Guest guest Posted December 7, 2006 Report Share Posted December 7, 2006 Julie, I would be glad to help you but you might think about taking one of Dr. Kevin McNamee's (DC and LAc) online seminars or in person (in CA) on these various aspects of practice. It is better to have the info then risk a fraudulent billing charge (just because). > I am putting together my first superbill, I can't believe I succesfully avoided it this long, lol. But I need HELP! I have some questions: > ~I have seen some example superbill's w/out ICD9 codes - are these mandatory? Yes, as this code drives the condition and payment or rather a particular occurrance/illness/problem. > ~It is my understanding you don't do E & M for every treatment, You are right about not billing E & M codes for each visit but these also have certain criteria as to severity/tests and the more extreme ones are not used by LAc (but rather by ER docs and the like). >so I have two charges (two different clinics) You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. one I charge > NP - 85 > EP - 65 > the other I charge > NP - 75 > EP - 60 > ~how do I price these, literally what would I put for the different codes? Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. > Utterly confused, Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. Mike W. Bowser, LAc _______________ Express yourself with gadgets on Windows Live Spaces http://discoverspaces.live.com?source=hmtag1 & loc=us Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2006 Report Share Posted December 7, 2006 Sorry but I made a mistake about the 97140. The 97124 is billed in time incriments and not 97140. Mike W. Bowser, L Ac ________________________________ > Chinese Traditional Medicine > naturaldoc1 > Thu, 7 Dec 2006 19:14:58 +0000 > RE: Superbill Help > > Julie, > I would be glad to help you but you might think about taking one of Dr. Kevin McNamee's (DC and LAc) online seminars or in person (in CA) on these various aspects of practice. It is better to have the info then risk a fraudulent billing charge (just because). > > I am putting together my first superbill, I can't believe I succesfully avoided it this long, lol. But I need HELP! I have some questions: > > ~I have seen some example superbill's w/out ICD9 codes - are these mandatory? > Yes, as this code drives the condition and payment or rather a particular occurrance/illness/problem. > > ~It is my understanding you don't do E & M for every treatment, > You are right about not billing E & M codes for each visit but these also have certain criteria as to severity/tests and the more extreme ones are not used by LAc (but rather by ER docs and the like). > >so I have two charges (two different clinics) > You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. > one I charge > > NP - 85 > > EP - 65 > > the other I charge > > NP - 75 > > EP - 60 > > ~how do I price these, literally what would I put for the different codes? > Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. > Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? > Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. > > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. > This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. > > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? > I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. > > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? > You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. > > Utterly confused, > Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. > Mike W. Bowser, LAc > ________ > Express yourself with gadgets on Windows Live Spaces > http://discoverspaces.live.com?source=hmtag1 & loc=us > _______________ Express yourself with gadgets on Windows Live Spaces http://discoverspaces.live.com?source=hmtag1 & loc=us Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2006 Report Share Posted December 7, 2006 Mike, >so I have two charges (two different clinics) You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. one I charge > NP - 85 > EP - 65 > the other I charge > NP - 75 > EP - 60 Well the issue on this is my price to operate is much higher at one place than the other and they are in two different cities, so Im not sure what to do on that? > ~how do I price these, literally what would I put for the different codes? Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. I did already read the article, thanks. There are articles but none seem to have the specifics, even going back through school papers I couldn't find this. I would like the fees to be set, and not necessarily higher than what I charge, but I just charge a flat fee, I don't charge extra if I give them a hot pack you know? Or spend 20 min or 40 min talking. I don't get how this converts? > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. Not clear on this. > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. So if I don't charge extra for patients cash paying patients then I just don't use these codes? Do acupuncturists really charge extra for the heat lamp (or whatever) for their cash paying patients? > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. So how does the same day payment work and how do you note it? I have no intention of commiting fraud in fact quite the opposite which is why I am asking all of this. I took a class years ago and this wasn't all clarified, perhaps I should look for a different one, but Im really trying to get something pulled together now for the new clinic. Thank you for the help it is much appreciated! Julie > Utterly confused, Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. Mike W. Bowser, LAc ________ Express yourself with gadgets on Windows Live Spaces http://discoverspaces.live.com?source=hmtag1 & loc=us Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2006 Report Share Posted December 7, 2006 There is a day long seminar this Sunday on 11 new diagnostic codes to be implemented in 2007 plus a lot of information on billing for insurance. HR Ross Co is putting it on in Commerce, CA. email: aacinfonetwork.com for information. Maybe I will see some of you there. Reenah Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > > Sorry but I made a mistake about the 97140. The 97124 is billed in time incriments and not 97140. > > > Mike W. Bowser, L Ac > > ________________________________ > > Chinese Traditional