Most providers who bill insurance also offer some type of prompt-pay (time-of-service) discount. That’s allowed, and it makes sense—it reflects the real costs the office avoids when it doesn’t have
This builds on my other article about prompt-pay discounts and sliding scales—because this is where a lot of providers unintentionally get themselves into trouble. First, let’s clear up some common
Beginning in early March, acupuncturists—primarily on the East Coast—began reporting recoupments involving patients with Medicare Advantage coverage. Below is a summary of the known facts at this time: In practical
The typical reimbursement for medical providers is called a Fee-for-Service model this is where providers are paid for the services they provide, with no real oversight as to how the
Between 2021 and 2023, health insurance companies issued more than 49 million claim denials annually. But here’s what made regulators sit up and notice: Less than 0.2 percent of patients
Financial Policies When was the last time you looked at your financial policy? Do you even have one? Financial policies allow for patient engagement. If patients are aware of and
1. The DOJ is investigating Medicare Advantage Plans The Federal False Claims Act (FCA) is a law that prohibits knowingly submitting false claims for payment to government healthcare programs like
I’m increasingly seeing providers use codes for services that are not typically performed in acupuncture clinics. When questioned, the common response is: “I’m getting paid, so it must be okay.”
Can YOU supervise staff to provide acupressure or massage to patients? Yes, in some states you can, for example, in California, the Business and Professions Code permits acupuncturists to direct
Starting in 2025 we saw many changes to Medicare Advantage plans. In 2025 Premera BCBS exited the MA marketplace and BCBS of MA discontinued specific plans. This year BCBS of
Recently it was discovered that Aetna had been incorrectly processing claims for Suffolk County Employees insurance plan (EMHP). Apparently, this plan has a $30 max benefit, yet up until recently
The 2026 updates are mostly focused on making sure clinics have real, documented systems to protect patient information, (cybersecurity). Even solo-practitioners don’t fly under the radar as far as HIPAA
