The Department of Veterans Affairs (VA) classifies acupuncture as a complementary and integrative health (CIH) approach within the innovative VA’s Whole Health system of care. This is great news for acupuncture practices because it means they can be reimbursed for providing services to veterans when acupuncture care is deemed clinically necessary by the patient’s care team.
Acupuncture can be a great treatment for veterans suffering from a variety of complications. Besides its benefits as a pain reliever, acupuncture treatments are also a safer method than opioids for pain management. As an acupuncture insurance billing company, we know many acupuncture providers are interested in providing services to military veterans. However, it seems most providers still are not familiar with the process of enrolling with the VA. If you’re looking for how to optimize your VA medical billing, or have questions about the billing process in general, then follow this guide for billing the VA for acupuncture in six easy steps!
The Advantages of Acupuncture For Veterans
Acupuncture has been growing in popularity as an effective and minimally invasive pain relief method, as opposed to conventional pain relievers. Besides their minimal burden on the patient, acupuncture treatments have been shown to be sufficient in treating veterans for a wide range of conditions.
Acupuncture as a Pain Reliever
Acupuncture treatments have been increasingly gaining traction as an integrative therapy method for effective pain relief. As a minimally invasive procedure, acupuncture is considered generally very safe when administered by a trained provider. While ongoing studies are finding that acupuncture may offer more benefits than for pain management alone, the VA considers acupuncture effective for veterans who suffer from:
- Pain associated with an injury or illness
- Nausea and vomiting after an operation
- Nausea and vomiting related to chemotherapy
- Knee pain from osteoarthritis
- Low back pain
- Depression or other mental health concerns
- Substance dependency
Acupuncture for veterans may be effective as a stand-alone treatment or adjunctive with other medical treatments.
Acupuncture as an Opioid Drug Alternative
Acupuncture has the potential to become a front-line treatment for pain management as an alternative to opioid drug prescriptions. Acupuncture and other holistic practices have been helping reduce the number of active service members prescribed opioids. In 2011, 26 percent of all service members were prescribed at least one type of opioid medication. That number has since gone down due to the armed forces offering alternatives, such as acupuncture, for conventional pain killers.
Veterans can take advantage of the health benefits of acupuncture without the need to subscribe to painkillers. As an opioid drug alternative, acupuncture can be used in place of the prescriptions for acute to chronic pain for the same effects with none of the side effects.
Acupuncture as a PTSD Treatment
Although more research needs to be done, acupuncture holds promise to help treat PTSD and stress-related conditions. The prevalence of PTSD among veterans ranges widely throughout different eras and wars. While one major study of 60,000 Iraq and Afghanistan veterans found that over 13% of them tested positive for PTSD, other studies have found the rate to be as high as 20% to 30%.
According to the American Massage Therapy Association (AMTA), over 40 percent of adults suffer adverse health conditions due to stress and 70 to 90 percent of visits to primary care physicians are for stress-related problems. Studies show that acupuncture, as well as other holistic practices, can significantly help reduce stress, anxiety and depression — which all contribute to PTSD. Acupuncture for veterans and active military members can have a significant impact on their well-being of life and overall wellness.
How to Start Treating Veterans at Your Acupuncture Practice
While the VA may hire licensed acupuncturists to provide direct care at VA Medical Centers, this is not always a convenient solution for patients or for acupuncture practices. Fortunately, the VA’s Community Care Network (CCN) allows you to become credentialed as a VA healthcare provider, which makes it possible for your practice to deliver acupuncture for veterans outside of the VA Medical Center system. Working through your VA region’s CCN is a great opportunity to grow your practice due to the unique patient population, reasonable reimbursement rates, and patient visit pre-authorization
If a VA beneficiary lives too far away from a VA location or the facility isn’t able to treat a patient within 30 days, the VA refers them to registered community providers. Depending on which region of the country you’re located in, one of two companies, TriWest or Optum, will be responsible for credentialing, administering, and processing CCN payments. Given the high level of organization, the CCN is a great opportunity for licensed acupuncture practices that are just starting out accepting insurance payments.
The team at Holistic Billing highly recommends that practices get involved with their regional CCN. It’s a great way to help grow your patient pipeline and while also contributing to the strengthening relationship between the VA and holistic healthcare providers like acupuncturists, massage therapists, and chiropractors.
Checklist to Complete Before Seeing VA Patients at Your Acupuncture Practice
Before you can start receiving VA patients at your practice, there are some VA billing guidelines you must follow. Make sure you complete this checklist before receiving patients so you can bill the VA for acupuncture treatments.
Step 1: Apply for an NPI Number.
We recommend you use a web-based application for NPI applications. To complete the process, you can visit the National Plan and Provider Enumeration System (NPPES) website (https://nppes.cms.hhs.gov/#/).
