Acupuncture and No-Fault Insurance Coverage

No-fault insurance pays for medical treatment after an automobile collision. No-fault coverage pays for acupuncture treatment along with other therapies, including massage therapy, chiropractic and physical therapy.

In recent years, there has been an increase in the number of clinics set up specifically to do no-fault work. While there is nothing inherently wrong about working with no-fault insurance, unfortunately some clinics abuse the system. Practitioners report that these clinics encourage different types of providers (e.g. chiropractor, physical therapist, massage therapist, acupuncturist) to treat a patient at one time, making treatments brief and minimal. Highly unethical billing practices are common. Patients, perhaps at the urging of their attorney (who often makes the referral to a specific clinic) are treated almost daily, usually with little informed consent to the treatment they receive. The worst such “mills” hire people to stage accidents, then bill for treatments that never occurred.

With acupuncture treatment, practitioners in such clinics are required to give treatments lasting perhaps a few minutes, sometimes using only ear seeds and billing it as an acupuncture treatment (which is insurance fraud). In short, most of these clinics are set up for revenue generation purposes, not for patient care. In the year 2000, over $100 million was paid in no-fault acupuncture treatments alone. The no-fault clinic problem is certainly not limited to acupuncture alone. It is a systemic problem involving all covered modalities, and caused by those who put money ahead of patient care and ethical billing practices. One result is that acupuncture is held in less than high regard, particularly by those who receive such poor treatment. Another is the sometimes dramatic increases in automobile insurance premiums.

Right now, the State legislature, State Acupuncture Board, State Education Department, insurance industry, Office of Professional Discipline, and State Attorney General’s office are all aware of the problem and are actively investigating such clinics and examining the no-fault system in general. This is an effort to reform the system and restore the spirit of the no-fault law’s intention—to provide medical care for those injured in an automobile collision.

On April 3, 2001, the NYS Senate “proposed a comprehensive package of legislation to combat the increasing problem of (no-fault) insurance fraud that is driving up auto insurance rates, and nearly $10 million of state assistance to help local law enforcement and prosecutors fight insurance fraud.” Senate Majority Leader Joseph L. Bruno stated that “One-quarter to one-third of all auto insurance claims contain some element of fraud. We need to change our laws to make it tougher to commit fraud. The bills we are proposing would increase criminal penalties to deter people from committing fraud and increasing penalties on those who do.” For the full text of the Senate press release, visit http://www.senate.state.ny.us, click on “Press Releases,” then “April 2001.”

There has been some talk of removing acupuncture from no-fault coverage. This would be a short-sighted error, a symptomatic treatment for a systemic disease. Acupuncture alone is not the problem, and removing it would deny patients its great benefits, leave the root of the problem unaddressed, and create a negative image of acupuncture. The NYS Board for Acupuncture is now working on a Standards for Acupuncture Care document, which will provide guidelines and good practices for patient care and insurance billing.

ASNY is staying on top of this important issue. We have answered questions from insurance companies, met in Albany with legislators, held a successful and effective insurance forum, formed an Insurance Relations committee (new members welcome), answered the questions of practitioners and students, and kept our members up-to-date through our publications and website. There is more to do, and you can make a difference.

ASNY’s Position Statement on Acupuncture and No-Fault Insurance Coverage:
ASNY is interested in securing acupuncture's continued inclusion in patient care under the provisions of 'no-fault' regulations in New York State. ASNY is aware that there is room for increased involvement on the part of New York State regulating bodies to provide guidance to 'no-fault' clinics regarding patient care and billing practices.

The ASNY Board of Directors offers the following recommendations to begin the process of assessing and improving quality of care and billing practices:

  • Provide acupuncturists with strong guidelines for standards of patient care.
  • Acupuncturists use and document a method of assessment based on the basic principles of acupuncture and Oriental medicine and the tradition of that individual's training, (i.e. palpation, pulse and tongue assessment).
  • Acupuncturists use appropriate clinical record keeping in accordance with SOAP (subjective, objective, assessment, plan) standards. All record keeping includes detailed initial visit documentation. Follow-up treatment notes include form of acupuncture treatment used, patient response to previous treatment, and progress.
  • Acupuncturists spend an appropriate amount of time with a patient providing assessment, treatment and guidance consistent with that provider's tradition and educational background.
  • Practitioners re-evaluate and alter their treatment plan if there is no reported improvement after several treatments, and make referrals to other providers when appropriate.
  • All insurance company peer reviews for acupuncture treatment claims be done by a NYS licensed acupuncturist.
  • All providers use ethical billing practices.

