resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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.
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.
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.
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."
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.
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 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.
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.
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.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
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.
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 Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
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.
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.
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.
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.
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).
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.
August, 2005, Vol. 05, Issue 08
Roberts vs. State Farm Insurance and the Medical Massage Controversy
By Vivian Madison-Mahoney, LMT
David Luther recently wrote a letter that created quite a stir throughout the massage industry. A class action lawsuit was bought against State Farm Insurance in the state of Pennsylvania titled, Roberts vs.State Farm. Mr. Luther stated that it was his company, the United States Medical Massage Association (USMMA) - formerly the American Medical Massage Therapy Association - that filed the class action suit against State Farm for downcoding. No references to this association are made on the docket or final settlement agreement. The case reads "Tracey Roberts (Plaintiff)" and states, "Tracey Roberts on behalf of herself and others similarly situated v. State Farm." The settlement agreement states that the suit was brought against State Farm for denying payment to massage therapists because they were not physical therapists.
In the letter, Mr. Luther stated that it was he who wrote the lawsuit's declaration at the request of his attorney. According to Luther's letter, his "declaration says that they [State Farm] must pay a 'medical massage therapist.'" His letter further states that when the judge asked him to define the term "medical massage" therapist: "We answered that they would be a Nationally Certified Medical Massage Therapist (NCMMT) through the Medical Massage National Certification Board," and adds, "We tried to add another clause: 'Or a member in good standing with the United States Medical Massage Association (USMMA),'" but that statement "will not be included in the decree."
The settlement agreement contains the words "medical massage therapists" many times throughout. Several concerned parties in the massage community have been writing to the attorneys and judge requesting reconsideration of that language prior to finalization. This situation has created much confusion, fear and anger. It is the opinion of many that if this (or any) case were to be ruled on with inclusion of terminology such as "medical massage" or "medical massage therapist," it would open doors for individuals, organizations or associations to establish specific criteria that massage therapists would have to meet before they could be reimbursed by insurers. This could have a negative impact on the entire profession. Were this to take place and spread throughout the insurance industry, it could severely limit the right to work and seek insurance reimbursement by thousands of massage therapists, some of whom have been receiving reimbursement now for over 20 years.
I know this because I was doing this kind of work approximately 10 years before Mr. Luther came upon the insurance scene. I remember him praising me for my manual. He said that it "helped him to collect the outstanding insurance money owed to him while unable to do massage due to an accident." He even used my "original" manual to get his start with his own medical massage office manual. These are not "opinions," but provable facts.
We are all astounded that Mr. Luther, who oversees the USMMA (a membership association), the Medical Massage National Certification Board (MMNCB), and The Medical Massage Office and Associates (TMMO) (a company through which he offers seminars), is posturing himself to monopolize the entire massage therapy profession by writing his own declaration, trying through the court system to regulate therapists as "certified medical massage therapist[s]," and further requiring that these therapists be certified only through his organizations. It seems he is trying to require insurers to allow only his "certified medical massage therapists" the use of Current Procedural Terminology (CPT) Code 97140 or other codes already in our scope of practice.
Such a requirement would be in direct conflict with several states such as Florida and Washington that require insurers to reimburse massage therapists for procedures that are within their scope of practice. It would also be in conflict with the 2005 AMA CPT® code book, which clearly states in the introduction, "Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional." Licensing, state and national certification and training have already qualified us.
Now, about downcoding: What is it? Downcoding is when an insurer/adjuster changes a code to one of a lesser value or cost and reimburses for that code instead of the originally billed code. In all of my years of investigating bills and denials for massage therapists, insurance auditing companies, and defense and plaintiff attorneys, it has been my experience that the insurance company does not make a habit of downcoding, but actually reimburses for the code that reflected the prescribed and/or documented procedure or modality. For example, a physician writes a prescription for massage therapy but the therapist bills for myofascial release, neuromuscular re-education or others not designated on the prescription. The insurance company paid for what was only prescribed, leaving the therapist to feel that the claim had been "downcoded."
As a side note, I personally have no problem with those who use the term "medical massage" for certifying their courses and their offices or businesses, or to indicate that they specialize in working with doctors or medical referrals. What I object to are those who (without shared or documented proof) tell us that we must be certified in anything as a requirement to be reimbursed by insurance, or suggest that doctors are going to be required to refer only to "Medical Massage Therapists." Insurance companies reimburse for medically necessary care and treatment. What constitutes "medically necessary" is a medical diagnosis by a physician. What constitutes medical massage is the fact that the massage services are provided according to a prescription written with stated diagnosis by the treating physician.
If you believe I have overstepped my bounds, please forgive me. It is in the name of protection of our massage therapy profession, a profession in which we have all worked long and hard to build a positive reputation. If by some chance we are all misinformed, it is due to the letter and statements written by David Luther.
Click here for more information about Vivian Madison-Mahoney, LMT.
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.