Guest guest Posted January 25, 2009 Report Share Posted January 25, 2009 While coverage in Medicare might be great for seniors, it may not be so great for acupuncturists. Current reimbursement for a basic chiropractic visit is $27, plus a $6 co-pay. MD friends of mine say that it costs them to see a medicare patient as payment is lower than their average overhead cost-per-patient. Having done medicare billing in years past, I know that medicare billing is complicated with rules constantly changing and with stiff penalties, even for " innocent " errors. i do realize that other insurance companies often only cover what medicare covers, and acupunctures inclusion in medicare may open doors to many who might not otherwise benefit from our amazing medicine. However, we must be diligent in seeing that our reimbursements are at levels that exceed our cost of doing business! In addition, don't think that just because you don't take insurance that you are immune from medicare laws. Once acupuncture is a benefit, licensed providers will have to comply with all medicare laws, whether you take insurance or not. " Opting out " is possible, but is a tricky cumbersome process, as told to me by MD friends and my chiropractor husband. Be careful of what you ask for because you might actually get it Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2009 Report Share Posted January 26, 2009 Joni: Can you share with us how opting out works. I had an osteopath that told me he did this. He was also concerned about the rules and probably his fee. Anne -- Anne C. Crowley, L.Ac., M.Ac., Dipl.Ac. www.LaPlataAcupuncture.com -------------- Original message ---------------------- " Joni Kroll, D.Ac. " <acujoni > While coverage in Medicare might be great for seniors, it may not be so > great for acupuncturists. Current reimbursement for a basic > chiropractic visit is $27, plus a $6 co-pay. MD friends of mine say > that it costs them to see a medicare patient as payment is lower than > their average overhead cost-per-patient. Having done medicare billing > in years past, I know that medicare billing is complicated with rules > constantly changing and with stiff penalties, even for " innocent " > errors. i do realize that other insurance companies often only cover > what medicare covers, and acupunctures inclusion in medicare may open > doors to many who might not otherwise benefit from our amazing > medicine. However, we must be diligent in seeing that our > reimbursements are at levels that exceed our cost of doing business! In > addition, don't think that just because you don't take insurance that > you are immune from medicare laws. Once acupuncture is a benefit, > licensed providers will have to comply with all medicare laws, whether > you take insurance or not. " Opting out " is possible, but is a tricky > cumbersome process, as told to me by MD friends and my chiropractor > husband. Be careful of what you ask for because you might actually get > it > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2009 Report Share Posted January 26, 2009 Thank you for this, Joni. I appreciate you explaining this in terms of good business sense. While we want greater acceptance for our medicine, we want to avoid the pitfalls that are now causing so many doctors and chiropractors to leave their practices in droves, and pursue alternative means of making money, such as selling nutritional supplements. Andrea Beth Traditional Oriental Medicine Happy Hours in the CALM Center 1770 E. Villa Drive, Suite 5 Cottonwood, AZ 86326 (928) 274-1373 --- On Sun, 1/25/09, Joni Kroll, D.Ac. <acujoni wrote: Joni Kroll, D.Ac. <acujoni medicare Chinese Medicine Sunday, January 25, 2009, 4:31 PM While coverage in Medicare might be great for seniors, it may not be so great for acupuncturists. Current reimbursement for a basic chiropractic visit is $27, plus a $6 co-pay. MD friends of mine say that it costs them to see a medicare patient as payment is lower than their average overhead cost-per-patient. Having done medicare billing in years past, I know that medicare billing is complicated with rules constantly changing and with stiff penalties, even for " innocent " errors. i do realize that other insurance companies often only cover what medicare covers, and acupunctures inclusion in medicare may open doors to many who might not otherwise benefit from our amazing medicine. However, we must be diligent in seeing that our reimbursements are at levels that exceed our cost of doing business! In addition, don't think that just because you don't take insurance that you are immune from medicare laws. Once acupuncture is a benefit, licensed providers will have to comply with all medicare laws, whether you take insurance or not. " Opting out " is possible, but is a tricky cumbersome process, as told to me by MD friends and my chiropractor husband. Be careful of what you ask for because you might actually get it --- Subscribe to the free online journal for TCM at Times http://www.chinesemedicinetimes.com Help build