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Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
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 previous articles by Vivian Madison-Mahoney, LMT.
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