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Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
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.
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