An Excerpt from Playing the Game:A Step-by-Step Approach to  Accepting Insurance as an Acupuncturists

by Dr. Greg Sperber and Tiffany Andersen-Hefner

Many acupuncturists tell me they will never choose to bill insurance, and that is a common enough choice. Still, whether or not you choose to accept insurance, systems are vital to the organized functioning of your practice. Below are some recommended forms to ensure your office has the necessary structure and remains organized. Some of these are insurance related; some are not:

1. Patient sign-in sheet (yes, they are still legal under HIPAA).

2. Daysheet summary—hopefully with whatever software used to enter patient data and visit information, a daysheet or equivalent which summarizes each day’s transactions can be printed. A day sheet summary cover sheet should be created. This recaps the day and incorporates data from the daysheet print-out, the sign-in sheet (to ensure that the amount of people who signed in that day match the total amount of visit charge entries made into your practice software) and balances the monies collected in the format received, i.e., cash, checks, credit cards, payer payments. The summary should also include any reminders to do at the end of the day, such as: make change in your change box with smaller cash monies received, send welcome postcards or thank you cards for referring patients, send patient statements to any who left without paying that day, log data into stat log, etc.

3. Statistics log—to create statistics for the practice’s growth. Three separate logs should be kept: one for each day in a month, one for each month within a year, and one for annual tracking between years. The log should include: patient visits, total charges, total collections, and total new patients at a minimum. One can add additional, important items to this log. Filling these fields in, after you have reviewed a daysheet also ensures that you haven’t misplaced any of them…or the money that goes with them. There have been times when a day’s stats were missing on the stat sheet which made this author have to look for the information. I had misplaced the daysheet and hadn’t yet checked it or deposited those monies. It’s just another way to check operations and prevent errors. Currently in business, using a dashboard for these statistics has become standard. A dashboard takes these stats and creates graphs from many of them and places them on one page so that many different areas of a business can be seen in one place. Using graphs makes it easier to pop out trends, but loses some of the specifics, but those can always be looked up. A sample dashboard is available on our website, www.acu-insurance.com.
4. Patient intake forms—these should include: patient demographics, fee schedule acknowledgement by the patient, financial responsibility agreed to by the patient, HIPAA forms, arbitration agreement (if necessary by your malpractice insurance), and health history information. If the patient does have insurance, you should also make sure they sign an assignment of benefits form; this is a common form used to authorize the patient’s insurance company to pay the provider directly. Copies of the patient’s driver’s license should be kept in the file in the event collections needs to be pursued and to guard against identity theft. Plus, it is nice to have a face to go with the file.

5. Insurance verification forms—this form should include patient’s name, date of birth, insurance company name, phone number, and patient’s ID number as well as your Tax ID and NPI for easy reference.
It should address the following:
• Are there acupuncture benefits?
• If so, are they in- or out-of-network benefits? (If unsure about your network affiliation, ask them to check your Tax ID)
• Is there a deductible, if so, how much has been met?
• Does their plan go by calendar year or other?
• How many visits do they have per year, have any been used?
• Or is there a dollar limit per year, if so, has any been used?
• Is there a set copay or is it a coinsurance?
• Address to submit claims, and are there any special submission requirements with the claim(s)?
• Always document with whom you spoke, the date, and get a reference number for the call.
• The person who completed the form should initial and date it.
Verification forms should also be made for workers compensation and personal injury (PI)/med-pay cases since each requires slightly different information. The workers comp verification form should include the claim number, date of injury, insurance company name and address for claims, the adjuster’s name, phone and fax along with the utilization review (UR) phone and fax. The same information should also be determined for the nurse case manager, if one is assigned to the claim. Ensuring the claim is open and active should be verified as well.
PI/med-pay verification forms include much of the same information as workers compensation. Since there is an adjuster assigned to these types of claims as well, the adjuster’s information should be recorded along with the claim number and date of injury. The insurance company’s name and claims submission address should also be obtained. Verifying the patient has straight med-pay versus excess is also important. Remember that if the patient does have excess med-pay, their health insurance must also be verified since it will be the primary insurance billed prior to the med-pay. If the patient has no health insurance, have them sign a quick statement to that affect. Although you should ask what the med-pay limit is on the patient’s policy during the verification, they often will not tell you. Ask the patient if they know. They will receive a letter in the mail after opening their claim that reiterates the benefits and limitations of their med-pay policy, so they should know within a couple of weeks of opening the claim what the limit is, if they don’t already.

6. Policies and procedures manual – A manual that contains instructions on how to do every task in your office, the correct way, is an excellent reference for employees. This manual should include original forms for copying, with what insurance companies the providers are contracted, any discount programs with which you participate and their rates, how to verify insurance, worker compensation, and personal injury cases, and finally, opening procedures in the morning, closing procedures at night, etc. Putting this manual together will help you to get and stay organized.