Medicine > > naturaldoc1 > > Thu, 7 Dec 2006 19:14:58 +0000 > > RE: Superbill Help > > > > Julie, > > I would be glad to help you but you might think about taking one of Dr. Kevin McNamee's (DC and LAc) online seminars or in person (in CA) on these various aspects of practice. It is better to have the info then risk a fraudulent billing charge (just because). > > > I am putting together my first superbill, I can't believe I succesfully avoided it this long, lol. But I need HELP! I have some questions: > > > ~I have seen some example superbill's w/out ICD9 codes - are these mandatory? > > Yes, as this code drives the condition and payment or rather a particular occurrance/illness/problem. > > > ~It is my understanding you don't do E & M for every treatment, > > You are right about not billing E & M codes for each visit but these also have certain criteria as to severity/tests and the more extreme ones are not used by LAc (but rather by ER docs and the like). > > >so I have two charges (two different clinics) > > You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. > > one I charge > > > NP - 85 > > > EP - 65 > > > the other I charge > > > NP - 75 > > > EP - 60 > > > ~how do I price these, literally what would I put for the different codes? > > Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. > > Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? > > Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. > > > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. > > This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. > > > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? > > I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. > > > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? > > You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. > > > Utterly confused, > > Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. > > Mike W. Bowser, LAc > > ________ > > Express yourself with gadgets on Windows Live Spaces > > http://discoverspaces.live.com?source=hmtag1 & loc=us > > > > _______________ > Express yourself with gadgets on Windows Live Spaces > http://discoverspaces.live.com?source=hmtag1 & loc=us > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 8, 2006 Report Share Posted December 8, 2006 Julie, I will see if I can better explain things. First, it is illegal to have more then one fee schedule and it should be posted in plain view in ALL your office locations. Maybe we need to look at your office situation and what your rent is. I have a sneaky suspicion that you might be paying an illegal % (called fee splitting) to some landlord (other provider) for space. One better way to set up things is to rent space by the hour or day for a flat rate. I have seen this happen many times and I think it comes from looking at OM as if it were massage therapy, which we are not. We are regulated as medical providers in most states. Second, if your fees do not have an E & M code spelled out, then you cannot use this. You must use your fee schedule as your business/collections guide. If you charge one flat rate, then consider using just the acupuncture codes and never charge beyond your patients collected fee. To the insurance, there is no place for a cash discount and a superbill should only include the same amount patient paid and never more or less. Putting different info on there could get you into deep trouble anyway. As an aside, an insurance carrier can ask for a copy of your fee schedule or call you for that info. Be prepared to provide it for them. Your fees must be a set number, which is why many providers use the cpt codes with prices per code as add-ons. I know it is a different way of doing things but it will help you avoid mishaps. You can note a discount for services paid same day on your posted fee schedule. Your collections/fees can remain similar but you simply are charging per the procedure. Check out http://thesupplycenter.com/ for info on practice seminars. Hope all this helps. Where are you located and which program did you attend? Mike W. Bowser, L Ac ________________________________ > Chinese Medicine > cariadanam > Thu, 7 Dec 2006 13:25:29 -0700 > Re: Superbill Help > > Mike, > >so I have two charges (two different clinics) > You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. > one I charge > > NP - 85 > > EP - 65 > > the other I charge > > NP - 75 > > EP - 60 > Well the issue on this is my price to operate is much higher at one place than the other and they are in two different cities, so Im not sure what to do on that? > > ~how do I price these, literally what would I put for the different codes? > Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. > Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? > Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. > I did already read the article, thanks. There are articles but none seem to have the specifics, even going back through school papers I couldn't find this. > I would like the fees to be set, and not necessarily higher than what I charge, but I just charge a flat fee, I don't charge extra if I give them a hot pack you know? Or spend 20 min or 40 min talking. I don't get how this converts? > > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. > This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. > Not clear on this. > > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? > I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. > So if I don't charge extra for patients cash paying patients then I just don't use these codes? Do acupuncturists really charge extra for the heat lamp (or whatever) for their cash paying patients? > > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? > You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. > So how does the same day payment work and how do you note it? > I have no intention of commiting fraud in fact quite the opposite which is why I am asking all of this. I took a class years ago and this wasn't all clarified, perhaps I should look for a different one, but Im really trying to get something pulled together now for the new clinic. > Thank you for the help it is much appreciated! > Julie > > Utterly confused, > Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. > Mike W. Bowser, LAc > ________ > Express yourself with gadgets on Windows Live Spaces > http://discoverspaces.live.com?source=hmtag1 & loc=us > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 8, 2006 Report Share Posted December 8, 2006 Exactly what is or is not legal in any area must be determined only by careful study of state and local statutes and regulations. Do attorneys have absolute answers? NO! - that's why they argue their points in court. Even State Boards only have attorneys issue legal opinions that are just that - opinions - , but you should heed their memos because they have power to suspend your license. Insurance carriers, malpractise insurance carriers, reps for malpractise insurance carriers who teach practise management and edit acupuncture newspapers for chiropractor owners - none of them have absolute answers either. In fact you could make a pretty strong argument that their interest and livelyhoods conflict with your desire to get paid for what you do. ( ! ) Specifically, you can certainly have different fees at different locations where you reasonably have different expenses. You are only bound to a set conversion value if working for Medicare, and we are currently not. You can also change your fees as often as necessary, although there may be advance notice required (see above mentioned state and local regs). One way to find out if healthcare providers are required to post a full fee schedule in your area is to walk into the local hospital or MD's office and look. Just don't ask; they WILL laugh. You haven't been in business too long if you automatically accept as fact any communication from an insurance company. You may very well benefit learning from people like AAC, but you should not be so green as to think they are not playing both sides of the fence. Before you do, if you want to be a medical professional integrating / interfacing with the rest of the world of healthcare and patients who pay into insurance entities, I suggest the following, IN ORDER: 1) Learn enough modern western diagnostics to code - to - a - triage - necessary - level - of - certainty, according to the International Classification of Diseases. That is for mandatory safety. 2) Study / Learn what Evaluation and Management actually means as it pertains to (the AMA's) Current Procedure Terminology. That is for payment because all insurance entities use this alone. 3) Practice and bill according to Level of Service. That means that a bandaid on a scratch gets documented and charged differently from a complex history that needs records review or outside lab before you even consider therapy. Learn how to establish and adjust Usual, Customary, and Reasonable Fees specific to your practice and your area. That's all for now, I have to go. As much as these issues don't seem to relate to healing, they are inextricably bound, and with our future as a profession as well. Joe Reid 12-08-06 Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > > Julie, > I will see if I can better explain things. > First, it is illegal to have more then one fee schedule and it should be posted in plain view in ALL your office locations. Maybe we need to look at your office situation and what your rent is. I have a sneaky suspicion that you might be paying an illegal % (called fee splitting) to some landlord (other provider) for space. One better way to set up things is to rent space by the hour or day for a flat rate. I have seen this happen many times and I think it comes from looking at OM as if it were massage therapy, which we are not. We are regulated as medical providers in most states. > > Second, if your fees do not have an E & M code spelled out, then you cannot use this. You must use your fee schedule as your business/collections guide. If you charge one flat rate, then consider using just the acupuncture codes and never charge beyond your patients collected fee. To the insurance, there is no place for a cash discount and a superbill should only include the same amount patient paid and never more or less. Putting different info on there could get you into deep trouble anyway. As an aside, an insurance carrier can ask for a copy of your fee schedule or call you for that info. Be prepared to provide it for them. Your fees must be a set number, which is why many providers use the cpt codes with prices per code as add-ons. I know it is a different way of doing things but it will help you avoid mishaps. You can note a discount for services paid same day on your posted fee schedule. Your collections/fees can remain similar but you simply are charging per the procedure. > > Check out http://thesupplycenter.com/ for info on practice seminars. Hope all this helps. Where are you located and which program did you attend? > > Mike W. Bowser, L Ac Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2006 Report Share Posted December 9, 2006 Hi Julie, Kevin McNamee of The Supply Center, and the American Acupuncture Council both offer classes on insurance billing. I think the AAC has one scheduled in the next month or two. " Julie Ormonde, L.Ac. " <cariadanam wrote: Mike, >so I have two charges (two different clinics) You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. one I charge > NP - 85 > EP - 65 > the other I charge > NP - 75 > EP - 60 Well the issue on this is my price to operate is much higher at one place than the other and they are in two different cities, so Im not sure what to do on that? > ~how do I price these, literally what would I put for the different codes? Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. I did already read the article, thanks. There are articles but none seem to have the specifics, even going back through school papers I couldn't find this. I would like the fees to be set, and not necessarily higher than what I charge, but I just charge a flat fee, I don't charge extra if I give them a hot pack you know? Or spend 20 min or 40 min talking. I don't get how this converts? > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. Not clear on this. > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. So if I don't charge extra for patients cash paying patients then I just don't use these codes? Do acupuncturists really charge extra for the heat lamp (or whatever) for their cash paying patients? > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. So how does the same day payment work and how do you note it? I have no intention of commiting fraud in fact quite the opposite which is why I am asking all of this. I took a class years ago and this wasn't all clarified, perhaps I should look for a different one, but Im really trying to get something pulled together now for the new clinic. Thank you for the help it is much appreciated! Julie > Utterly confused, Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. Mike W. Bowser, LAc ________ Express yourself with gadgets on Windows Live Spaces http://discoverspaces.live.com?source=hmtag1 & loc=us Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2006 Report Share Posted December 9, 2006 Mike, I'm not sure that giving a percentage of your income is considered fee-splitting. My understanding is that it refers to giving a percentage to another provider who provides you with patients. Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > > Julie, > I will see if I can better explain things. > First, it is illegal to have more then one fee schedule and it should be posted in plain view in ALL your office locations. Maybe we need to look at your office situation and what your rent is. I have a sneaky suspicion that you might be paying an illegal % (called fee splitting) to some landlord (other provider) for space. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2006 Report Share Posted December 9, 2006 Julie, I will see if I can better explain things. First, it is illegal to have more then one fee schedule and it should be posted in plain view in ALL your office locations. Maybe we need to look at your office situation and what your rent is. I have a sneaky suspicion that you might be paying an illegal % (called fee splitting) to some landlord (other provider) for space. One better way to set up things is to rent space by the hour or day for a flat rate. I have seen this happen many times and I think it comes from looking at OM as if it were massage therapy, which we are not. We are regulated as medical providers in most states. I pay rent in one place, and rent in the second plus a flat fee per patient for reception with a cap, I don't believe this falls under percentage. Second, if your fees do not have an E & M code spelled out, then you cannot use this. You must use your fee schedule as your business/collections guide. If you charge one flat rate, then consider using just the acupuncture codes and never charge beyond your patients collected fee. To the insurance, there is no place for a cash discount and a superbill should only include the same amount patient paid and never more or less. Putting different info on there could get you into deep trouble anyway. As an aside, an insurance carrier can ask for a copy of your fee schedule or call you for that info. Be prepared to provide it for them. Your fees must be a set number, which is why many providers use the cpt codes with prices per code as add-ons. I know it is a different way of doing things but it will help you avoid mishaps. You can note a discount for services paid same day on your posted fee schedule. Your collections/fees can remain similar but you simply are charging per the procedure. I do have a financial policy that all patients sign which contains my fees, just trying to figure out the crossover to a superbill - how to divvy up the money between e/m codes and acu codes, but I think Im starting to understand about " bundling " . But I am still unclear as to how I denote or do same day discount. Thanks Julie Check out http://thesupplycenter.com/ for info on practice seminars. Hope all this helps. Where are you located and which program did you attend? Mike W. Bowser, L Ac ________________________________ > Chinese Medicine > cariadanam > Thu, 7 Dec 2006 13:25:29 -0700 > Re: Superbill Help > > Mike, > >so I have two charges (two different clinics) > You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. > one I charge > > NP - 85 > > EP - 65 > > the other I charge > > NP - 75 > > EP - 60 > Well the issue on this is my price to operate is much higher at one place than the other and they are in two different cities, so Im not sure what to do on that? > > ~how do I price these, literally what would I put for the different codes? > Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. > Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? > Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. > I did already read the article, thanks. There are articles but none seem to have the specifics, even going back through school papers I couldn't find this. > I would like the fees to be set, and not necessarily higher than what I charge, but I just charge a flat fee, I don't charge extra if I give them a hot pack you know? Or spend 20 min or 40 min talking. I don't get how this converts? > > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. > This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. > Not clear on this. > > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? > I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. > So if I don't charge extra for patients cash paying patients then I just don't use these codes? Do acupuncturists really charge extra for the heat lamp (or whatever) for their cash paying patients? > > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? > You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. > So how does the same day payment work and how do you note it? > I have no intention of commiting fraud in fact quite the opposite which is why I am asking all of this. I took a class years ago and this wasn't all clarified, perhaps I should look for a different one, but Im really trying to get something pulled together now for the new clinic. > Thank you for the help it is much appreciated! > Julie > > Utterly confused, > Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. > Mike W. Bowser, LAc > ________ > Express yourself with gadgets on Windows Live Spaces > http://discoverspaces.live.com?source=hmtag1 & loc=us > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2006 Report Share Posted December 9, 2006 Thanks for your response Joe, I appreciate the different points of view. I was a bit flabbergasted at the thought of having to have set fees in two different places, it just doesn't make sense (not that laws often do) why I should charge the same considering its two different cities with two very different overheads. - jreidomd Chinese Medicine Friday, December 08, 2006 4:00 PM