For the VA Optum WAS sending out recoupment letters for codes 97139, 97039, going back to 2022. THIS WAS AN ERROR
They will recoup for these codes for any dates of service AFTER 2/23/2024, as those codes were removed from the list of authorized codes. Here is what we have received from Optum:
We are thrilled to share the news that HB 1490 passed the Senate on Tuesday and was concurred in the House on Wednesday. It is now headed to Gov. Shapiro's desk for signature. This historic milestone was made possible by the tireless efforts of our Legislative committee, diligence of our lobbyist and his team, and the support of all APA members.
We've had a great discussion on the FSOMA Forum about setting up "Credit Care" Payment Plans for your patients to pay for their care.
Discussion includes an alternative to "Credit Care"
Florida's New Massage Establishment Law
(click link above for FULL TEXT HB 197)
Effective: July 1, 2024
House Bill 197 on Massage Establishments was signed by Governor DeSantis on April 22, 2024. The Bill will impact every office currently working under a massage establishment (ME) license and it goes into effect on July 1, 2024. It will also affect you if you have LMTs contracted to give massages out of your office.
- "I would like to open a practice that provides house calls only, treating patients in their homes. I will not be accepting insurance or have any employees. The local county Business Tax Office is asking me to determine, according to state regulations, whether I need to have an actual brick and mortar office in order to open this business.
Can you please advise where I can find this information? I have tried the Dept of Health and the Florida Agency for Healthcare Administration."
An entity (person/business) that provides mobile services ONLY may be a home-based business or have a non-home-based business address, like a commercial address.
Are you dealing with pain? Maybe you have conditions like plantar fasciitis, heel spurs, or other joint and back issues? I've had success treating various pain problems using acupuncture and herbal remedies.
Let's talk about some herbal formulas designed to address different joint and back ailments. There are formulas for gout, neuropathy, muscle injuries, spasms, and more. One formula tackles cold-type arthritis and fibromyalgia, while another deals with heat-related joint problems like swelling and inflammation. Sometimes, I combine formulas for complex issues like bone spurs and plantar fasciitis to ensure complete relief.
I often get asked what is the one thing I wish I knew when I started my practice. It’s relatively simple: the things you THINK will give you a successful practice and good patient outcomes are not the things that drive the most impactful results for patients. It’s amazing to me in our holistic medicine field how we can get so tunnel visioned on the perceived skill set necessary to generate exceptional outcomes with patients. A “successful” treatment or treatment plan is multifaceted, and our approach should be as well. We can be exceptionally skilled with a needle and know powerful protocols for different patterns. However, if we aren’t considering all aspects of what drives people to comply with a treatment plan, or even curating an effective plan and just letting the patient dictate things like frequency and duration of treatment, we are not getting the best result possible.
Enter your game changer: patient communication. This goes well beyond explaining how acupuncture works (which yes, we will cover in class) into delicately navigating important aspects of a care plan, and influencing patients to comply with important aspects of your recommendations. Don’t get hung up on the word influence, which gets a bad rep, but rather think about how you are helping to influence positive health outcomes for as many patients as possible. We are trusted providers who need to be able to effectively articulate all potential factors which could impact patient results. Patients need to know, like, and trust us. If there is one thing which can drastically improve patient results in your practice, it’s learning to properly communicate in any setting.
The wisdom behind these formulas comes f rom Dr. Gouping Zheng, Ph. D., DOM., L. Ac.
The Role of the Abdominal Muscles in Lumbar and Abdominopelvic Dysfunction
Featured Speaker: Brian Lau, AP, CSMA
Most of us were taught Gua Sha in school. I did very little of it; patients came in for Acupuncture, not a massage. In a continuing education class, I took another course in Gua Sha and Cupping. That's where I learned about the nature of pain and the toxic buildup in muscle and tendon tissue.
Have you ever wondered what causes pain? Nerves must be fed blood, body fluids, and energy to feel good. Please take one of these away; the nerve is not being fed, so it sends a pain signal. As an example, intertwine your fingers and clutch them very tightly together. You can see how your fingers are no longer getting the blood supply, body fluids, and energy they need. The longer you clutch your fingers and hands together, the more pain you are in. When you release them, the pain goes away.
