3 Myths Preventing Integrative, Functional, and Lifestyle Medicine Doctors From Accepting Medical Insurance

dr. cheng ruan Feb 15, 2022

**CME Link for reflecting on this post available at the end of this post**

Why do I think doctors should really take patients with medical insurance when doing integrative health? So, let's talk about some old urban legends that used to be true but are no longer valid.

Myth 1: "I don't get paid for my work. I don't get paid enough for the time I spend with patients."

That used to be true until very recently when the AMA CPT panel made some major changes- the biggest changes ever since the early 90s. It used to be that a lot of doctors view the charting process like a waste of time. Which inevitably takes time away from their patients. Because of their new criteria for E&M codes and CPT updates, time-based billing is lot clearer and reimburses for more. Furthermore, there are now telehealth, phone call, and even messaging CPT codes that can be used away from the patient-physician encounter. With the advance of remote patient monitoring and chronic care management, your staff time can also be billed under these CPT code series. This puts doctors in the drivers seat to design their own health platforms the way medicine is meant to be practice.

Myth 2: I have to document a certain way to get this type of reimbursement.

So in 2021 that also changed quite a bit. So before 2021 doctors used to have to you write in different sections to qualify for higher levels of reimbursement. In fact there's one section that no doctor I know likes called the "review of systems". That's criteria is gone as of Jan 2021 (for outpatient billing) because that sections no longer needed as part of the reimbursement criteria for medical documentation. In fact, in some cases, the history and physical is actually not necessarily needed either. It's really based on the complexity of the actual medical decision making process and how complex it is. A lot of Integrative Health Doc's get medical history from not just the patient, but also their family members, and their friends as well as other doctors. Integrative Health doctors tend to also look at other labs/imaging themselves and analyze those data points (We do this because one we trust no one else to look at these results and interpret them differently in some occasions). Well believe it or not, the fact that we're actually getting history from a third party and the fact that we're actually analyzing imaging/data ourselves qualifies for a higher level of billing. So in fact, integrative health docs are already doing the things that are necessary for a higher level of billing.

Myth 3: There is a limit to what I can bill to insurance for my time with patients.

Insurance and reimbursement is not just about spending time with the patients. In fact in 2020 there are other CPT codes that are accessible to Integrative Health docs and even certified health coaches. An example is behavioral assessment and behavioral intervention CPT codes. Since the assessment is not even time based, these interventions can be done away from the date of service of the actual patient visit. The lifetime value of that patient in terms of revenue generated can be significantly higher. It's also fantastic for the patients, because they're getting a really much higher level quality of care because of much more touchpoints that can be automated which allows for improved health outcomes.

Myth 4: I currently charge $500 to $1,000 per hour. I can't do that with medical insurance.

The key to making a successful company is not to ask how time might be exchanged for money, but rather how resources may be traded for money. So you have resources that you can trade for cash; we call those technical or non-face-to-face reimbursements where the doctor isn't required to be physically there to deliver a quality a service for the patient. Examples of some of these services are neuroimaging devices, automated patient reported outcome questionnaires (such as OutcomeMD), home sleep studies, etc. After all, its important to take vacation once in awhile without affecting cash flow into your business.

This was originally Live Streamed video into LinkedIn

This content in this Journal / Blog Post Reflection is not approved for credit by CMEfy, however, you may reflect on how it applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ from point-of-care learning activities here: https://earnc.me/Z2K88I 

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