Re: Superbill Help Exactly what is or is not legal in any area must be determined only by careful study of state and local statutes and regulations. Do attorneys have absolute answers? NO! - that's why they argue their points in court. Even State Boards only have attorneys issue legal opinions that are just that - opinions - , but you should heed their memos because they have power to suspend your license. Insurance carriers, malpractise insurance carriers, reps for malpractise insurance carriers who teach practise management and edit acupuncture newspapers for chiropractor owners - none of them have absolute answers either. In fact you could make a pretty strong argument that their interest and livelyhoods conflict with your desire to get paid for what you do. ( ! ) Specifically, you can certainly have different fees at different locations where you reasonably have different expenses. You are only bound to a set conversion value if working for Medicare, and we are currently not. You can also change your fees as often as necessary, although there may be advance notice required (see above mentioned state and local regs). One way to find out if healthcare providers are required to post a full fee schedule in your area is to walk into the local hospital or MD's office and look. Just don't ask; they WILL laugh. You haven't been in business too long if you automatically accept as fact any communication from an insurance company. You may very well benefit learning from people like AAC, but you should not be so green as to think they are not playing both sides of the fence. Before you do, if you want to be a medical professional integrating / interfacing with the rest of the world of healthcare and patients who pay into insurance entities, I suggest the following, IN ORDER: 1) Learn enough modern western diagnostics to code - to - a - triage - necessary - level - of - certainty, according to the International Classification of Diseases. That is for mandatory safety. 2) Study / Learn what Evaluation and Management actually means as it pertains to (the AMA's) Current Procedure Terminology. That is for payment because all insurance entities use this alone. 3) Practice and bill according to Level of Service. That means that a bandaid on a scratch gets documented and charged differently from a complex history that needs records review or outside lab before you even consider therapy. Learn how to establish and adjust Usual, Customary, and Reasonable Fees specific to your practice and your area. That's all for now, I have to go. As much as these issues don't seem to relate to healing, they are inextricably bound, and with our future as a profession as well. Joe Reid 12-08-06 Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > > Julie, > I will see if I can better explain things. > First, it is illegal to have more then one fee schedule and it should be posted in plain view in ALL your office locations. Maybe we need to look at your office situation and what your rent is. I have a sneaky suspicion that you might be paying an illegal % (called fee splitting) to some landlord (other provider) for space. One better way to set up things is to rent space by the hour or day for a flat rate. I have seen this happen many times and I think it comes from looking at OM as if it were massage therapy, which we are not. We are regulated as medical providers in most states. > > Second, if your fees do not have an E & M code spelled out, then you cannot use this. You must use your fee schedule as your business/collections guide. If you charge one flat rate, then consider using just the acupuncture codes and never charge beyond your patients collected fee. To the insurance, there is no place for a cash discount and a superbill should only include the same amount patient paid and never more or less. Putting different info on there could get you into deep trouble anyway. As an aside, an insurance carrier can ask for a copy of your fee schedule or call you for that info. Be prepared to provide it for them. Your fees must be a set number, which is why many providers use the cpt codes with prices per code as add-ons. I know it is a different way of doing things but it will help you avoid mishaps. You can note a discount for services paid same day on your posted fee schedule. Your collections/fees can remain similar but you simply are charging per the procedure. > > Check out http://thesupplycenter.com/ for info on practice seminars. Hope all this helps. Where are you located and which program did you attend? > > Mike W. Bowser, L Ac Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2006 Report Share Posted December 9, 2006 You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. If this is correct how come hospitals can jack up the rate for those people who do not have health insurance and give a discount to those who are insured? We recently had a lot of coverage on this with the news media in my area. Are we in a different system than the MD's? S Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 Doug, Any time you give a % of your fee, that is fee-splitting. It matters not whether it is to another provider or not. I have run across a court case wherein a DC was accused and finally pled guilty to this when he hired foreign interpretters/drivers. Years ago, this was a major concern in the medical profession, which is why they saw it necessary to make ownership of medical corps only available to medical providers. The cost of healthcare goes up when one is paying someone else a portion of one's fees. The concept of fee-splitting is not limited to one who provides patients (a definite conflict of interest) but whether they have access to a part of your collections. I know this seems like splitting hairs but that is why providers should be paying flat rental rates and not part of their collections. You might want to access your state's attorney general for their opinion on this. Mike W. Bowser, L Ac ________________________________ > Chinese Medicine > > Sat, 9 Dec 2006 16:14:57 +0000 > Re: Superbill Help > > Mike, I'm not sure that giving a percentage of your income is considered fee-splitting. My > understanding is that it refers to giving a percentage to another provider who provides you > with patients. > _______________ Check the weather nationwide with MSN Search: Try it