There are other systems not discussed here that can help you manage many aspects of your business. Inventory management systems for ordering supplies can be helpful. End-of-day outbound call routines, scheduled marketing times, orgainzed patient record maintenance, banking and bookkeeping routines, all these should become part of your daily and weekly systems. For me, an end-of-the-week practice that keeps me on track is to make a list of the next weeks projects so that I don't have to "take the list home." Once written down, I can leave my work at the office. It will be there waiting for me on Monday morning!

Dr. Greg Sperber is also the author of Integrated Pharmacology: Combining Modern Pharmcology with Chinese Medicine

By Eric Brand Honora’s blog about the power of touch really resonated with me. Prior to studying Chinese medicine, I studied massage in my childhood hometown of Boulder, Colorado. To this day, massage has remained one of my greatest loves, and a big part of my initial interest in acupuncture came from a desire to help people using an art that entails less physical toil than bodywork requires (largely so that I would continue to love massage and not get burned out like my friends did). In one of those bizarre yet somehow significant coincidences, after I came back to Boulder to work for Blue Poppy years later, I learned that my massage school was founded by none other than Honora Wolfe. In Chinese, there is a concept called “yuan fen” that encapsulates a meaning akin to a combination of coincidence, serendipity, and destiny, a connection that is meant to be. The fact that I coincidentally ended up working for the person that founded the school where my education all started felt highly significant in the yuan fen sense, and I’ve always been grateful to Honora for her fantastic spirit and her early foundational efforts that changed the lives of more people than she will ever know. During my study of acupuncture, I felt that my massage background gave me a tremendous advantage because I was already used to the variances of the human body and I had learned to trust my hands and anatomical knowledge long before I had to locate acupoints in school. After seeing a few generations of students, I’ve noticed that many students with a bodywork background excel in the field of Chinese medicine. There is something inherently valuable about learning to listen to the body, knowing how to create trust and allow the body to express itself, knowing how to touch and not just to palpate, like some type of martial art that benefits the bodyworker and the patient at the same time. Some of the best acupuncturists I’ve seen don’t measure point locations, they don’t ask tons of questions or elaborate complicated theories in their minds, they simply feel the body, look at its contours, bulges, and depressions, and needle wherever it seems right. They trust their hands and look at the shapes of the muscles and channels, trusting the objective evidence of the actual body in front of them rather than a theoretical concept from a textbook. This intuitive skill is hard to teach, and we often see acupuncture students poking and prodding without a clear concept of how to touch, how to listen to the body’s qi, how to discern the subtle things that stand out about the person’s tissue. This information is not on the board exam, there is no place for it in curriculum, yet the ability to really observe and interact with the human body is far more important than the charts that students spend their time memorizing. I’ve never had much success in convincing students to put down their silly charts, but I have a firm belief that the best points to needle are the ones that cry out on the body itself, the real healing doesn’t come from the chart. All too often, students treat acupuncture points like an arcane combination lock to be devised with a code book, but the real magic comes from the actual hands on the actual body; the textbook is only a basic trail map. At any rate, I truly hope that Honora understands how much her little massage school changed the lives of all of us students…not to mention all the patients we’ve touched since then. Thanks Honora!

by Honora Lee Wolfe

This week I again treated a patient who, though having come to me to treat her knee, shoulder, and head pain, had lived through a sub-arachnoid hemorrhage about a year ago. This person has suffered immeasurably with the sequellae of her brain event with disability that continues to affect her strength, mobility, and vision. She cannot work, read, drive, or even watch television. Working with her brings up all kinds of emotions and fears, as well as compassion and wanting to help in any way possible. What I’ve discovered with her…and keep discovering with patient after patient…is that touch and massage is likely the best part of the therapy that I do for her.

Of course I also bleed dark veins around her knee scars from two previous surgeries, place needles along the scar and moxa on the tender spots. I do thread moxa on the “san jian” points around her shoulder. I needle requisite points for headaches. All this helps her manage the pain without the use of mind-numbing narcotics that she does not like to take. But of all the work I do for her, she likes and responds best to my touch. For me this is a constant. I am touching and massaging all the way through her (and everyone else’s) treatments.

As an acupuncturist who came to this medicine originally because of an interest in tuina and massage (this is true for many of us), my bottom line belief has always been that physically touching my patients is important, even vital, to establishing the right relationship…one that fosters true healing. I believe my hands are far more potent than any acupuncture needle.

Still, it is easy to relegate the bodywork parts of a therapeutic encounter to something secondary, something not really necessary, something just to be nice to the patients or help them relax. Once we got our acupuncture education, all of a sudden maybe the massage pieces weren’t important or good enough any more! We no longer wanted to be “just” a massage therapist! Do we even chart the bodywork part of a treatment session?

Because of my personal passion for touch in the clinic setting, however, I try to give my students not just permission, but real enthusiasm for once again taking ownership of their massage therapy or bodywork past and make it a much bigger deal in their clinical life. It may be the best thing we do for many of our patients!

