Quite a few of our clients bill acupuncture for veterans. In 2014, the US Department of Veterans Affairs (VA) conducted a systematic review of the safety and effectiveness of acupuncture. In their assessment, they wrote:
Acupuncture is often associated with pain management, but it is also may be useful for other conditions, and the body of literature for acupuncture effectiveness is growing. Acupuncture may be effective as a stand-alone treatment or as an adjunctive treatment to other medical interventions. An evidence map of acupuncture was developed by VA Health Services Research & Development (HSR&D) in 2014. This systematic review identified evidence of potentially positive effect for several pain conditions, including chronic pain and headaches, mental health conditions such as depression, anxiety and PTSD, and wellness indicators such as insomnia.
From va.gov
A Critical Opportunity
Acupuncture is generally considered a proven method for the treatment of pain and nausea. Billing for mental health conditions has a much lower success rate, and is often considered experimental.
Acupuncture was not always accepted as a viable medical intervention. Decades ago, acupuncturists could only render treatment under the direct supervision of an MD. They painstakingly set precedent for the alternative care coverage we enjoy today.
The VA’s broad interpretation of the potential health benefits of acupuncture is surprising. There is little precedent for acupuncture as a viable form of treatment for mental health conditions. By treating veterans, you have an opportunity to show that acupuncture has uses beyond pain management.
But there’s a downside, and it’s this:
Billing Acupuncture for Veterans Is Tricky
Veterans are painfully underserved, and the VA is often the only healthcare option available to them. Providing them with the care they need is a great kindness. It’s not easy, though.
Four Hoops
It’s important to jump through the hoops correctly. Roughly speaking, there are four hoops:
Registration
To bill acupuncture for veterans, you must first register with the VA. Unfortunately, sometimes registration goes poorly — even when you do everything correctly. In one case, Triwest repeatedly denies a provider’s claims because of a tax ID mismatch, despite confirming on multiple occasions that the provider’s tax ID is correct.
Authorization
You must secure authorization in order to treat VA patients. Authorizations are valid for a specific date range and number of units or visits. File each claim under a valid authorization number.
Coding
Only use procedures and diagnosis codes listed on the authorization when billing for veterans. Use modifier codes GP and 59 for modality codes like 97140 or 97016.
Bad Information
Billing acupuncture for veterans involves multiple entities, and they might provide conflicting information. For example, VA Community Care tells our clients they can bill unauthorized diagnosis codes. However, Community Care does not process claims. If you bill unauthorized procedures or diagnoses for a VA patient, expect a denial.
Some VA representatives think you can file claims under the patient’s VA-issued identification number, or the last four digits of their SSN. Unfortunately, that’s incorrect. In our experience, the patient’s SSN is the only ID that works across all of the entities involved in VA billing.
Frequently Asked Questions
You’ll notice a theme here.
- What if I bill without authorization? No pay.
- What if I bill unauthorized diagnoses or procedures? No pay.
- What if I bill outside of the authorization period? No pay.
- What if I file a paper claim, but don’t use a red CMS-1500 form? No pay.
- What if I file corrected claims to removed unauthorized diagnoses or procedures? In the best case scenario, the correction counts against the visit limit.
- What if I don’t use the patient’s full SSN? If a dispute arises, VA representatives will be unable to locate the patient’s claims.
- What if I call the VA? We’ve experienced hold times of up to six hours. Chat options may be available, but will also involve lengthy holds.
- Why does Triwest tell me to use the patient’s VA Member ID or the last 4 digits of their SSN? Apparently, they don’t know any better.
Quality Control
Ultimately, there is no trick to billing acupuncture for veterans. Implement a quality control program to prevent mistakes. Your best bet is to submit claims correctly the first time.
Before you file, double-check the following:
- Authorization number and date range. File VA claims under a valid authorization number. Note the authorization date range in the patient’s record.
- Approved procedures and diagnoses. Only bill authorized procedures and diagnosis codes.
- Correct patient ID. Use the patient’s full SSN.
- Correct modifier codes. Use modifiers GP+59 when using codes like 97140 or 97016 to bill for modalities.
- Correct payer ID. Optum processes VA claims for New England providers. If you’re anywhere else in the US, Triwest is likely the correct payer.
- Correct forms. If you have to mail claims, use a red HCFA CMS-1500 2/12 form.