Operating a successful acupuncture practice can be a rewarding and worthwhile endeavor that makes a real difference in the lives of patients. Unfortunately, it can also be quite a challenge thanks to confusion over how to bill for services effectively. The ins and outs of medical coding are complex and even a minor error can cause a claim to be denied by insurance providers.
Like other therapy-based practices, acupuncture practices bill their services according to Current Procedural Terminology (CPT) codes. Each code is considered a billable unit used to track what treatments have been administered. Some of these codes are service-based, representing a specific billing amount for a specific treatment. It doesn’t matter how much time it takes for this treatment to be administered. For billing and coding purposes, a service-based code has the same unit value (in this case, one unit), regardless of whether it takes twenty minutes or two hours to administer treatment (although each code has an average expected treatment time). Only one unit of service-based codes can be billed at any one time.
Many acupuncture codes, however, are time-based or multiple-unit codes. This means that each code is billed according to 15-minute increments. Most insurance providers follow Medicare guidelines when it comes to measuring this time. Often referred to as the “Medicare 8 Minute Rule” or the “Rule of Eights,” Medicare’s standards for outpatient therapy services require practices to deliver direct, one-on-one therapy for at least eight minutes to receive reimbursement for a time-based CPT code.
Medicare calculates billable units by dividing the total minutes of direct therapy time by 15 and then rounding the remaining value up or down according to the Medicare 8 Minute Rule. For instance, if a time-based acupuncture treatment (such as ICD-10 code 97811 for subsequent acupuncture) takes 20 minutes to administer, the practice would only be able to bill for one unit (the remainder of 5 minutes would not qualify for an additional unit). If the treatment took 23 minutes, however, it would be able to bill for two units (the remainder of 8 minutes does qualify for an additional unit).
Since most acupuncture treatments involve direct, one-on-one therapy, they are classified as time-based codes. That means that an acupuncture practice needs to be very diligent and precise when it comes to calculating billable units. Failing to accurately document the amount of treatment time could result in rejected claims or far lower reimbursements than the practice should receive.
A typical 60-minute acupuncture treatment, for example, consists of four distinct billing units:
Where some practices get into trouble is when they fail to bill for multiple units. In the above scenario, the practice could mistakenly submit this claim:
when it should be submitting this claim:
Failing to calculate billable units correctly can cause acupuncture practices to miss out on collecting revenue for treatments they’ve provided. In this case, the practice would have missed out on two units of code 97811. Spread over multiple patients, it’s easy to see how these oversights could add up quickly and have a devastating impact on a practice’s revenue cycle management.
One of the best ways to ensure billable units are being calculated accurately is to become very familiar with the most frequently used acupuncture treatment codes. This goes beyond the most basic codes for initial care to include services like evaluation management codes and more specific modalities. Every practice needs to know which codes can be billed multiple times to ensure that it’s being accurately reimbursed for its services.
Simply knowing which codes to use and which ones can be billed as multiple units is important, but that knowledge won’t be of much use if a practice doesn’t keep detailed and accurate records about patient treatments. Acupuncture practitioners need to document how much time they spend delivering direct, one-on-one care throughout the day.
This is especially important when it comes to auditing purposes, as they need to make sure they’re not overestimating how much time they’ve spent administering treatments. Technically, a provider cannot deliver more than four billable units of care in an hour because each unit is broken into 15-minute increments. If a practice seems to be billing more units than its staff can actually deliver, it could be inviting unwelcome scrutiny by external auditors.
Delivering quality can be difficult when a practice also has to dedicate time to managing billing insurance providers for reimbursements. Since there are only so many hours in the day, most acupuncture physicians want to treat as many patients as possible in that time, which leaves little opportunity to handle the sometimes tedious paperwork of billing and coding. That’s why partnering with an experienced holistic billing service can be extremely beneficial.
Outsourcing the hassle of billing and coding to a trusted partner allows an acupuncture practice to see more patients and deliver better care without having to worry about whether or not they’re calculating the correct number of billable units.
Holistic Billing offers a variety of billing services for acupuncture, massage, and other integrated healthcare practices. In addition to our extensive experience with insurance billing, we understand the unique needs of these practices and what sets them apart from other medical practices.
Our certified team of coders, MBAs, CPAs, and IT professionals can help you get your claims reimbursed quickly and set up a reporting dashboard that makes it easier than ever for you to get a comprehensive view of your business. Contact us today to tell us all about your practice’s unique needs.
At Holbie, we offer complete and innovative Holistic Billing Services for acupuncture, massage therapy, and chiropractic providers.
At Holbie, we offer complete and innovative Holistic Billing Services for acupuncture, massage therapy, and chiropractic providers.
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