Lest you feel dismayed, there is light at the end of the tunnel, at least in terms of insurance billing. I would like to share a few tips, and some of this is obviously hindsight, which can be summarized in a few points:
1) Take a billing class ASAP, as soon as you graduate if not before. Why this was not discussed in my practice management class is beyond me, and I lost 4 years tying to navigate this maze blindly. This is something I tell my students as soon as they are licensed: regardless of whether you plan to take insurance or not, at the very least you need to know how to code a super bill, how to discuss claim forms with clients, how to phrase things so that your clients will be reimbursed and how to discuss diagnosis codes with other clinicians. Forget about being an intern and “We don’t make a western Diagnosis.” You must learn how to make a western diagnosis in order to participate in the medical system and since most clinic time is focused on TCM pattern differentiation, learning the ropes of effective coding will save you about 5 years of pain and thousands of lost dollars. The changes coming next year with the new ICD-10 codes will make taking a new billing class mandatory.
One lesson I learned the hard way is that I simply don’t code for internal medicine. I have found that many carriers try the “Acupuncture for this diagnosis is considered experimental.” In truth, 100% of my clients have pain, whether musculoskeletal or headaches. I may code for additional issues so that I am in compliance with my charting, but my #1 issue will always include pain of some kind. Period. If the patient comes in with another complaint, particularly fatigue, endocrine issues, etc. It opens the door for balance billing to cover aspects of the treatment associated with their other condition rather than for pain.
2) Consider using a free electronic billing service such as Office Ally, again not discussed in my practice management class, but will be addressed in a billing class. I actually did not begin to use them until this year, when I opted to be in net-work with several HMO based fee schedules where the remuneration was so poor that it didn’t make sense to have my biller do the case. Office Ally has some amazing features, not the least of which is that if you have an error on the HCVA form it will not be accepted for the batch. I have only had to rebill a few cases with this amazing software. And, as I said, free for the user.
3) If you have an expanding practice, consider hiring an insurance biller sooner rather than later. I waited too long for this step and so did several of my colleagues. In fact, most of my colleagues wish they hired a biller sooner. What I did not know at the time is that I only have a certain amount of qi, and if I am wasting 15 hours a week trying to bill $25 than this is not an effective use of my time. Better to use my talent in generating income (e.g. treating), and let someone who is an expert in terms of billing navigate that. A biller brings the benefit of being current in coding and HIPPA changes that we may not know about as solo practitioners. In addition, a professional biller is far more knowledgeable in verifying insurance, finding the loopholes, hidden deductibles, etc. This has saved tremendously in terms of billing cases where the patient in fact had no coverage.
Be advised, billing for ancillary care such as acupuncture is DIFFERENT than billing for western medicine, and a biller will have their own learning curve in terms of billing for acupuncture, It took my biller and I about a year to work the kinks out – who required chart notes, who was most likely to deny payments, wait times, etc. It was admittedly scary that someone was now getting 15% or more of the take, but my own acupuncturist found that when she hired a biller, the service paid for itself in a few months.
As your qi is freed up from the drain and frustration of billing, it becomes available to treat the new clients who are waiting. My own practice expanded about 30% after I hired a biller, sort of an if-you-build-it-they-will-come scenario. Had I not had this billing relationship in place, I would not have been ready to see such a high volume of patients.
4) Don’t get greedy. This was a great piece of advice from my beloved chiropractor prior to billing my first Workers Compensation case. He said “ Don’t get greedy, don’t over code.” His advice to me was to never code for more than three procedures in any one visit lest you run the risk of being red-flagged by the insurance carrier. I have seen some acupuncturists bill PI cases at over $400 per session since PI still tends to pay at 100% of the fee schedule for a period of time. This is completely unethical and depletes the patient’s med-pay, to say nothing of creating bad impressions for us within the industry. Chiropractors are reaping the rewards of greed and over billing now so let’s learn from their mistakes.
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