resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
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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