the world's largest online encyclopedia for Chinese medicine and acupuncture, click, http://www.chinesemedicinetimes.com/wiki/CMTpedia and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2009 Report Share Posted January 26, 2009 I worked in a chiros office for 7 years and he saw 8 clients an hour, making a payment of $27 not so bad. His theory was that the adjustment only takes 15 seconfa and spending 5 minuets per client was generous. Also, as a Medicare provider you have the choice to " accept assignment " or not. Accepting assignment means you take the payment as payment in full, not accepting assignment means you charge additional what you see fit. Clients that are poor and do not have any additional coverage may call ahead and ask if you accept assignment. I also worked in a physicians office where I learned insurance billing, and Medicare billing is pretty consistent, less cumbersome than ASH in my opinion. Having Medicare cover acupuncture is clearly in the interest of patients who are on very limited income. Objecting to such coverage because you don't want to do the billing seems very self-centered and devoid of empathy to me. Do you know that many people suffer from chronic pain and are unable to pay for the care they need? Does that not bother you?? I wonder why you entered a healing profession.... Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Joni Kroll, D.Ac. Chinese Medicine Sunday, January 25, 2009 3:31 PM medicare While coverage in Medicare might be great for seniors, it may not be so great for acupuncturists. Current reimbursement for a basic chiropractic visit is $27, plus a $6 co-pay. MD friends of mine say that it costs them to see a medicare patient as payment is lower than their average overhead cost-per-patient. Having done medicare billing in years past, I know that medicare billing is complicated with rules constantly changing and with stiff penalties, even for " innocent " errors. i do realize that other insurance companies often only cover what medicare covers, and acupunctures inclusion in medicare may open doors to many who might not otherwise benefit from our amazing medicine. However, we must be diligent in seeing that our reimbursements are at levels that exceed our cost of doing business! In addition, don't think that just because you don't take insurance that you are immune from medicare laws. Once acupuncture is a benefit, licensed providers will have to comply with all medicare laws, whether you take insurance or not. " Opting out " is possible, but is a tricky cumbersome process, as told to me by MD friends and my chiropractor husband. Be careful of what you ask for because you might actually get it Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2009 Report Share Posted January 26, 2009 Hi Angela and everybody: I am strongly against any regulated type billing, 1. because non CM organisations start getting their dirty sneaky little tendrils into defining my treatment plans for me, and 2. the paperwork involved takes away precious time that I need to work on my caseload. And of course having to hire someone to do that for me starts us right down the road to the City of Administrative Bloat. There are many many many solutions regarding the delivery of healthcare to poor people and none of them have to involve governments or insurance companies (even with western medicine). I use three major methods: 1. Sliding scale 2. community acupuncture 3. pro bono, or in plain old english, freebie Underlying all these methods is my real method: create consumers / patients / clients that are not merely stuffed full of information, but, rather, are savvy. People who begin to cultivate their internal power, as we might say in our field. Actually, some of my most motivated and most successful patients are those without money. They get a different opportunity than those who come to pay me to do something to them. Keeping all of this together is the KISS principle. It's a nice balance for me, and I don't have to turn anyone away for financial reasons. In fact, I would hate to push these people, who need the Internal methods in order to make up for the other odds stacked against them, into a " regular " treatment schedule because now they can afford it through " medicaid " or whatever. Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ " Angela Pfaffenberger, PH.D. " <angelapfa Chinese Medicine Monday, 26 January, 2009 13:30:35 Re: medicare I worked in a chiros office for 7 years and he saw 8 clients an hour, making a payment of $27 not so bad. His theory was that the adjustment only takes 15 seconfa and spending 5 minuets per client was generous. Also, as a Medicare provider you have the choice to " accept assignment " or not. Accepting assignment means you take the payment as payment in full, not accepting assignment means you charge additional what you see fit. Clients that are poor and do not have any additional coverage may call ahead and ask if you accept assignment. I also worked in a physicians office where I learned insurance billing, and Medicare billing is pretty consistent, less cumbersome than ASH in my opinion. Having Medicare cover acupuncture is clearly in the interest of patients who are on very limited income. Objecting to such coverage because you don't want to do the billing seems very self-centered and devoid of empathy to me. Do you know that many people suffer from chronic pain and are unable to pay for the care they need? Does that not bother you?? I wonder why you entered a healing profession.. .. Regards, Angela Pfaffenberger, Ph.