now! http://search.msn.com/results.aspx?q=weather & FORM=WLMTAG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 I don't take insurance but occasionally one of my patients will submit my bill to their insurance company for reimbursement. Am I required to follow all the same rules and regulations as acupuncturists who do take insurance? Thanks for any info, Liz Casey - Julie Ormonde, L.Ac. Chinese Medicine Saturday, December 09, 2006 5:47 PM Re: Superbill Help Julie, I will see if I can better explain things. First, it is illegal to have more then one fee schedule and it should be posted in plain view in ALL your office locations. Maybe we need to look at your office situation and what your rent is. I have a sneaky suspicion that you might be paying an illegal % (called fee splitting) to some landlord (other provider) for space. One better way to set up things is to rent space by the hour or day for a flat rate. I have seen this happen many times and I think it comes from looking at OM as if it were massage therapy, which we are not. We are regulated as medical providers in most states. I pay rent in one place, and rent in the second plus a flat fee per patient for reception with a cap, I don't believe this falls under percentage. Second, if your fees do not have an E & M code spelled out, then you cannot use this. You must use your fee schedule as your business/collections guide. If you charge one flat rate, then consider using just the acupuncture codes and never charge beyond your patients collected fee. To the insurance, there is no place for a cash discount and a superbill should only include the same amount patient paid and never more or less. Putting different info on there could get you into deep trouble anyway. As an aside, an insurance carrier can ask for a copy of your fee schedule or call you for that info. Be prepared to provide it for them. Your fees must be a set number, which is why many providers use the cpt codes with prices per code as add-ons. I know it is a different way of doing things but it will help you avoid mishaps. You can note a discount for services paid same day on your posted fee schedule. Your collections/fees can remain similar but you simply are charging per the procedure. I do have a financial policy that all patients sign which contains my fees, just trying to figure out the crossover to a superbill - how to divvy up the money between e/m codes and acu codes, but I think Im starting to understand about " bundling " . But I am still unclear as to how I denote or do same day discount. Thanks Julie Check out http://thesupplycenter.com/ for info on practice seminars. Hope all this helps. Where are you located and which program did you attend? Mike W. Bowser, L Ac ________________________________ > Chinese Medicine > cariadanam > Thu, 7 Dec 2006 13:25:29 -0700 > Re: Superbill Help > > Mike, > >so I have two charges (two different clinics) > You should really look into this more as it is my understanding that one practitioner can only have one fee schedule regardless of location or risk some serious trouble. For example, do you provide a different level of care at each location and if you do then one group is overpaying while the other is underpaying, etc. > one I charge > > NP - 85 > > EP - 65 > > the other I charge > > NP - 75 > > EP - 60 > Well the issue on this is my price to operate is much higher at one place than the other and they are in two different cities, so Im not sure what to do on that? > > ~how do I price these, literally what would I put for the different codes? > Again, I would suggest you rethink your fee schedule and start using price/code, much like add-ons for cars. > Such as if I charge 60 for acupuncture, would I do E & M 99215, 97810, and 97811? > Check out the acupuncturetoday.com past article on this issue. The 97810 is for initial acupuncture and up to 15 minutes of time w/needles in. Each 15 minute incriment after that is billed with 97811. As an example, your EP fee of $60 could be billed as 97810 - 15 and 97811- 3 units of 15 (or 45). These numbers do not need to be all equal either. Insurance companies tend to favor the initial time and pay more on this, so think about how you want to structure this before hand and then notify your patients in writing with a copy of your fee schedule as well as post it in office with effective dates on it. > I did already read the article, thanks. There are articles but none seem to have the specifics, even going back through school papers I couldn't find this. > I would like the fees to be set, and not necessarily higher than what I charge, but I just charge a flat fee, I don't charge extra if I give them a hot pack you know? Or spend 20 min or 40 min talking. I don't get how this converts? > > ~Which E & M code do you use, I spend two hours with a new patient and an hour on established patients, I don't double book. > This will depend upon how you have your fees structured. Failure to have a schedule set up this way will make this item null and void. > Not clear on this. > > ~Can we use 97124 massage therapy, 97140 manual therapy (tui na), 97010 hot/cold tx, 97026 infrared heat therapy (heat lamp)? What prices do we put for these? Are there any I am not listing that we can use? > I am going to lump these all together and again repeat that you can only charge for these items if you have an established fee schedule otherwise they are included within your acupuncture fee. Be aware that 97140 can billed in incriments of time. 97010 is for a hot/cold pack or compress and not moxa. > So if I don't charge extra for patients cash paying patients then I just don't use these codes? Do acupuncturists really charge extra for the heat lamp (or whatever) for their cash paying patients? > > ~Now essentially the bill will end up being a lot higher than example of 60.00, so is this where the cash discount comes in and how do we denote that? > You cannot. You must, by law, charge the insurance and a paying client the same but you can provide a same day payment discount. The problem with this is that your numbers and what a patient pays are really different. This can get you into real hot water. I keep reading of CAM providers who are convicted of insurance fraud even a few in our profession. > So how does the same day payment work and how do you note it? > I have no intention of commiting fraud in