Acupuncture Billing and REIMBURSEMENT

Over the last few years, the trend of getting acupuncture treatment has become really famous among people trying to get healthier. As a matter of fact, patients who could find some positive changes in their health after the acupuncture treatment now prefer it and other holistic treatment approaches over the contemporary ones. 

With increasing numbers of people inclining toward acupuncture medical treatment, its billing and reimbursement processes have also been enhanced. Obviously, this has turned into a burden on the Acupuncture billing services.

Simply put, this medical billing involves the process of submitting and following up on the claim of payment for services that a healthcare professional has provided. It’s a lengthy process that requires one to move through various steps to get paid for the services.

Before 2020, acupuncture services were not covered by Medicare. However, as it grew popular, especially in terms of pain management, specific codes were provided by Medicare, and it became a part of acupuncture insurance billing.

It also involves the steps of putting up claims of insurance on the patient’s behalf. These claims are made to multiple insurance payors. The main purpose is to acquire payment against services offered through medical facilities. 

This process could get lengthy and strenuous if you don’t know how to do it properly. Here are some things you must know about acupuncture and reimbursement billing:

Keep Your Insurance Verifications Updated


Keep Your Insurance Verifications Updated

One of the most common reasons acupuncture and reimbursement claims may get hindered is the delay in insurance verification updates. Undoubtedly, this is the most significant element of insurance billing. Your medical credentials must be updated to get due process without being hampered. 

If your verification is complete, the claims get paid successfully and immediately. As the patient benefits and plans get modified at the beginning of each year, it’s necessary for you to file for recent insurance verifications on time. 

Know About The Insurance Codes

Insurance codes are basically procedure codes. It’s a catchphrase or code that is used for the quick identification of a procedure that was done on the patient. These include everything from medication to surgeries and even durable medical equipment. If you want to analyze the claims data properly, it is necessary to be able to identify the relevant codes efficiently. 

For this, you would need to study two kinds of codes: ICD-10 and CPT. The former discusses the patient’s diagnosis, and the latter is about identifying services provided to the patient. 

Insurance Benefits Depend On The Plan

For each plan of insurance, the benefits that you get are different. The same insurance company may often be offering different benefits according to its varied plans. This is why there is no way you can get to know whether the patient’s insurance will actually cover the acupuncture treatment! 

This is why you need to serve the patient according to the case they show. You must confirm the patient’s insurance benefits first and then treat him. Make sure to connect with the payer and authenticate the case. 

The best Medical billing company, in this case, is Zee Medical Billing, as it offers case-to-case details to the medical specialists to ensure they have no issues to face later on. 

Re-negotiate Your Rates


Billing The Office Visit For Acupuncture

You don’t have to stay stuck with the current rates for the rest of your life. Rather, you can re-negotiate them with the companies you are in-network with. As a matter of fact, most of the time, there is an annual renewal of the contracts, and acupuncture billing services get automated.

Calculate the reimbursements at the end of each year and ask for negotiations as soon as the new year starts. Compare payers’ volumes to analyze if variances in reimbursement offset volume variances. This will help you reach a new agreement with the company easily. 

Billing The Office Visit For Acupuncture

There is often confusion regarding the billing of acupuncture office visits, which delays the reimbursement and payment for the medical practitioners. Such an office visit is called the E/M service, also known as the evaluation and management service. You must be well aware of it as it comes with some guidelines. 

While billing the E/M services, you must know that the acupuncture visit requires you to use the codes from 99201 to 99204 in CPT. If there are follow-ups and subsequent evaluations, you use the codes that are from 99211 – 99214 in CPT. This is set for every subsequent thirty days visits and evaluation. 

In case you are billing the services from the chunk of the daily treatment, you can code it using the 97810, 97813, 97811, and 97814 figures. 

Avoid Rejections

One of the biggest reasons your medical billing outsourcing claims may get rejected is using the wrong codes. For both CPT and ICD, you need to use the exact codes according to the treatment you have provided to the patient. 

Once you get even a single bill rejected, it can affect your revenue generation in a negative manner. Resultantly, you won’t be able to keep up your business regularly, and the patient traffic would also lower subsequently. 

Final Thoughts

To grow your acupuncture and needle therapy practice, you must ensure that your acupuncture billing and reimbursement claims are met and accepted on time. If that doesn’t happen, it can seriously affect your business and hinder your growth. Acupuncture insurance billing is not yet a part of the CMS list. However, it’s believed that it will soon make its place there. ZEE Medical Billing, offering its services since 2010, is one of the most trusted and reliable medical billing companies you can get your services from! 


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