Step 2: Obtain a CAQH number.
You need a CAQH ID and a login and password for the website to build an online profile so that healthcare entities can access your credentials. A CAQH ID can be obtained straight from the website with the new CAQH Proview. https://proview.caqh.org/PR/Registration. We recommend authorizing access to “any organization that requests access” to avoid future changes.
Step 3: Establish your region.
The VA Community Care Network is divided into six regions covering the continental United States and Hawaii, the Caribbean, and the Pacific Islands. TriWest manages the Western networks, while Optum handles the Eastern regions. You can visit the VA website to determine which region your practice resides in.
Then get credentialed with the region’s administrator.
Before the network will refer patients to your practices, you must be credentialed. In most circumstances, completing the credentialing process takes at least three months. You can start the process by contacting Optum or Triwest directly.
Region 1: 888-901-7407 (Optum)
Region 2: 844-839-6108 (Optum)
Region 3: 888-901-6613 (Optum)
Region 4: 866-286-4174 (Triwest)
Step 4: Complete registration paperwork.
After the preliminary credentialing process, you must sign the necessary paperwork to become fully registered with the network. Forms are typically submitted electronically through DocuSign and will stipulate any final requirements that must be met to complete the credentialing.
Once your practice has been accepted into the network, you will receive referrals for VA patients authorized to receive acupuncture or massage treatments. Your CCN administrator will email the patient’s authorization letters before their initial visits.
How to Submit a VA Insurance Claim
After you’ve received a VA patient’s authorization letters, you’re able to begin treatment. In most cases, the VA will authorize a certain number of visits. While you are certainly free to schedule additional visits, keep in mind that you will not be able to bill the VA for these visits. Make sure patients understand which treatments will be covered by the VA and which will be out-of-pocket or require another source of insurance.
When submitting a VA insurance claim for the first time, you will need to submit all the authorization letter pages together with the claim. Make sure that you transmit all the following information with your claim to avoid a denial:
- A cover letter.
- The date range for services.
- Authorization numbers.
- The total visits authorized.
- The patient’s demographics will also need to be attached, including address, date of birth, and social security number.
- Documentation and CPT codes of reatments administered.
By following this checklist, you can ensure your Veterans Administration insurance claim will have all the accurate information it needs for a smooth billing process.
Additional VA Medical Billing Questions
Find the answers to some of the more common VA medical billing questions.
Does the VA Bill Medicare or Medicaid for Services?
The VA does not currently bill Medicare or Medicaid. However, there is information for veterans about the new Medicare prescription drug benefits.
Will the VA Pay for Massage Therapy?
Clinical massage therapy is one of the complementary integrative health (CIH) approaches covered by the VA’s Whole Health system of care. The provider must have passed requirements for basic or advanced training and maintains the required licenses and credentials to practice massage therapy.
What are the Requirements for VA Covered Acupuncture Practices?
Credentialed acupuncturists must be properly licensed and meet the proper training requirements based on the scope of their practice to ensure veterans are receiving the highest quality of care.
What Types of Acupuncture Does the VA Cover?
Besides traditional acupuncture, providers may be eligible to become certified providers for Battlefield Acupuncture (BFA). BFA is an acupuncture protocol where needles are placed in the ear to reduce pain. Since BFA believes the entire body is represented in the ear, inserting small needles in the ear alone can affect pain throughout the whole body.
Maximize Your Reimbursements for VA Insurance Claims with Holistic Billing
As a medical billing provider with a special focus on holistic and integrative health practices, Holistic Billing Services can help you get credentialed by your region’s CCN and help you start treating veterans right away. We have plenty of experience navigating the unique VA billing guidelines, which allows us to maximize your reimbursements and keep your practice’s revenue flowing.
To learn more about how you can get started providing acupuncture for veterans and active service members without worrying about having your VA claims denied, talk to our acupuncture billing and coding experts today!
Many acupuncture providers have trouble deciding whether or not to join insurance networks, and what’s right for one practice may not be right for another. There are both positive and negative aspects of joining an acupuncture insurance billing network, depending on your geographic location and your practice’s needs, but understanding the pros and cons requires knowing a little more about HMOs and PPOs, in general.
HMO vs PPO
Broadly, there are two major benefit types: HMO and PPO. While both are types of managed care—which is one way for insurers to help regulate costs—let’s break down what each one entails:
What Is HMO?
To start, HMO stands for Health Maintenance Organization; this kind of coverage restricts patients to a particular group of physicians called a network. In an HMO plan, a patient is typically required to select only doctors and providers from their HMO’s established or predetermined network. In most instances, the patient is required to obtain referrals from their primary care provider (PCP) in order to receive acupuncture treatments.