fact quite the opposite which is why I am asking all of this. I took a class years ago and this wasn't all clarified, perhaps I should look for a different one, but Im really trying to get something pulled together now for the new clinic. > Thank you for the help it is much appreciated! > Julie > > Utterly confused, > Please take a class on this stuff if you do not understand it. Best of luck and hope this info helps. > Mike W. Bowser, LAc > ________ > Express yourself with gadgets on Windows Live Spaces > http://discoverspaces.live.com?source=hmtag1 & loc=us > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 Yes you are. Mike W. Bowser, L Ac ________________________________ > Chinese Medicine > lizzzrd > Sun, 10 Dec 2006 07:38:34 -0500 > Re: Superbill Help > > I don't take insurance but occasionally one of my patients will submit my bill to their insurance company for reimbursement. Am I required to follow all the same rules and regulations as acupuncturists who do take insurance? _______________ All-in-one security and maintenance for your PC. Get a free 90-day trial! http://www.windowsonecare.com/purchase/trial.aspx?sc_cid=wl_wlmail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 Julie, I am glad to hear that you are paying a flat rental fee. The discount does not go into the superbill. In your situation, which is a little different from those who bill and collect from insurance, the fees do not always line up. Charge only what a patient pays and no more, there is no reason to make this harder then it seems. A patient wants to send a bill for reimbsursement to their insurance company for what they have paid you (basic concept). You only need to consider how to allot the amounts (per cpt) so that they equal payments received. Please consider both a class on this as well as making yourself a fee schedule. I would appreciate knowing for my own info which program you attended (none of them really address the practice management side of things well) and what state you practice in. Take care and hope this helps. Mike W. Bowser, L Ac _______________ Check the weather nationwide with MSN Search: Try it now! http://search.msn.com/results.aspx?q=weather & FORM=WLMTAG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 I am curious as to what info there is to support this supposition that " ...you can certainly have different fees at different locations where you reasonably have different expenses " . If a provider charges different rates they can be found guilty of insurance fraud even though Joe is correct about Medicare being one authority (so are your state's insurance statutes regarding claims submission). Many a provider, has gone to court on this and even some LAc. In the end, honesty and integrity (meaning one set of rates is the best way to go. Part of doing business means that we take the risk and also pay the expenses, which might not always allow us make the amount we want if we are at more then one locale. Consistancy, consistancy, consistancy in your business dealings and you will find a lot less problems. Take care and best of luck. Mike W. Bowser, L Ac _______________ Search from any Web page with powerful protection. Get the FREE Windows Live Toolbar Today! http://get.live.com/toolbar/overview Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 " Are we in a different system than the MD's? " No. Mike W. Bowser, L Ac _______________ Search from any Web page with powerful protection. Get the FREE Windows Live Toolbar Today! http://get.live.com/toolbar/overview Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 I should mention that a hcfa 1500 form is a legal document, that providers sign, and also states a warning about defrauding insurance. Insurance companies will, from time to time, audit providers by requesting a copy of your fee schedule and followup calls to inquire about fees. Mike W. Bowser, L Ac ________________________________ > Chinese Traditional Medicine > naturaldoc1 > Sun, 10 Dec 2006 14:27:08 +0000 > RE: Re: Superbill Help > > " Are we in a different system than the MD's? " > No. > Mike W. Bowser, L Ac _______________ All-in-one security and maintenance for your PC. Get a free 90-day trial! http://www.windowsonecare.com/purchase/trial.aspx?sc_cid=wl_wlmail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 11, 2006 Report Share Posted December 11, 2006 Hi Liz. Yes, if you give someone a form you must complete it correctly. Soneone is depending on you doing that. --- Liz <lizzzrd wrote: > I don't take insurance but occasionally one of my > patients will submit my bill to their insurance > company for reimbursement. Am I required to follow > all the same rules and regulations as acupuncturists > who do take insurance? > Thanks for any info, Liz Casey > > > > - > Julie Ormonde, L.Ac. > Chinese Medicine > Saturday, December 09, 2006 5:47 PM > Re: Superbill Help > > > > > Julie, > I will see if I can better explain things. > First, it is illegal to have more then one fee > schedule and it should be posted in plain view in > ALL your office locations. Maybe we need to look at > your office situation and what your rent is. I have > a sneaky suspicion that you might be paying an > illegal % (called fee splitting) to some landlord > (other provider) for space. One better way to set up > things is to rent space by the hour or day for a > flat rate. I have seen this happen many times and I > think it comes from looking at OM as if it were > massage therapy, which we are not. We are regulated > as medical providers in most states. > > I pay rent in one place, and rent in the second > plus a flat fee per patient for reception with a > cap, I don't believe this falls under percentage. > > Second, if your fees do not have an E & M code > spelled out, then you cannot use this. You must use > your fee schedule as your business/collections > guide. If you charge one flat rate, then consider > using just the acupuncture codes and never charge > beyond your patients collected fee. To the > insurance, there is no place for a cash discount and > a superbill should only include the same amount > patient paid and never more or less. Putting > different info on there could get you into deep > trouble anyway. As an aside, an insurance carrier > can ask for a copy of your fee schedule or call you > for that info. Be prepared to provide it for them. > Your