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NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
January, 2001, Vol. 01, Issue 01
Medically Necessary and/or Insurance-Related Cases for Therapists
By Vivian Madison-Mahoney, LMT
I would like to express my excitement and appreciation for this wonderful opportunity to be able to communicate and share with you my most passionate subject: physician-referred, medically necessary insurance cases.My goal will be to inform, guide, and assist you in this sometimes complicated yet ever-rewarding adventure.
The following are some of the many issues we will cover in future articles in Massage Today:
In this our first issue, I will discuss what determines a medically necessary case, and help you understand the importance of physician-referred cases (whether or not you have intentions to or are able to accept insurance cases for payment in your region). I will also discuss how and when to make reference to a "patient" vs. a "client."
Medically Necessary Cases
To be classified as a medically necessary case to be eligible for insurance coverage, a physician must determine that the patient has a specific diagnosis. A professional examination and history of the patient is needed to determine a diagnosis. This must be obtained by one trained and licensed to practice medicine for which the diagnosis is given.
Definition of "Medically Necessary"
Medicare and most insurance companies define "medically necessary" as: "Services or supplies that:
Legalities of Medically Necessary Cases
Medically necessary cases need to be viewed as legal cases. Documentation must be maintained, accurate and in order for possible legal purposes in the future.
Physician-Referred Cases May Not Necessarily Be Insurance-Related Cases
A case that is medically necessary or referred for therapy by a physician is not necessarily an insurance-related case. One may have been diagnosed with a disease or injury and referred to you by a physician, but not have any type of insurance coverage. When treating a physician-referred case, you must keep accurate documentation, regardless of whether the case is covered by insurance.
You cannot bill an insurance company for any treatment that has not been determined by a physician's diagnosis to be medically necessary. This does not mean you cannot treat medically necessary cases referred by physicians.
Whether or not you are allowed to bill for insurance cases will be determined by many factors. Licensure or certification, insurance company requirements, and your state and local laws or rules may come into play.
There were no laws or rules in Florida that pertained to insurance billing for a massage therapist when I began in 1984. Therapists set the pace, and insurance companies paid for therapies performed and billed by a licensed massage therapist. You also may have to set the pace in your area.
Patient vs. Client
Physicians like to claim the title "patient." Attorneys like to claim the title "client." When a physician refers a case to you, this person is referred to as a "patient."
What has worked well for us the past 15 years is to always refer to the patient as the "physician's patient," and not claim them as "my patient." As one who works under the authority of a physician, by way of a prescription, we are acting as an extension of the physician, so to speak.
If you realize this, it will:
No information given within these articles is meant to override your licensing or state and local laws or requirements, or to take the place of legal counsel. It will always be your ultimate responsibility to know the laws and rules of your state and locale, and those of your licensure or certification boards.
Click here for more information about Vivian Madison-Mahoney, LMT.
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