An HMO limits the amount of freedom that a patient has in choosing where they go for care and they typically have to see their primary physician first before going to another provider or specialist. HMOs don’t normally have annual deductibles and only charge one copay at a time for coverage. In 2022, this type of coverage has a monthly premium of about $457, or nearly $5,500 annually.
What Is PPO?
On the other hand, with PPO plans, a patient has the option to select any providers they like—no referrals needed. They can select providers that are in-network with their insurance, which is preferable since their costs will be lower, or patients can choose to go to doctors that are out-of-network.
Although patients with PPO-level benefits have more freedom in choosing their providers, they also tend to have higher deductibles and coinsurance costs. In 2022, the average monthly cost of a PPO plan is $522, or roughly $6,300 over the course of the year. While this is almost $1,000 more expensive than HMO coverage, it’s all about what the patient prioritizes: less upfront cost of healthcare coverage or more freedom in choosing where they go for their healthcare?
Benefits of Joining a Network
When determining if your acupuncture practice should join an insurance’s network, consider these perks:
Larger Pool of Patients
Joining a particular network enables you to treat both HMO and PPO patients who are covered within that network. If you choose to stay out of an insurer’s network, then your practice is limited to seeing only PPO patients who choose to use their out-of-network liberties that come at a higher cost. Thus, joining a network means that you’ll have a bigger pool of patients to potentially use your acupuncture services.
More Referral Opportunities
Being in-network also enables you to accept more patients who have HMO benefits only. After joining a network, your name and practice information will be posted to the insurance carrier’s website and database, potentially garnering you a larger clientele and more referrals from patients’ PCPs. As more and more Americans continue to turn to holistic medicine as part of their wellness journey, this is a huge opportunity!
Additional Marketing Supplies
When you join an insurance network, you have the ability to leverage that big company name to your advantage. This means that you can advertise that you accept patients who are on that insurance coverage and it can build your reputation as a great practice since you’ve been vetted by a trusted insurance provider. Joining an insurance network results in immediate marketing collateral and the potential to grow your practice!
Challenges of Joining a Network
Just as there are benefits to joining an insurance network, there are also some challenges including:
Lower Fee Schedules
By signing up and agreeing to an insurer’s contract providers in-network, that typically means you’ll get paid at a lower fee schedule than providers who are not contracted. In-network providers also usually cannot bill patients for the remaining portion of a balance for a service that the insurance does not cover.
For instance, if you sent a claim for $120.00 and the insurance paid only $40.00, you would not be allowed to bill the patient for the outstanding $80.00. If you’re out-of-network, you usually have the flexibility and freedom to bill the patient for the difference to make up for any low insurance payments.
Limited Coding Freedoms
Another negative aspect of being contracted into a network is that you could be limited to billing only acupuncture codes, whereas as an out-of-network provider, you can utilize numerous other modality codes. For example, United Healthcare covers Gua Sha services for non-participating providers, but not for in-network acupuncturists.
Shorter Claim Filing Window
Additionally, being a contracted in-network provider often shortens your claim filing time. Usually, providers have a one-year window to submit their claims; a January 1 claim can be processed so long as it’s received by December 31. If you are contracted, however, your timely filing period can be cut down to 3-6 months. That may sound like a sufficient amount of time, but claims can easily fall through the cracks on your side or that of the insurance company.
It’s Tough Work Getting Contracted
Lastly, getting contracted with an insurer is tedious work. You’ll need to fill out a thick packet of questionnaires about your experience, practice, and degree and then give the insurer three months to review and approve your application. After that, you’ll need to revisit your paperwork often and meet the insurer’s particular standards to maintain your in-network status.
How HMO or PPO Impacts Acupuncture Billing
When determining which strategy is best for your acupuncture practice, only you can really make that decision! Your medical billing will look slightly different for each plan and there are advantages—and disadvantages—to both HMO or PPO coverages.
Regardless of what you choose to do, your acupuncture practice will still have to handle medical billing and coding and the overall claims process. Take that burden off of your staff’s workloads by partnering with Holistic Billing Services to streamline your medical billing process and optimize your revenue cycle! Contact us today to learn how we can be an extension of your practice!
Over the last few years, more people than ever before are turning to acupuncture and other holistic treatments to alleviate ailments. As more people intentionally seek this service, your practice is likely to grow in size as members of your community begin to visit.
With this exciting growth in business comes the not-so-exciting amounts of medical billing paperwork – not to mention the headache of it all! Holistic Billing Services knows medical billing can be a challenge to navigate, especially for acupuncture practices. This post addresses some of the most frequently asked questions about billing for acupuncture to equip you with the fundamentals of medical billing.