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2009 Report Share Posted January 26, 2009 Hugo, in the states where I have practiced, Colorado and Oregon, have laws that say that a licensed provider has a fee schedule that needs to be administered consistently, in plain English, freebies and sliding scales are on the verge of not being entirely legal. The Oregon Acupuncture Association contacted a lawyer and solicited an opinion, and she said you can create paperwork that a client fills out and if they can show that they are below the poverty line, you can give them a discount, however, you have to make it public that you give those discounts, they have to be given consistently and not just when requested, and you have to keep the paperwork on file and do it every year!!! Now, that sounds a bit more work to me than billing insurance. Community acupuncture is a bit tricky. For example I bill $95 for a 1/2 hr visit; I am plainly not allowed to offer $20 visits without violating the rule that you have to bill the same amount consistently. The physician office where I worked limited their office to 25% Medicare/Medicaid. The reason being that if all providers accept that percentage of low income clients, everyone will be covered. You can become a provider and not accept everyone from a specific plan. Also, if you never apply for a Medicare provider number you are automatically opted out; nothing needs to be done. Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Hugo Ramiro Chinese Medicine Monday, January 26, 2009 12:37 PM Re: medicare Hi Angela and everybody: I am strongly against any regulated type billing, 1. because non CM organisations start getting their dirty sneaky little tendrils into defining my treatment plans for me, and 2. the paperwork involved takes away precious time that I need to work on my caseload. And of course having to hire someone to do that for me starts us right down the road to the City of Administrative Bloat. There are many many many solutions regarding the delivery of healthcare to poor people and none of them have to involve governments or insurance companies (even with western medicine). I use three major methods: 1. Sliding scale 2. community acupuncture 3. pro bono, or in plain old english, freebie Underlying all these methods is my real method: create consumers / patients / clients that are not merely stuffed full of information, but, rather, are savvy. People who begin to cultivate their internal power, as we might say in our field. Actually, some of my most motivated and most successful patients are those without money. They get a different opportunity than those who come to pay me to do something to them. Keeping all of this together is the KISS principle. It's a nice balance for me, and I don't have to turn anyone away for financial reasons. In fact, I would hate to push these people, who need the Internal methods in order to make up for the other odds stacked against them, into a " regular " treatment schedule because now they can afford it through " medicaid " or whatever. Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ " Angela Pfaffenberger, PH.D. " <angelapfa Chinese Medicine Monday, 26 January, 2009 13:30:35 Re: medicare I worked in a chiros office for 7 years and he saw 8 clients an hour, making a payment of $27 not so bad. His theory was that the adjustment only takes 15 seconfa and spending 5 minuets per client was generous. Also, as a Medicare provider you have the choice to " accept assignment " or not. Accepting assignment means you take the payment as payment in full, not accepting assignment means you charge additional what you see fit. Clients that are poor and do not have any additional coverage may call ahead and ask if you accept assignment. I also worked in a physicians office where I learned insurance billing, and Medicare billing is pretty consistent, less cumbersome than ASH in my opinion. Having Medicare cover acupuncture is clearly in the interest of patients who are on very limited income. Objecting to such coverage because you don't want to do the billing seems very self-centered and devoid of empathy to me. Do you know that many people suffer from chronic pain and are unable to pay for the care they need? Does that not bother you?? I wonder why you entered a healing profession.. .. Regards, Angela Pfaffenberger, Ph.D. Quote Link to comment Share on other sites More sharing options...
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