AAAOM:  …nor would acupuncturists be allowed to opt out under the current system.
Schram: That’s right, but there is more. If you want to treat a Medicare covered patient you must enroll in Medicare. You can’t treat a Medicare patient without being enrolled and enrollment is permanent. If you do enroll, you agree to follow all of the Medicare guidelines. If you treat a Medicare patient (even in a community setting), you must follow all of the rules and submit a claim on their behalf.

Bottom line: You are not forced to enroll, but if you don’t enroll, you cannot treat a Medicare patient. AAAOM needs to make this explicit.

SERVICES: (AAAOM) It should be noted, however, that once the bill is passed acupuncturists may be able to bill for multiple modalities since HR 646 specifies that Medicare is to pay for the services (not service) of a qualified acupuncture practitioner.

WRONG:  (Schram) Chiropractors, who have a nearly identical enabling statute and can only bill for manipulation. “a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services”

It is likely that Medicare will only reimburse for acupuncture codes of 97810, 97811, 97812, 97813. If non-covered services (tui-na, moxa, herbs, etc.) are permitted under your state license, you can charge the patient directly for them at whatever fee you charge other patients. This is good because you can bill the patient (not Medicare!) for ancillary services. AAAOM needs to be clear on this.

AAAOM: On the other hand, using current RVU data tables, a non-par acupuncturist in New York could expect to collect $98.57 for ½ hours of electro-acupuncture.

Schram: Actually, my calculation shows that is 85.72 for electro-acupuncture. $78.24 for regular. These fees are fine.  Not sure they will stay this way.

AAAOM: In addition to this fee, by utilizing the Advanced Beneficiary Notice, an acupuncturist could also collect the full amount of his fees for all other services not covered by Medicare.

Schram: False: The ABN is not needed for statutorily non-covered services. It is needed for covered services that you think won’t be reimbursable because they are for maintenance or a non-covered diagnosis. AAAOM needs to understand and correct this.

AAAOM: Concerns about fraud have also been voiced. The concern is that acupuncturists should not be part of the Medicare system because it is possible that some will commit fraud in attempts to manipulate the system.

Schram: Fraud affects us all. I am not suggesting that we not join the system because of it. I am saying we must be aware of it because someone other than the patient will be paying for the services, making the system ripe for abuse and fraud. Some practitioners will scam the system with fraudulent billing. This includes treating the patient longer than is medically necessary or changing how the practitioner codes for the services. In essence, the way the system is set up rewards the practitioner to do things he/she would normally not do in order to get paid. Note that fully detailed documentation of why upcoding is done will be a necessity for the practitioner.  Bottom line is we must train our profession how to work in the system to insure compliance. Harsh documentation requirement will follow if fraud becomes prevalent. That will affect us all.

AAAOM: It has also been expressed that “billing requirements will change often.” This is not true. Medicare is the largest healthcare provider in the country. They are so large that it is not fiscally possible for them to frequently change billing requirements.
Schram: WRONG: Claim forms for services must be on a CMS-1500 form (or electronically).