So what does the research out there suggest? In less than fifteen minutes of poking around on the internet, it is easy to find studies that show the following results from varying amounts of massage or the healing use of touch, professional or not:

1. Facilitates weight gain in preterm infants
2. Enhances attentiveness in babies and young children
3. Alleviates depressive symptoms in all ages
4. Reduces pain from many sources
5. Reduces stress hormones and the body’s various stress responses
6. Improves immune function

More specifically, formal studies show improvements in many specific disorders from regular professional massage therapy: sleep disturbances, eating disorders, low back pain, fibromyalgia, test anxiety (actually any form of anxiety), improved recovery times in professional and recreational athletes, various PTSD symptoms, increases placebo effect in cases of any other form of therapy being used; this list goes on and on.

Actually I found the most interesting study to be one where elders in nursing homes gave very simple massage to infants. The elderly nursing home patients had all sorts of improvements in their health from giving regular massage to these babies!

What this information says to me as someone who practices a variety of Asian healing arts in combinations depending upon patient need, is that it is vital for those of us in the bodywork sector of this medicine to continue to sing out loud about the power of professional touch! It is in no way a child of a lesser god, but remains, a few thousand years later, one of the most powerful healing modalities there will ever be on this planet.

For anyone interested in more specific training on combining bodywork and tuina with acupuncture therapy, see my distance learning video course on this subject at the link below. Thanks for reading!

Combining Bodywork with Acupuncture Therapy

The rich, supplementing effects of E Jiao and egg yolk were first described in combination in the ancient formula E Jiao Ji Zi Huang Tang (ass-hide gelatin and egg yolk decoction). This formula was first recorded in a text on the Shang Han Lun, and is often considered in the context of Shang Han Lun formulas.

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by Shawn Kirby L.Ac.

Blue Poppy has changed the names of two of our most popular Blue Poppy Originals formulas.  Resolve Depression and Stabilize Sleep is now “Resolve and Stabilize”, and Modified Eleven Flavors Warm the Gallbladder is now “Modified Eleven Flavors.”

Absolutely nothing has changed with either formula other than the name on the label.

We decided to make this change both for FDA compliance reasons, as well as for your patient’s peace of mind.  Over the years we have had many comments from our practitioners that patients would respond with alarm to the word “depression” appearing on the label.  While you or I might instantly recognize this as a reference to “liver depression qi stagnation”, almost none of the patient population would, and depression is a very loaded word in our modern culture.  Similarly, many practitioners reported that patients became alarmed at the word gallbladder on the label.  Instead of thinking Dan 膽,they were worried that they needed to go to their GP and get checked for gallstones.

I am personally glad to see these changes, because these two workhorses are by far the two most used formulas I prescribe in my practice.  These patterns are some of the most ubiquitous in the modern patient population, and can be used to address a remarkably wide range of problems.

The pattern for Resolve and Stabilize is liver depression qi stagnation with possible depressive heat and blood stasis with malnourishment and disquietude of the heart spirit.  While Resolve and Stabilize was originally designed to treat one of the most common modern western presentations for insomnia, it is always vitally important to remember, when using any Chinese herbal formula you must treat the pattern and not the disease.  It may seem redundant, but as always with Chinese herbal medicine, The Song Remains the Same –

Yi bing tong zhi.  Tong bing yi zhi

“Different diseases, same treatment.  Same disease, different treatments.  ”

Resolve and Stabilize can be used very effectively to not only address insomnia, but also smoking cessation, stress on the job, hypertension, and any other disease diagnosis that might walk in your door that has this pattern.  Hypertension can be very effectively addressed because Chuan Niu Xi (as well as Huai Niu Xi, Achyranthis Bidentatae Radix,) among its other more traditional functions, can lower blood pressure extraordinarily well.   I picked up this little factoid from my herbal mentor, Jiayu Zhang, in herb clinic years ago.  Jiayu always cautioned us to be careful using Niu Xi if a patient has a tendency towards hypotension.

Thinking in terms of pattern as your primary focus can free you up to use a formula like Resolve and Stabilize for “off label use”.   Remember, Resolve and Stabilize is not Sominex.  It is a Chinese herbal prescription that addresses a pattern within the body’s energetic system.  What matters is that the formula you are using addresses that patient’s presenting pattern.

My other favorite workhorse is Modified Eleven Flavors.  The pattern for this formula is heart gallbladder qi timidity with depressive heat in the heart, liver, and possibly stomach and intestines. Bob states, “This is a shorthand name for a complex pattern made up of liver spleen disharmony with depressive heat and phlegm harassing the heart spirit as well as heart qi and blood vacuity due to enduring spleen vacuity.”  This pattern is wildly common, and you can see it in almost any age group or sex.  Typically the person is slightly overweight, though I’ve seen Jiayu give this formula, or something very similar, to very thin women providing the pattern was present.  The patient is also often the quiet yet conscientious type – someone who often gets taken advantage of by other people or may have internalized stress and/or anger.

There is one other particular sign that Jiayu would often emphasize to help make this diagnosis, and it’s one that I often start with – startling at loud noises.  I have actually slammed a door or dropped a copy of my Bensky 3^rd edition on the floor to see if they jump.  Once you’ve established this symptom, filling in the rest of the blanks is often a formality.