resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
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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