It is imperative that the profession of acupuncture and Oriental medicine not be assigned blame in this dialogue. The entire system of 'no-fault' needs to be reviewed and reformed. All providers of therapeutic service to an injured patient must be reviewed for appropriate and inappropriate practices.

ASNY, along with the other NYS professional associations, has a strong interest in providing leadership and information to encourage appropriate patient treatment. It is always the desire of the state associations to advocate for the best acupuncture and Oriental medicine care that can be provided to the patients of New York State.

What you can do:

1. There are many ethical clinics that provide quality acupuncture care to no-fault patients. Consider working in a clinic which provides good quality of care and uses ethical billing practices.

2. Report any unethical clinic to the State Board for Acupuncture and the Office of Professional Discipline (contact information below). You will need to provide the clinic’s address and details of what you know. You may make these reports anonymously. If we don’t help clean up our own profession, then others who may not share our views will. If you become aware of questionable or inappropriate practices in a particular clinic, the people to contact are Ronnie Hausheer, Executive Secretary of the NYS Board for Acupuncture, phone 518.473.0221 ext. 100, fax 518.486.4846, E-mail acupbd@mail.nysed.gov; and Jospeh Teppedino at the Office of Professional Discipline, phone 212.951.6444.

3. Contact members of the Senate and Assembly Insurance Committees (see Parity article above). Let them know that you want acupuncture care to remain within no-fault coverage, and that all providers and the system as a whole need to be reviewed and improved.

Contact Information for Key Legislators NYS Senate Insurance Committee Chairman:
Senator James L. Seward
50th Senatorial District
Counties Represented: Cortland, Otsego, Schoharie, parts Chenango, Herkimer, Tompkins
District Office: 41 South Main Street Oneonta, NY 13820 607-432-5524
Albany: 307 Legislative Office Building Albany, NY 12248 518-455-3131

NYS Assembly Insurance Committee Chairman:
Assemblymember Alexander B. Pete Grannis
65th Assembly District
Counties Represented: New York
E-mail Address grannis@assembly.state.ny.us
District Office: 1672 First Avenue New York, NY 10128 phone 212-860-4906
Albany Office: 712 Legislative Office Building Albany, NY 12248 phone: 518-455-5676

To Find Your Elected Officials
http://www.vote-smart.org (the best all-around citizen activism site; unbiased & highly recommended)
http://www.senate.state.ny.us
http://www.assembly.state.ny.us

ASNY Insurance Forum a Success
In response to the rapidly changing world of acupuncture and insurance coverage, the Acupuncture Society of New York held its first forum on insurance-related issues. The meeting was on Sunday, March 25th, 2001 at the Pacific College of Oriental Medicine, Manhattan. The meeting was a resounding success, with over 70 practitioners and students in attendance. The panelists included Mark Feldman, DPM, from the Robert Plan Insurance Company; Steve Bernstein, LAc, ASNY Board member and member of ASNY’s Insurance Relations committee; Deanna Waldron, Esq., ASNY Vice-Chair and Michael Gaeta, LAc, ASNY Chair, who also moderated the discussion. The discussion was a lively and informative one, with many practitioners sharing their experiences with third-party payment.

ASNY has set up an online insurance discussion group on this website. Visit the site for member news and legislative updates, and to communicate with Board and committee members. ASNY plans to hold its next insurance forum in Autumn 2001.

Correct Insurance Codes

97780 Acupuncture, one or more needles, without electrical stimulation Note: You cannot use this code unless you insert at least one needle. Ear seeds, piezo stim, magnets, etc. alone are not to be billed with this code. If you use any such non-needle procedure alone, you can use 97799 (“unlisted procedure”), with a description of what it is.
97781 Acupuncture, one or more needles, with electrical stimulation
97799 Unlisted physical medicine/rehabilitation service or procedure
 


 
 

   
 
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