fees must be a set number, which is why many > providers use the cpt codes with prices per code as > add-ons. I know it is a different way of doing > things but it will help you avoid mishaps. You can > note a discount for services paid same day on your > posted fee schedule. Your collections/fees can > remain similar but you simply are charging per the > procedure. > > I do have a financial policy that all patients > sign which contains my fees, just trying to figure > out the crossover to a superbill - how to divvy up > the money between e/m codes and acu codes, but I > think Im starting to understand about " bundling " . > > But I am still unclear as to how I denote or do > same day discount. > > Thanks > Julie > > Check out http://thesupplycenter.com/ for info on > practice seminars. Hope all this helps. Where are > you located and which program did you attend? > > Mike W. Bowser, L Ac > > ________________________________ > > Chinese Medicine > > cariadanam > > Thu, 7 Dec 2006 13:25:29 -0700 > > Re: Superbill Help > > > > Mike, > > >so I have two charges (two different clinics) > > You should really look into this more as it is > my understanding that one practitioner can only have > one fee schedule regardless of location or risk some > serious trouble. For example, do you provide a > different level of care at each location and if you > do then one group is overpaying while the other is > underpaying, etc. > > one I charge > > > NP - 85 > > > EP - 65 > > > the other I charge > > > NP - 75 > > > EP - 60 > > Well the issue on this is my price to operate is > much higher at one place than the other and they are > in two different cities, so Im not sure what to do > on that? > > > ~how do I price these, literally what would I > put for the different codes? > > Again, I would suggest you rethink your fee > schedule and start using price/code, much like > add-ons for cars. > > Such as if I charge 60 for acupuncture, would I > do E & M 99215, 97810, and 97811? > > Check out the acupuncturetoday.com past article > on this issue. The 97810 is for initial acupuncture > and up to 15 minutes of time w/needles in. Each 15 > minute incriment after that is billed with 97811. As > an example, your EP fee of $60 could be billed as > 97810 - 15 and 97811- 3 units of 15 (or 45). These > numbers do not need to be all equal either. > Insurance companies tend to favor the initial time > and pay more on this, so think about how you want to > structure this before hand and then notify your > patients in writing with a copy of your fee schedule > as well as post it in office with effective dates on > it. > > I did already read the article, thanks. There > are articles but none seem to have the specifics, > even going back through school papers I couldn't > find this. > > I would like the fees to be set, and not > necessarily higher than what I charge, but I just > charge a flat fee, I don't charge extra if I give > them a hot pack you know? Or spend 20 min or 40 min > talking. I don't get how this converts? > > > ~Which E & M code do you use, I spend two hours > with a new patient and an hour on established > patients, I don't double book. > > This will depend upon how you have your fees > structured. Failure to have a schedule set up this > way will make this item null and void. > > Not clear on this. > > > ~Can we use 97124 massage therapy, 97140 > manual therapy (tui na), 97010 hot/cold tx, 97026 > infrared heat therapy (heat lamp)? What prices do we > put for these? Are there any I am not listing that > we can use? > > I am going to lump these all together and again > repeat that you can only charge for these items if > you have an established fee schedule otherwise they > are included within your acupuncture fee. Be aware > that 97140 can billed in incriments of time. 97010 > is for a hot/cold pack or compress and not moxa. > > So if I don't charge extra for patients cash > paying patients then I just don't use these codes? > Do acupuncturists really charge extra for the heat > lamp (or whatever) for their cash paying patients? > > > ~Now essentially the bill will end up being a > lot higher than example of 60.00, so is this where > the cash discount comes in and how do we denote > that? > > You cannot. You must, by law, charge the > insurance and a paying client the same but you can > provide a same day payment discount. The problem > with this is that your numbers and what a patient > pays are really different. This can get you into > real hot water. I keep reading of CAM providers who > are convicted of insurance fraud even a few in our > profession. > > So how does the same day payment work and how do > you note it? > > I have no intention of commiting fraud in fact > quite the opposite which is why I am asking all of > this. I took a class years ago and this wasn't all > clarified, perhaps I should look for a different > one, but Im really trying to get something pulled > together now for the new clinic. > > Thank you for the help it is much appreciated! > > Julie > > > Utterly confused, > > Please take a class on this stuff if you do not > understand it. Best of luck and hope this info > helps. > > Mike W. Bowser, LAc > > > ________ > > Express yourself with gadgets on Windows Live > Spaces > > > http://discoverspaces.live.com?source=hmtag1 & loc=us > > [Non-text portions of this message have been > removed] > > > > > ________ > All-in-one security and maintenance for your PC. > Get a free 90-day trial! > > http://www.windowsonecare.com/purchase/trial.aspx?sc_cid=wl_wlmail > > [Non-text portions of this message have been > removed] > > > === message truncated === Dr. Reenah McGill Licensed Acupuncturist & Biofeedback Specialist Healing Energy Center Modern Technology and Ancient Wisdom 323.668.0278 ph 323.668.2206 fax visit http://WWW.healingenergycenter.com and signup for your FREE ezine of health news and information to improve your life. ______________________________\ ____ Cheap talk? Check out Messenger's low PC-to-Phone call rates. http://voice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 11, 2006 Report Share Posted December 11, 2006 For several reasons you really ought to consult a lawyer before making any changes in your business. JOE Quote Link to comment Share on other sites More sharing options...
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