Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
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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