What is Medical Billing?
Medical billing involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. It can be a long, grueling process that requires jumping through hoops left and right to receive payment for services rendered.
Why Is Medical Billing Important for Acupuncture Practices?
Though it may be a complicated process, it is also absolutely necessary for acupuncture practices because it is the most common way of getting paid for services rendered. The majority of your patients will likely have some form of insurance as payment, so your practice needs to be adept at navigating the many facets of dealing with insurance companies. This includes being knowledgeable of the appropriate medical billing codes for the treatment you provide to your patients, keeping track of the relevant patient records, and understanding how to communicate with the insurance company in order to be reimbursed.
Top Acupuncture Billing Questions and Answers
Medical billing can be a challenging portion of your acupuncture practice’s administrative needs. Let’s review some of the top acupuncture billing questions with our expert answers:
When Should I Update My Insurance Verifications and Medical Credentials?
Insurance verification is a critical component of billing insurances for acupuncture, and medical credentialing is a key part of this, too. Current verifications have the strongest correlation with successfully getting claims paid, which is obviously essential to your acupuncture practice. Patient plans and/or benefits will often change at the start of a new year, so it’s imperative you request new insurance verifications as soon as the new calendar year starts.
I am In-Network for a Couple of Insurance Companies, How Often Should I Re-Negotiate My Rates?
Managed care contracts are usually written to auto-renew on an annual basis so you will want to analyze your contracts annually. Use the end of the year to calculate your per-visit reimbursement for a given contract and compare it to per-visit reimbursements for your cash and out-of-network patients. Based on these figures, you can determine if the volume of patients seen from a particular payer offsets any variance in reimbursement. Then, negotiate accordingly.
Which Procedure Codes are Most Frequently Used by Acupuncturists?
In general, the most frequently used CPT procedure codes are those relating to medical evaluation and management, a few of which include:
- 99201-05: New Patient Office Visit
- 99211-15: Established Patient Office Visit
- 99281-85: Emergency Department Visit
- 99241-45: Office Consultation
Specifically for acupuncturists, the following are the most frequently used CPT codes:
- 97810: Initial Acupuncture Session (Tip: do not report this in conjunction with 97813; use one or the other)
- 97811: Subsequent Unit of Acupuncture (You may use it in conjunction with either 97810 or 97813)
- 97813: Initial Acupuncture with Electrical Stimulation (Don’t report this in conjunction with 97810; use one or the other)
- 97814: Subsequent Unit of Acupuncture with Electrical Stimulation (This may be used in conjunction with either 97810 or 97813)
Accurate medical billing codes are instrumental for streamlining your billing process and further growing your acupuncture practice.
Do You Have a List of Insurances That Will Pay for Acupuncture That I Can Use?
Unfortunately, we don’t have a perfect answer for this! Insurance benefits will vary from plan to plan – even within the same insurance company – so there’s no quick shortcut for knowing if the patient‘s insurance will cover acupuncture. It’s really a case-by-case basis when serving patients who might have Medicare, go through the VA, or hold a private insurance policy otherwise. HBS recommends that you verify the patient‘s benefits before you treat the patient by contacting the payer directly or confirming their insurance plan prior to each visit.
Do I Have to Implement Electronic Health Records (EHR) in My Practice?
No, although you will need to document each patient visit, there is no legal mandate to implement EHR for your acupuncture practice. The Centers for Medicare and Medicaid Services (CMS) rolled out Meaningful Use non-compliance penalties in 2015, but most acupuncture practices do not meet the minimum revenue standard for Medicare so these penalties should not apply to your practice.
Though not legally required, using electronic health records can greatly streamline your administrative tasks and help your acupuncture practice operate more efficiently.
Can I Bill Insurances for Massage Therapy?
Yes, there are insurance plans that will pay for massage therapy treatments performed by a licensed massage therapist or licensed acupuncturist! As always, be sure to verify the patient’s insurance benefits information and utilize accurate medical billing codes. The following are the most frequently used for massage therapy sessions:
- 97124: Massage Therapy
- 97140: Manual Therapy
- 97112: Neuromuscular Re-Education
- 97010: Hot/Cold Packs
- 97110: Therapeutic Exercise
Have More Questions About Acupuncture Billing? Reach Out to the Experts at HBS!
HBS is an acupuncture billing service that is experienced in billing for both licensed massage therapists and licensed acupuncturists. As an experienced billing provider for holistic practices, Holistic Billing Services can help your practice navigate the insurance billing process to minimize denials and increase revenue.
With our team of experts by your side, you can focus more on treating patients to help your practice grow rather than worrying about insurance billing. To learn more about our acupuncture or massage therapy billing services, talk to one of our billing and coding experts today.