For many clinics, back pain can be something that we see the most, but is often understood the least. Or perhaps we treat all of them with the same local points and just hope for the best. It’s true, back pain does have ambiguity and lots of overlap, but that is never a reason to forfeit our diagnostic principles and inherently thorough assessment skills.
Take Francis, for example. He’s fit, athletic, and the last repetition of his deadlift “tweaked" his back one week ago, and it’s not improving the way previous back episodes have. Next comes in Cara, who bent over to pick something up in her office, felt a sudden twinge, and had to leave work early and lie on a heating pad for the rest of the day. Both of these cases are just different enough from Kelly, who occasionally experiences a feeling of having a tight strip across her lower back, but flared recently after a prolonged period of standing on concrete floors for a real estate showing. Amy’s pain has a sudden onset and is dull, diffuse, and difficult to locate but seemed to really get worse last night, and Jen’s pain flared up after the heel broke off her boot, but she needed to keep working through a hectic day and didn’t notice until 20,000 steps later. It’s only 11 am and all of these people, all with back pain, have pointed to the exact same area of discomfort.
Featured Speaker: Chad Bailey, AP
What are the classical branches of Chinese Medicine? Acupuncture, Tui Na Massage, Herbology, Diet Therapy, and Qi Gong.
Featured Speaker: Darren O’ Rourke
J.P. (47y/o, Male) Initial visit 10/20/23
Extremely athletic: CROSSFIT 5 times a week, in addition to Pilates, yoga, and running several times a week. Clean living, no medications reported, no drugs/alcohol prescribed or recreational.
I met Master Deng Hua Qing in the small village of Yi Chun in Mainland China in 2001. This was the longest stop of our month long trip, 10 days to train with Master Deng in Tai Ji Quan, Lan Shou Quan, and Qi Gong as well as our daily hours at the regional hospital. Master Deng was from the northern city of Harbin but traveled to Yi Chun for our training.
We started each morning around 6am. 60 minutes of Qi Gong followed by 60 minutes of Yang style Tai Ji Quan. Most of our group would leave after Tai Ji practice. A few of us stayed for Tai Ji applications, push hands, and Lan Shou for the last 60 minutes.
As an Acupuncturist, low back pain is likely a common complaint you treat. You likely have your tried-and-true ways of treating it, whether it’s deep needling of the Huatuojiaji points, Master Tung points, or something else. You also likely have impressive success stories using these techniques to solve problems that other practitioners could not solve. This is a tremendous feat that I’m sure those patients are grateful for.
What I will cover in the first session of my lecture, Lumbo-Pelvic-Hip Complex: Testing, Assessment, and Programming, will be straightforward and easy to implement orthopedic and muscle tests to better understand the nature and anatomy of the common pain syndromes afflicting the lumbopelvic region. Being more proficient in our anatomy and ability to stress anatomical structures for a more concrete orthopedic understanding of the patient’s pain is always a valuable endeavor. After all, our bodies are biomechanical machines, and our pain syndromes often present themselves within the machinery. They are obviously much more than this, but a working diagnosis from this context is a great step towards an actionable treatment plan. For instance, if I can produce 3 or 4 positive tests for the illusive sacroiliac joint pain, I feel strongly that my plan should include direct treatment to the SI joint. That’s a solid anatomical starting point. From there, we can branch off to holistic treatment of the entire person in front of us, knowing we are stepping from solid ground.
Mental health imbalances including depression, anxiety, ADD, addictions, and PTSD are rampant in our society. Perhaps some of us are guilty of thinking depressed people in our lives should just “buck up” and be grateful for what they have. Many of these people consider that these conditions are somehow their fault. In working with these patients through the years, I previously had some success—but nothing spectacular - until I began working with the genetic variants. This lead to a greater understanding of the causes of these conditions and greater levels of compassion.
