resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
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.
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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