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We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
September, 2004, Vol. 04, Issue 09
We Get Letters and E-Mail
By Editorial Staff
Editor's note: The following letters are in response to Vivian Madison-Mahoney's article, "A Word About Insurance Reimbursement," which appeared in the April issue. www.massagetoday.com/archives/2004/04/12.html.
Differing Perspectives on Insurance Billing
I have been practicing massage therapy for 21 years, and billing insurance for about 15 years.I am in this profession for the long haul; if I wanted to get rich quick, I would not be doing massage for a living. However, that does not mean I can afford to ignore sensible business practices!
Unlike Vivian Madison-Mahoney, I believe that billing "just a bit more" for injury rehabilitation is bad business and bad political strategy. One needs to understand the differences between the relaxation and rehabilitation massage markets to understand why. Unlike most other health care providers, massage therapists work in two separate markets. I believe that confusing the two markets has led to charges of greed, fraud and abuse by commentators like Ms. Madison-Mahoney.
Most of us work in the relaxation market, in which rates are determined by what individuals can afford to pay. A few of us also work in the injury rehabilitation market, in which rates are determined by what insurance companies are willing to pay. Both of these markets are self-regulating. If I charge more than individuals are willing to pay for relaxation massage, then they will not hire me to work on them. If I charge more than insurance companies are willing to pay for rehabilitation, then they cut my reimbursement. The similarity ends there.
When I do a relaxation massage, I do work that requires minimal training and experience. No clinical expertise is required. The client pays me right away, and I have no extra duties to perform afterward. The techniques of rehabilitation massage are specific and demanding, and they require much more training and experience to perform well. Furthermore, I have legal and ethical responsibilities to my rehabilitation clients that simply do not exist for my relaxation clients. I do a thorough intake assessment, take copious treatment notes, and fill out umpteen numbers of forms. I have to get a doctor's referral, including ICD-9 diagnostic codes. I have to call the insurance companies involved - sometimes, many times - to make certain that I will eventually get paid. I frequently have to get letters of protection and third-party liens to protect my financial interests. I send progress reports to referring doctors who want them. On top of all that, I have to bill the insurance company myself and wait months (or even years) for payment.
The only similarities between the relaxation and rehabilitation massage markets are the hands-on nature of the work and the licensing status of the practitioner. Three kinds of insurance pay for massage therapy: health insurance, workers' compensation and auto insurance. Health insurance routinely pays for massage therapy in only two states: Florida and Washington. Lawsuits in state courts opened these markets. In other states, health insurance policies rarely cover massage, and those that do typically charge higher premiums for the privilege. Outfits that contract with therapists who are willing to charge lower rates are not offering insurance! They offer the illusion of insurance; clients still pay the discounted bill out-of-pocket. Workers' compensation policies vary from state to state.
Most states will pay us, but coding can be idiosyncratic and reimbursement rates vary. On the other hand, auto insurance has covered massage therapy in most states for years. In my experience, they will usually pay 145 percent to 185 percent of the standard Medicare rates for the specialized physical medicine (97---) codes we use. They pay massage therapists the same amount they pay physical therapists and chiropractors for similar work, regardless of experience. I send auto insurance companies a bill that I consider reasonable, and they pay it almost every time. I can see no reason to charge less money than other health care professionals do for similar services, especially when my work is often more effective. Of course, I will never receive the payment I deserve if I do not ask for it.
Ms. Madison-Mahoney implies that massage therapists who charge rates determined by the insurance market are taking unfair advantage of patients and defrauding insurance companies. Hogwash! If I charged the same rates for injury rehabilitation and relaxation massage, I would be cheating my clients who were injured in motor vehicle accidents caused by others. The medical bills in such cases help determine compensatory damage awards for the clients' pain and suffering. I believe that charging artificially low rates actually harms other therapists and the profession itself by undervaluing our skills.
Ms. Madison-Mahoney also states that insurance companies are reducing fees paid to massage therapists. That is true in some places, but insurance companies have been doing the same thing to all health care providers for several years. Reduced payments to providers reflects endemic problems with our health care system, not specific problems with massage therapists overcharging for services, as Ms. Madison-Mahoney claims. Massage therapists already reduce insurance companies' costs by providing treatments that are more effective and less expensive than the alternatives. For example, massage therapists probably save insurance companies millions of dollars each year by eliminating the need for costly surgeries.
When we prove it with research, the insurance industry will be sending us more work than we can imagine. I do not presume to tell other therapists what fees to charge; however, I do believe that therapists who do not consider the economics of the health care industry when making billing decisions are doing a disservice to themselves, their clients and the massage therapy profession as a whole.
Keeping our fees artificially low only encourages insurance companies to devalue our services. I believe that they will only respect massage therapy as a health care profession when we insist on fair payments that reflect our actual worth. Yes, that means taking legal action if necessary.
Remember that the chiropractic profession only broke the monopoly of the medical orthodoxy by winning an antitrust lawsuit against the American Medical Association. I prefer other options, but I am not opposed to legal action when necessary.
Donald F. Schiff, BS
I believe that the current differences we have regarding fee billing will disappear when we get the codes we need. There will be no need for exaggerated claims and convoluted arguments to justify how we bill. No one will bother trying to do things like using unacceptable interpretations of modifiers to create multiple fee schedules. In 2006, we likely will have an evaluation code. It will carry with it a recommended per-unit fee value, which will allow us to account for our evaluation time separately from our therapeutic time. Following that code will be a code for management purposes, which will allow us to bill for our office management expense. Along with that code will come recommended fee values per unit.
I think it is clear that trying to have a therapeutic code cover the costs incurred for doing business is an inappropriate strategy. Therapeutic codes are for the purpose of billing for the therapy only, not evaluation or paperwork. Attaching evaluation and management to a therapeutic code makes the per-unit value meaningless and useless for statistical and research purposes. It destroys our ability to prove the cost-effectiveness of our therapy. It is a short-term, thoughtless strategy.
The issue then will be to determine how much to charge per unit for our therapeutic work alone, which will be much easier to determine without evaluation and office management attached to the therapeutic codes. The appropriate fee for therapeutic work that I prefer is whatever the market will bear - as long as it is the same fee for the same service. In other words, you must charge your cash client the same as your insurance client for the therapeutic work done.
When we reach this point, we can have cash client fees lower than insurance fees because we would not have the same office management expense. That will provide the price differential many seem to be trying to achieve in other ways. The price differential will be a clear unambiguous difference in service provided. If we are lucky, the ABC codes, or at least some of them, will be accepted and provide us with many codes.
Office management, coding issues and billing need to be taught in our schools using professionalism in business conduct as the standard. The damage being done to our profession will stop when our associations step forward to enunciate the principles by which we are expected to conduct this aspect of our businesses. The profession needs the guidance, which only the associations can provide.
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