Monthly Archives: December 2014

Be Aware of Virtual Credit Card Fees

Many providers accept credit cards as a form of payment, but need to be aware of the associated fees when accepting virtual credit card payments from insurers for reimbursement purposes. Virtual credit cards are unique card numbers generated for a specific one-time transaction and linked to real accounts with card issuers. Clinics need to be aware that these transactions carry significant fees compared to traditional forms of payment--up to five percent of the transaction amount--and may include additional fees to offset fraud risk when card numbers are entered manually, which in effect reduces reimbursement to the clinic. It also effectively transfers the cost of the transaction from the payer to the clinic.

Ask the Expert: Billing & Coding

Question: I am new to billing insurance for acupuncture and have some concerns over how to bill. I have heard in addition to the acupuncture codes (97810-97814) there is a code to also bill for the needles themselves. Is this true and how would I bill for it?

Answer: This question comes up often and is one that is interpreted incorrectly by many as there are codes for needles (A4215 needle, sterile, any size, each) however, it is inappropriate for this code to be used for acupuncture services. Using needles is integral and essential for acupuncture and as such needles are considered part of the service and not separately billable. In other words the value of the needles is included in the charges for the overall service.

Specifically the needless are considered “incident to” the acupuncture service. In billing for acupuncture you may bill for the sets of needles provided with codes 97810 initial set, manual, 97811 additional set(s) manual or 97813 initial set, electrical, and 97814 additional set(s) electrical with no separate coding for the needles themselves.
The needle code is used for the patient to take home and use for home injections like what a diabetic patient would use for insulin.

Potent Benefits Under the Affordable Care Act (Obama Care) for the Acupuncture Profession

The two most potent benefits under the Patient Protection Affordable Care Act (Obama Care) for the acupuncture profession and consumers who wish to utilize acupuncturists for their health care needs is the implementation of essential health benefits section 2707 and the non-discrimination clause under section 2706.

“Essential Health Benefits” (EHB’s) under section 2707, require a core of benefits that will be the minimum coverages that the plans must contain. These may include acupuncture services (5 states did so) but also offer benefits such as out-patient rehabilitation as well as preventative care, weight loss et al.

The Affordable Care Act requires that non-grandfathered, insured health plans offered in the individual and small group markets, both inside and outside of the Exchanges, provide a core package of health care services, known as “essential health benefits”. Note this specifically is for individual policies or small group market which means that self-insured and or large group plans are “grandfathered” or exempt, at this time, to mandatorily provide these services.

Non-discrimination in health care (rule 2706): This mandates that no health plan or insurer may discriminate against any health provider acting within the scope of that provider’s license or certification under applicable State law. This provision is a federal protection applicable to all groups including ERISA and other plans established or regulated under the bill. Just as the HIPAA protections apply across the board, the non-discrimination provision will be applicable to all health benefit plans both insured and self-insured. Specifically this section indicates group or individual and does not limit to small group which means less potential exemptions.

This provision may be the strongest advocate for acupuncturists as it first and foremost will not allow plans to have acupuncture benefits limited to when provided by an MD. Meaning if there is acupuncture benefits they must pay an acupuncturists equally. Additionally the acupuncture scope of practice may allow a myriad of services including physical medicine and rehabilitation, nutritional counseling et al and consequently when a plan pays for those services to any provider it must also pay to any licensed provider the same services when acting within their scope. Meaning when a plan has limited or no acupuncture benefits but unlimited physical medicine services it would be required to pay a licensed acupuncturist for the physical medicine services on an equal basis and at what is allowed under the plan for all providers.
However there can be some exemptions - If a group purchased an a plan on or before March 23, 2010, the plan may now be considered “grandfathered”, and may be exempt from many of health reform’s mandates.

However, some mandates apply to all plans, including grandfathered plans. If changes not mandated by law are made to a policy, the plan could lose its grandfathered status and become subject to all health reform mandates.

Self-funded or highly-customized plans will have the option to grandfather as long as their plan was in effect on or before March 23, 2010 and meets all grandfathering requirements.

Ask the Expert-Affordable Care Act State Spotlight: Arizona

Question? Can an acupuncturists bill insurance in the state of Arizona?

Answer: Acupuncture is billable in AZ and allowed on many plans. However, it is not a mandated benefit under the Affordable Care Act in Arizona.

The non-discrimination law 2706 does apply unless a plan is considered grandfathered. This means they will have to pay a licensed acupuncturist when acupuncture is a covered benefit, meaning no longer can they pay MD only.

Also this applies to physical medicine, exams etc. that are within scope.

Want More Information? All AAC billing and coding seminars discuss region specific Affordable Care Act details based on the seminar location.