resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
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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