Guest guest Posted January 26, 2009 Report Share Posted January 26, 2009 I believe Angela may have misunderstood. I am not objecting to acupuncture's inclusion in Medicare, rather encouraging we see that our reimbursement remain reflective of the level of care we are offering. For example, my chiropractor husband spends 15 to 20 minutes per patient because of the amount of muscle work and exercise instruction he gives, not 5 minutes as per Angela's experience, yet Medicare only pays Chiropractors for the adjustment, not the extra time or therapies. Thus $27 per patient is not adequate. He still accepts Medicare, as a convenience to the patients who have been with him 20+ years, but he barely breaks even with those patients. As Hugo mentioned, I have created sliding scales and do pro-bono for those who have difficulty paying. I also partcipate with several insurers, have done billing in the past and have recently hired a billings specialist to handle that paperwork. What I don't want to see happen to our profession is having insurance reimbursement, due to financial realities, dictate the time or level of service we provide our patients. As to instructions on " opting out, " I'm not up-to-date on current regulations. If and/or when acupuncture is included, the regulations as that time will be what count! As I stated previously, the inclusion in Medicare may open doors to many who might not otherwise benefit from our amazing medicine, and that alone is very encouraging, both for individuals and for a broken health care system. I also hope that we are fairly compensated! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2009 Report Share Posted January 27, 2009 Hi Angela: --Angela-- 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. -- I woudl hate to call my practices illegal since they are far more ethical than medicare or medicaid could ever hope to be. I posted a couple of weeks ago on this point, but I got censored (probably for good reason, right Mark ). In any case, what you mention above is an example of people who have no business administering CM sticking their dirty little tentacles where they don't belong. There is a long and generous tradition of sliding scale and pro bono services in , even to the point where entire herbal formulation practices are designed to support poor peasants, for example in the MengHe lineage. --Angela-- 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. -- These are clearly problems with the law, and not with community acupuncture. Now these are some of the reasons that I sometimes ask people if they want to govern their own practices or if they want them to be governed for them, either by HMO beaureaucrats or (western) medical associations. Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress..com http://www.chinesemedicaltherapies.org ________________________________ " Angela Pfaffenberger, PH.D. " <angelapfa Chinese Medicine Monday, 26 January, 2009 17:13:15 Re: medicare 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. 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 (AT) comcast (DOT) net www.InnerhealthSale m.com Phone: 503 364 3022 - Hugo Ramiro 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://middlemedici ne.wordpress. com http://www.chinesem edicaltherapies. org ____________ _________ _________ __ " Angela Pfaffenberger, PH.D. " <angelapfa (AT) comcast (DOT) net> 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 27, 2009 Report Share Posted January 27, 2009 Wow, this opens up a whole can of worms for me. Compassionate care and earning a living comes to mind. First, let me say that I think Community Acupuncture is a wonderful answer to low-cost acupuncture. The practitioner is not forced to go into poverty, since it is group work and can return a decent wage. Chrios at 5 mins for $27 - like someone said, not bad, but all that paperwork to go with it. I, like Hugo, get very concerned about the government getting into this. I think the profession can take care of itself by offering community acupuncture. I wish it were more available in my area, as I really see it as a unique business model and difficult to integrate into what I do. I really think the experience in my clinic (and I see two patients and hour) is a lot more relaxing and inviting than a 5 min visit with a chiro. At least the chiros I have seen do that, don't give off that relaxing feeling. I think that accounts for the difference in fees and service. I see many in the healing profession that do not give discounts or treat for free, e.g. doctors and dentists. There are many nurses in the healing profession, that at the end of the day, don't say " I'll take a 20% discount because that is what the market will bear.' As we have stated on this site many times, acupuncturists go out of business or work very part time, all the time. Most cases can be attributed to knowing how to run a business, and market a practice. It is tricky in the healing we do. We all want to give it to everyone, but is that really feasible? It took me about 3 years to go beyond break even. If I didn't have my husband's income, I would be a statistic in this field. Later I learned more about running a business and consider myself doing well. One of my colleagues in another area has a very successful practice (again with growing pains) doing fertility work. She just told me the other day she has no retirement. Her health care has a $5000 deductible, so she pays out of pocket for uncovered services. She had some medical work done recently that costs $3000. All out of her pocket. No visits to an emergency room for free. So the real cost of doing what we do is more