding the field. Here are a few ideas for the types of questions you may want to ask:

1) What is the Philosophy and Conceptual Theory behind the practice?

2) How can an Acupuncturist or Oriental Medical Practitioner help to integrate Eastern Medicine with Western Medicine.

3) Are Oriental Medical Practitioners taken seriously in the United States?

4) How do you find clients and what are some of your marketing strategies?

5) What do you see in regards to the future of Acupuncture and Oriental Medicine?

6) Which types of people are most interested in Oriental Medical Treatment?

If you want to be an acupuncturist, you may want to know as much information as possible about the profession. So, don’t be afraid to ask! It is more than likely that an Acupuncturist and/or OMD will be delighted to take the time to speak with you and answer all of your questions.

Also, try speaking with graduates or people attending an Acupuncture school or Oriental Medical Institution. Learn more about the types of things you will be learning and find tips on how to better prepare yourself for the school curriculum.

3. EARN YOUR B.A. DEGREE

Not all, but many Acupuncture and Oriental Medical Colleges require students to first earn a B.A. degree in a field of study. Although, a degree in Biology, Anatomy Physiology, Chemistry or almost any science may be very helpful for the future study of Oriental Medicine and Acupuncture, there are many Acupuncturists and Oriental Medical Physicians with undergraduate degrees in Psychology, Sociology, Philosophy and other non-science related degrees. You just want to make sure that your GPA is well over the 2.5 GPA mark. That way, you will be a likely candidate for admittance in almost any Acupuncture or Oriental Medicine School, College or University.

4. PICK A LOCATION

Even with the countless articles written on it’s effectiveness (such as the use of Acupuncture by the United States military), some states still do not acknowledge Acupuncture as a legal form of medical treatment. There are no laws governing acupuncturists in Wyoming, North Dakota, South Dakota, Oklahoma, and Alabama. Delaware and Kentucky are the most recent states to finally legalize acupuncture as a profession. To find out if your state recognizes Acupuncture, check out Acufinder.com. Acufinder.com will provide you with information on which states recognize Acupuncture as a legal medical practice. Moreover, it is a good idea to research the Oriental Medicine and Acupuncture market in an area by speaking to Acupuncturists in that area.

5. PICK A SCHOOL

Before picking an Acupuncture/Oriental Medicine school, check to see if it is accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (or ACAOM). ACAOM is a private agency recognized by the U.S. Department of Education which accredits professional masters degree and professional masters level certificates and diplomas in Acupuncture and Oriental Medicine. If you go to ACAOM.com website, you can find a list of over 50 accredited Acupuncture Schools and Colleges.

Schools of Oriental Medicine focus not only on Acupuncture but also Chinese Herbal Medicines and Asian Bodywork. The curriculum and amount of hours dedicated to each particular subject will depend on the college’s curriculum. Normally, earning a Masters degree in MSOM in Acupuncture and/or Oriental Medicine will normally take 3 to 4 years. If you want to go for your Doctorates, add approximately 2 more years of schooling. Time well spent if you love helping others.

6. BOARD CERTIFICATION

Once you have completed your schooling, the next step is to pass the National Certification Commision for Acupuncture and Oriental Medicine (or NCCAOM) exam. to become state certified. The NCCAOM is recognized by a majority of states in the U.S. (except California). In order to become state certified in the state of California, you must pass their own Board Certification exam and requirements.

7. BECOMING AN ACUPUNCTURIST OR ORIENTAL MEDICAL DOCTOR

After you have completed your schooling, obviously, the next step is to begin work. Most new Acupuncturists begin by working with an established practice. This way, you can build a client base and observe how a practice operates before developing your own practice. If you live in a larger metropolitan town, it is typically easier to find a job as an Acupuncturist.

8. CONTINUING EDUCATION

Like many occupations in the field of medicine, Acupuncture and Oriental Medical treatments are constantly evolving and thus, you will need to continue your education even after you have established your practice. Focus on learning new strategies, improving your techniques, getting to know and staying in touch seasoned veterans of the field, teachers as well as those in the forefront of medical science research.

Western Medicine, especially when it comes to treatments regarding general wellness and healthcare, is limited in it’s ability to provide effective treatment. According to the documentary, ESCAPE FIRE. at least 30% of medical treatment is ineffective. Because of this, alternative medicine such as Acupuncture and Oriental Medicine will have a greater influence in the future of medicine.

So, to become a professional in an alternative form of medicine like Acupuncture and Oriental Medicine will not only benefit the communities of the future, but as a healer, practitioner or medical professional you will be part of the medical community blazing a new trail for modern medicine – treating the once untreatable and curing the once uncurable. Good luck to you in your journey towards becoming an Acupuncturist and/or Oriental Medical Doctor.

Chinese Acupuncture As an Ancient Medical Treatment

With the many, fast and rising medical technologies these days, it certainly wouldn’t hurt to choose natural treatments which have long term benefits. One of them would be Chinese Acupuncture. This method has been practiced for many centuries and up until now, many patients would still go for this healing method.

If you’d like to widen your healing options, you can consider Chinese Acupuncture as an ancient yet longstanding medical treatment. Here are just some of the benefits you can gain with this type of treatment method:

Personalized Treatments

Although every patient have similar sicknesses, acupuncturists never treat each one of them in the same way. For instance, common colds usually have standard prescriptions and treatment procedures. However upon going for Chinese Acupuncture, you’ll find the specialists will further classify and identify the causes of your colds.

Every person has a personal and unique health history. The details of a person’s appearance will also be considered by the acupuncturist, as these may be manifestations or signs of how the patient’s chi is balanced or imbalanced. Given the detailed diagnosis, each patient may then be given his or her personalized treatment.

It Definitely Works

For a method to last through centuries, it must be able to have positive effects on the body. The reason why Chinese Acupuncture is still widely used is due to its effectiveness. It works on the principle of activating or stimulating the body’s natural capacity to heal itself. Through very thin needle insertions, specific meridians of the body will allow a much more open flow of energy. If you’re thinking of lessening your drug intake, you’d be glad to find how you may not need medications when specific acupuncture techniques are applied to your body.

Effective for Stress Relief

It’s lately known that those who undergo acupuncture sessions have lessened instances of feeling stressful. The hormones which activate high levels of stress have significantly been reduced. The body’s fight or flight response wasn’t as evident upon having regular sessions of acupuncture.

It Relieves Anxiety and Depression

Instead of taking medications, some patients have actually resorted to acupuncture sessions to feel much better. If you’d like to know how your body can adjust itself to relaxation, you can ask your specialist on which specific techniques can work best for you. While acupuncture predisposes your body to feel calm and relaxed, it must however be noted that it can’t be the sole solution to anxiety and depression. It’s best to complement the sessions with your doctor’s advised methods so you can be on your way to wellness.

It Boosts Your Fertility

If you’d like to have a family soon, it may be a good idea for you to try acupuncture. For women, this ancient method has the capacity to regulate your hormones and increase the blood flow towards the ovaries and uterus.

These are only few of the benefits which can be gathered upon considering Acupuncture as method of treatment. If you’d like to know how the ancient practice can be beneficial to your specific condition, be sure to speak with a specialist soon.