resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
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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