resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
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.
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be published in a future issue of Massage Today and may be edited for space and clarity. Please send all correspondence by e-mail to or via regular mail to:
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.