than meets the eye. I am not even taking into account the cost of going to school, foregone income, overhead, equipment. And, I guess the underlying thing here is, " It really is okay to make money. " It's kinda necessary in the world in which we live. Again, I think the profession is getting creative for its own interest and for the community. Adam Smith's invisible hand is at work. Anne -- Anne C. Crowley, L.Ac., M.Ac., Dipl.Ac. www.LaPlataAcupuncture.com -------------- Original message ---------------------- " Angela Pfaffenberger, PH.D. " <angelapfa > 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 27, 2009 Report Share Posted January 27, 2009 ---Isn't this discussion really theoretical the Hinckley Bill has been introduced in Congress for the last 10 years and still hasn't gotten out of committee. The Hinckley Bill or Federal Acupuncture Act would cover Ac for all federal employees & those on Medicare. I for one thnk it should pass, but when or ever? Recently, I had a patient come back from a community Ac he really missed interscting with the practioner, individualized attention and the quiet. PS how can you really do a good job with herbs in that setting? MY 2 cents Steve I\Chinese Medicine , anne.crowley wrote: > > Wow, this opens up a whole can of worms for me. Compassionate care and earning a living comes to mind. > > First, let me say that I think Community Acupuncture is a wonderful answer to low-cost acupuncture. The practitioner is not forced to go into poverty, since it is group work and can return a decent wage. Chrios at 5 mins for $27 - like someone said, not bad, but all that paperwork to go with it. > > I, like Hugo, get very concerned about the government getting into this. I think the profession can take care of itself by offering community acupuncture. I wish it were more available in my area, as I really see it as a unique business model and difficult to integrate into what I do. > > I really think the experience in my clinic (and I see two patients and hour) is a lot more relaxing and inviting than a 5 min visit with a chiro. At least the chiros I have seen do that, don't give off that relaxing feeling. I think that accounts for the difference in fees and service. > > I see many in the healing profession that do not give discounts or treat for free, e.g. doctors and dentists. There are many nurses in the healing profession, that at the end of the day, don't say " I'll take a 20% discount because that is what the market will bear.' As we have stated on this site many times, acupuncturists go out of business or work very part time, all the time. Most cases can be attributed to knowing how to run a business, and market a practice. It is tricky in the healing we do. We all want to give it to everyone, but is that really feasible? > > It took me about 3 years to go beyond break even. If I didn't have my husband's income, I would be a statistic in this field. Later I learned more about running a business and consider myself doing well. One of my colleagues in another area has a very successful practice (again with growing pains) doing fertility work. She just told me the other day she has no retirement. Her health care has a $5000 deductible, so she pays out of pocket for uncovered services. She had some medical work done recently that costs $3000. All out of her pocket. No visits to an emergency room for free. So the real cost of doing what we do is more than meets the eye. I am not even taking into account the cost of going to school, foregone income, overhead, equipment. And, I guess the underlying thing here is, " It really is okay to make money. " It's kinda necessary in the world in which we live. > > Again, I think the profession is getting creative for its own interest and for the community. Adam Smith's invisible hand is at work. > > > Anne > > -- > Anne C. Crowley, L.Ac., M.Ac., Dipl.Ac. > > www.LaPlataAcupuncture.com > > -------------- Original message ---------------------- > " Angela Pfaffenberger, PH.D. " <angelapfa > > 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 30, 2009 Report Share Posted January 30, 2009 Opting out of Medicare is an option for MDs but not for chiropractors. I believe that MDs are the only provider type who may opt out of the system. The opt-out paperwork is significant and it must be resubmitted periodically. Chiros may elect to be non-participating ( " non-par " ) providers meaning that they do not have to accept assignment of benefits, but they must still submit claims on behalf of their Medicare patients. The don't have the opt-out option. While I don't believe that the Hinchey Bill would obligate acupuncturists to participate in Medicare, I've yet to see a clear analysis of this. --Bill. -- Bill Mosca, LAc San Francisco CA On Jan 25, 2009, at 3:31 PM, Joni Kroll, D.Ac. wrote: > " Opting out " is possible, but is a tricky > cumbersome process, as told to me by MD friends and my chiropractor > husband. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2009 Report Share Posted June 23, 2009 TODAY is the day to express your support for Medicare inclusion of acupuncture services; call your representative and ask for support and co-sponsorship of HR 646. See this link: http://chinesemedicinetools.com/article-sharing/aaaom-hr-646/aaaom-hr-646-flood-\ the-phone-lines If you don't know who is your rep, go to this site and enter your zip code and you get straight to their website: https://writerep.house.gov/writerep/welcome.shtml Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 Quote Link to comment Share on other sites More sharing options...
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