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Insurance Committee

INSURANCE/ CLINICAL PRACTICE COMMITTEE

Mission statement:  To increase FSOMA members’ awareness of best documentation and practice standards to ensure a decreased rate of claim denials.  Provide regular updates to the members about changes in the insurance industry. Educate FSOMA members on new local and worldwide developments in the practice of acupuncture, herbal medicine, and adjunct modalities.

Projects

Creating a list of Medicare/Medicaid and Insurance providers with the coding and the reimbursement so that we may provide this list to FSOMA members so that they might enhance the marketing capabilities and subsequent marketing materials. 

Colleges Insurance Billing project, has accomplished few meetings with Dragon Rises College, which now is undergoing the credentialing process.
This project will increase revenue for student clinics and teach proper medical record keeping to students.

Insurance Reimbursement Rate Negotiation which is based on the cost of doing business insurance surveys sent out to Florida practitioners. 

Billing Issues

The committee is keeping FSOMA members updated on current changes in the insurance world

December 2024

The last update is the development of the guidance document on use of GA modifier.  Click Here for UHC’s new GA modifier requirement starting Feb 1, 2025

Insurance committee in conjunction with the Legislative committee produced a letter to AHCA (FL department of medicaid ) to convince them to release guidance directing Private payers Medicaid plans to pay to colleges for student work performed under supervisor NPI.

July 2024

News on Optum VA and Insurance Claw Backs and VA Billing Issues.  Optum who handles the VA in Fl 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:  Optum’s Claims Department worked a special project intended to remediate a historical claims logic concern which impacted unlisted procedure codes. Although our analysis of the unlisted procedure codes is ongoing, the current recoupments are in the process of being voided. We sincerely apologize for the inconvenience this has caused and appreciate your patience as we work to void theses specific recoupments regarding the unlisted procedure codes. Additional communication will be sent in advance of any further actions related to the unlisted procedure codes after our internal analysis is complete.

**FSOMA Members are reporting receiving letters from Optum explaining this

June 2024

Click Here to download an APPEAL letter template to mail your insurance company to appeal an E/M Codes non-payment or recoupment processes they have initiated.

May 2024

VA Auditors Discuss Improper Payments for Community Acupuncture

References

  1. VA Notice of Audits and VHA Improperly Paid and Reauthorized Non-VA Acupuncture and Chiropractic Services. REPORT #20-01099-249. DECEMBER 8, 2021
  1. Affinity Acupuncture Agrees to Pay $250,000 to Resolve False Claims Act Allegations.

Committee News

Read the Archives

Upcoming Insurance Meetings

View Calendar

Insurance Committee Contact 

Committee Chair: Galina V. Roofener, AP

Email:

Apply to Join:  or click here

Donate to the Association

Your support can make a significant difference in advancing acupuncture medicine across Florida. By donating to the Florida State Oriental Medical Association, you empower our initiatives, educational programs, and community outreach efforts for everyone.

Make a Donation

Become a Member

Joining your state association supports local, state, and national efforts to present the profession as subject matter experts of acupuncture while improving standards of education, practice, doctorate programs, continuing education, credentialing, and privileging.

Join Now!

Thank you for your interest in the other Funds FSOMA has in place.

Please visit one of the other active funds to learn more and get involved,
(click here to donate to the PAC)

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Important updates to your account and the website platform

 

Hello FSOMA Acupuncturists! 

We’re thrilled to announce the launch of our new website platform for our valued members and the public! Your patience throughout this transition period has been greatly appreciated.

After diligent effort with our tech team, we’re proud to announce that we are launching a more stable and robust platform, designed to enhance your user experience and offer an array of new features and resources. Whether you’re accessing information or engaging with our community, we’re confident you’ll find the new website to be much more user-friendly. As we embark on this exciting journey together, we extend our gratitude for your ongoing support, which fuels our mission to serve and empower professional acupuncturists in Florida. 

Please take a moment to read through the important updates regarding membership renewal and payment processes outlined below. Your involvement is integral to our collective success, and we’re excited to grow and innovate together through this new platform. Thank you for being a vital part of the FSOMA community!

If this is the first time you are renewing your membership since March 1st, 2025, because of the changes to our system all memberships that were due to automatically renew will instead expire on their next renewal date. 

To keep your account active you must log in with your username and update your credit card information by manually re-registering your membership through our new gateway when it is time for your renewal. This is only a one time process. 

At the time of your first login you will be prompted to reset your password. Once logged in, just navigate to the Become a Member page and select your membership level and follow the checkout process.

For payment to process smoothly, please make sure that your payment method is active, and you have sufficient funds. And if you need to automate your payments in our new platform for the future, simply go to your Account Profile while logged in and under the ‘My Subscriptions’ tab select your active subscription and make sure auto-renew is toggled on.

As your renewal date gets close you will receive email reminders about this process and the steps to take. You will also receive reminders if your membership has lapsed as a helpful nudge in case you missed the initial reminder emails, so stay on the lookout through this process to help us help you keep your account active. 

Your ongoing support is what drives us to continue working to secure YOUR future as a professional acupuncturist in the state of Florida and to provide the best possible services to our members. The more we grow the more we can do and the new website will help take us there!

Please keep an eye out for future communications and updates as we move forward.

Best regards,

Your FSOMA Board of Directors