Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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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.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
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."
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.
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.
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.
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.
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.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
October, 2002, Vol. 02, Issue 10
By Vivian Madison-Mahoney, LMT
While it seems there are no laws regarding fees that may be charged to patients or insurance companies, there are certainly ethical and other considerations.
I am asked frequently to write about or offer my opinion on massage therapist fees.This is a sensitive subject with some, and therefore a difficult subject for me to write about. I ask you to please bear in mind when reading this article that mitigating circumstances may modify what one may charge or expect for reimbursement.
I am not recommending fees, but offering my opinion and suggestions, which are based upon personal experiences. My experiences consist of 16 years of billing and being reimbursed by insurance companies for prescribed medical cases referred to our office. Experience also comes from 37 court appearances, hearings and depositions. My opinions and advice also are based on communications with insurance companies, auditing companies, and defense attorneys. I am asked often about the legal and/or ethical billing practices of massage therapists, including fees and codes used. Finally, my recommendations are based on reports of denials or reductions from those who charge high rates and call or e-mail me later asking what they should do.
Insurance companies will not tell you what you can charge. However, they do set the amounts they will pay. Insurance companies normally reimburse at the established usual, customary and reasonable, (UCR) rate per geographical region.
I know some people who teach billing to massage therapists and advise them that they can or should bill high -- upward of $145 - $175 or more per visit. In my opinion, this is totally outrageous. Their explanation or reasoning for this is that insurance companies will pay it, usually based upon RBRVS.
According to the glossary of terms in the 2001 edition of the American Medical Association (AMA) publication Medicare RBRVS: The Physicians' Guide, RBRVS is defined as follows:
RBRVS takes into consideration the cost of a physician's practice overhead, rent, staff salaries and benefits, medical equipment and supplies. It is one of three resource cost components included in the formula for computing Medicare payment schedule amounts. Another of the three resource cost components includes the physician's work. "Physicians work includes the physician's individual effort in providing a service, which includes time, technical difficulty of the procedure, severity of the patient's condition, and the physical and mental effort required to provide the service."
You and I both know that our overhead cost of doing business and professional liability insurance are nowhere near a physician's costs, not even taking into consideration the work components involved. So if you think you are worth the same fee as a physician, or think you should charge outrageously high rates, please think twice. (A recent report stated that most physicians' medical malpractice insurance is in excess of $250,000 a year, causing some physicians to have to retire early or relocate their practices to other states).
For example, some insurers may allow as much as $45 per each unit or 15 minutes of treatment for CPT Code 97140, Manual Therapy Techniques. Does this mean we need to be billing that much? No! Does that mean we need to be reducing our fees per code to $10-$15 per unit? No! Billing too low can be as bad as billing too high. Carriers enter codes and fees into a database. They later establish usual, customary, and reasonable fees, according to fees and codes entered in their databases per geographic region.
If we bill too low, we harm the other professionals who may use these codes and who have a higher cost of doing business incorporated in their fee structure. By the same token, if we charge too much, we harm ourselves in several ways:
When I began working with insurance companies in 1984-85, we billed our prescribed cases at $56 per hour of therapy, later raising our fees to $65. We retained this fee for many years. The maximum fee we ever billed from our office was $95 with one or more modalities added, and only when prescribed. (This did not include special services or initial visit fees.)
If all insurance companies suddenly got together and decided that our services were costing them more than it was worth, what would we do? What would those patients who need our services do? Unfortunately, most insurers do not really care about patient recovery, prevention of medical problems, etc. Insurance companies care about the bottom line: cutting costs and saving money!
We have just begun to get our feet in the door and be recognized and accepted by insurance companies. Make no mistake; we have a long, long way to go.
What type of wage were you making before you became a massage therapist? Many of us were making minimum wage, if that. What makes us think that, just because we obtained a license with minimal training, we should now be making the same as others who have invested untold capital and spent years of training and residency time?
In the past few years, I have seen and heard of too many therapists just out of school who thought they could earn a ton of money without having to work for it. With this attitude, it is impossible to achieve any great level of success. (If it is possible, will someone please tell me how?) I have heard of massage therapists who complain to patients that they are not making enough money when working for a chiropractor or in another therapist's establishment. They complain to clients that they are only being paid $25 (or more). They complain, while working in a clean, quiet, air-conditioned room, with no overhead or worries, to clients who work in 95 to 100 degree weather or in rain and snow and make only $8 per hour. Now tell me, how in the world do you think that makes clients feel? Do you think they will feel sorry for therapists, especially when it is their $8 per hour that is being scrounged and saved to pay for massage? (This may be exaggerated a bit, but I guarantee, not by much). My husband, for example, a licensed funeral director and embalmer, managed a multimillion-dollar funeral home earning only $20 per hour. He certainly does not feel sorry for us when we complain about what we earn.
We need to reassess our values, training and goals. If we don't, what we have all worked so hard for will be priced right out of reach of the average person, and massage will be right back where it once was, available only to the wealthy as a luxury treatment.
Yes, we work hard -- probably harder than any other health care professional. Our work involves constant giving, caring, and it requires great physical effort. Additional educational training is expensive and time-consuming. Setting up our offices with the best equipment and supplies is expensive, too. I have been there, I know! But we still do not fall into physician or other health care provider categories when it comes to expense and time involved.
We are so fortunate to be in a profession that has grown so much and been so widely accepted in such a few short years, so to put it bluntly, let's not screw it up!
Let the following be your guide for rate setting:
As I was sitting down to write this article, I received a call from a defense attorney in Orlando, Florida regarding a therapist's billing practices. In this particular case, I believe I helped prevent the therapist's bills from being denied and avoided a potentially embarrassing court proceeding. However, it is not always that easy, especially when I am deposed to testify, as has happened before. I do not like testifying, or even indicating to an attorney or an insurer that a therapist is possibly in the wrong. I want to help you, not go against you!
Click here for more information about Vivian Madison-Mahoney, LMT.
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