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Changing Acupuncture Practice Models and Compliance Requirements

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Manage episode 516988472 series 3652666
Content provided by AT and Acupuncture Today. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by AT and Acupuncture Today or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

The modern healthcare landscape is driving acupuncturists away from the traditional fee-for-service model toward appealing alternatives like concierge and direct-pay care. These models offer stability and reduce the administrative burden associated with insurance processing, facilitating more individualized patient care. Key differences exist: direct-pay uses an all-inclusive membership fee, while concierge uses a membership fee but often continues to bill insurance. Adopting a mixed model structure, particularly concierge, introduces complexity regarding compliance with state and federal laws. A major point of confusion is HIPAA compliance. HIPAA applies only to "covered entities" who electronically transmit health information during standard transactions with insurers. Acupuncturists who strictly avoid these transactions are typically exempt. However, this exemption is lost if a practice handles Protected Health Information (PHI) or uses a mixed payor base. The article strongly recommends that all providers comply with HIPAA to satisfy state consumer and data privacy laws. Acupuncturists contemplating a practice transition must consult a licensed healthcare attorney and a HIPAA/IT compliance consultant for guidance.

  continue reading

97 episodes

Artwork
iconShare
 
Manage episode 516988472 series 3652666
Content provided by AT and Acupuncture Today. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by AT and Acupuncture Today or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

The modern healthcare landscape is driving acupuncturists away from the traditional fee-for-service model toward appealing alternatives like concierge and direct-pay care. These models offer stability and reduce the administrative burden associated with insurance processing, facilitating more individualized patient care. Key differences exist: direct-pay uses an all-inclusive membership fee, while concierge uses a membership fee but often continues to bill insurance. Adopting a mixed model structure, particularly concierge, introduces complexity regarding compliance with state and federal laws. A major point of confusion is HIPAA compliance. HIPAA applies only to "covered entities" who electronically transmit health information during standard transactions with insurers. Acupuncturists who strictly avoid these transactions are typically exempt. However, this exemption is lost if a practice handles Protected Health Information (PHI) or uses a mixed payor base. The article strongly recommends that all providers comply with HIPAA to satisfy state consumer and data privacy laws. Acupuncturists contemplating a practice transition must consult a licensed healthcare attorney and a HIPAA/IT compliance consultant for guidance.

  continue reading

97 episodes

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