While there can be a myriad of different causes for depression, genetic variants can be particularly causative. Specifically, the vitamin D receptor (VDR) gene can cause a person to be apathetic and depressed due to low dopamine and adrenaline levels. Dopamine is a catecholamine that is a precursor of adrenaline (an adrenal hormone associated with energy). Dopamine has a powerful effect on our reward system. Low dopamine levels have been associated with depression and addictive behavior. In addition, this same genetic variant is responsible for the production of serotonin, our other brain chemical associated with increased mood.
Working with the environment and utilizing sustainable practices is essential today. Traditional Chinese medicine (TCM) is deeply connected to the environment, farming, and agriculture, especially regarding manufacturing herbal formulas.
Using herbal formulas that have been sustainably sourced and manufactured safely to avoid contaminants allows for the best treatment results. Herbal formulas are crafted from a blend of herbs, which promote health and balance in different ways. Western pharmaceuticals often involve environmental impact reports, but some negative results show up later and may be more damaging than expected. Using properly sourced herbal formulas can help both the patient and the planet.
Each of us, when in school or reading our various reference books, whether it be point location (Where the red and the white meet) or identifying certain patterns (red face/malar flush) was exposed to a glowing error in education and practice standards that continues to be repeated even in mainstream medicine. When we speak of the “4 Pillars of Diagnostics”, no single pillar is more important than another. Clearly, we lacked exposure to any but lighter skinned examples of disharmony in a majority of educational settings. I use the newer term melanated on purpose. This term, to me, expresses the wide range of skin tone variation and is the most medically relevant term available.
What is melanation/melanated? The word “melanated" refers to the presence of melanin in the skin, hair, or eyes. Melanin is a pigment produced by cells called melanocytes and is responsible for determining the color of skin, hair, and eyes. People with higher levels of melanin are often described as melanated. It is also a term that is now commonly used to celebrate people of black and brown skin tones.
On April 14th, a 54-year-old woman came into the clinic seeking treatment for insomnia, hot flashes, stress, and she was postmenopausal for 3 years, and since then, she had gained about 25 pounds. Her sleep routine involved going to bed around 10 pm, but she consistently woke up in full alert between 1-4 am and would not be able to fall back asleep. She would turn on the television to try to tire her mind to fall back asleep. She described herself as being in a constant state of anxiety all day and night that she could not turn off. She was regularly and randomly having hot flashes all day and night. She had achilles pain that was taken care of in the past but seemed to have been reactivated with menopause. It had become chronic for 3 years. Her energy levels were low. She felt as though she always needed sleep, and she felt unmotivated. Digestion-related, she always felt bloated. She had constipation that had been going on since her 20s. She would have bowel movements one to two times per week and sometimes would go a week without a bowel movement. The stools were very hard and dry. She would do detox teas to help her bowels move when she was severely constipated. To make herself regular, she would do colon cleanses one to two times a month for about 5 months, but this approach was unsustainable. Her diet included 2-3 meals per day. She would often miss breakfast, which seemed to have made her more stressed at work. She relied mostly on sandwiches and starches and included a lot of vegetables in her diet. Some foods that were regularly included in her diet were peanut butter and jelly sandwiches for lunch, pretzels for snacks, pasta for dinner, and cereal with fruit or toast with avocado and eggs. She loves coffee and has been drinking 2 large cups a day since she was in her 20s. She has also gone vegan at times. She perspired often, especially when having hot flashes. Some of her other symptoms include dry phlegm in the nose at night, and swelling and tightness all over her body,
As she was sharing her symptoms, I was navigating the possible pattern differentiations I could diagnose her with, just like many Chinese Medicine Practitioners do. When it comes to menopause, most practitioners will consider some form of Yin Deficiency. With her hot flashes and constipation, one may consider heat signs. But when I looked at her tongue, I was surprised to find that she had a very thick, greasy tongue coat, and a pale tongue that was slightly redder at the tip. The tongue coating was not just centralized but was also on the sides of the tongue which would be considered the Liver area. Her pulse was overall slippery and wiry on the right and left sides respectively. This was the first time I had experienced menopause in this way. I diagnosed this as a Damp Phlegm Accumulation trapping Empty Heat.
Featured Speaker: Lisa Lapwing, AP
A 31-year-old patient came to me with the chief complaint of male infertility. In his case, he had low sperm morphology and motility which was diagnosed in 2020.
