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Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
November, 2005, Vol. 05, Issue 11
Top 5 Questions Asked of Me Daily
By Vivian Madison-Mahoney, LMT
While some of the following information might seem to be repeated, please know that since the same questions reoccur daily, it's apparent that many still are in need of this information.
Do I really need to be a "Certified Medical Massage Therapist" in order to bill and be reimbursed by Insurance?
The answer is emphatically NO! For the past year or so, you have been seeing lot of propaganda/advertising to this effect and many of us feel it's detrimental to our profession.Your massage magazines make a lot of money on these ads, so it is understandable why they run them, even though it has been brought to their attention from different sources that some of these ads have contained several false and misleading statements.
I will reference Florida here a couple of times due to present laws in effect. However, there also are other states, such as Washington, with laws in effect that pertain to the reimbursement requirements for a massage therapist.
In Florida the law states "IF the policy covers massage, it shall then cover the services of one licensed to perform massage."
It does not say one single thing about having to be "certified" in ANYTHING. Our license and the fact that patients' conditions meet medically necessary requirements, determined by a referring physician's medical diagnosis, is what designates if an insurance company will or will not reimburse for our service. There are, of course, a lot of other things involved that will determine whether or not an insurance company must or will reimburse, but one of them is NOT whether or not you are a "certified medical massage therapist."
I do, however, highly recommend you obtain all of the additional training possible in procedures and techniques that will enhance your skills to benefit the patient. To have the skills and knowledge equals more referrals and more repeat business. It just makes sense that you cannot perform your best if you have not given your best to learning more techniques and procedures that will help to create a more positive functional outcome for patients. That is what insurers look for when they consider further reimbursement. If you or I can't provide it, somebody else will.
Can you provide me with a list of insurance companies that will reimburse a massage therapist?
I'm sorry to say, there is no such thing as a list for this purpose. There are directories available from your state's Insurance Commissioners' offices that list every insurance company and other pertinent information. However, no single insurance company specifically listed will or will not reimburse a massage therapist or any other provider for that matter. Let me explain. If State Farm reimburses for an auto accident case, it does not necessarily mean this same insurer will reimburse for a major medical condition under the same patient's health policy, nor for a workers compensation related injury.
Some insurers only reimburse for workers' compensation cases, while others might cover auto injury cases and yet others might have a multitude of situations they will provide reimbursement for under different conditions. For example: Blue Cross of Florida might cover the services of a massage therapist for a medical referral under a private policy or under a state employee policy or certificate of coverage, and yet not under Medicare Supplemental Plans or even some self-insured employer plans. Blue Cross of Tennessee, and most other states, will not reimburse a massage therapist at all.
Do you think it possibly would benefit those of you in your individual states to seek legislative changes to help you, as has been done in Florida and Washington, rather than let profit seeking individuals set the rules for you in the future?
Do I need a prescription from a physician to be reimbursed from an insurance company?
In my 20 years experience in the insurance related field, I have never seen an incident where it was not necessary. The reason is this: For an insurance company to reimburse someone, the patient's condition must meet the medically necessary requirements. It's not in our scope of practice to diagnose a medical condition. Therefore, only a physician's prescription will provide the medical diagnoses. Also in some states, laws require that the prescription must indicate the frequency, duration, diagnosis and physician's signature.
Why are insurance companies denying one code or the other when I use 97124 and 97140 together?
Because they feel the two codes, myofascial release 97140 and massage 97124 provide the same service. If this were indeed true, the AMA CPT Code book would not need to have a separate definition for each code, nor would insurers reimburse differently for each code. However, it's sometimes easier to do what they want and be able to put the money in the bank. It's not always worth fighting city hall, although that is exactly what I was willing to do when I had my practice for nearly 16 years, in order to continue to make inroads for all of us.
I am constantly being turned down for payment for one reason or another. Can you tell me why?
When working with insurance companies, the insurer requires that all your "i's" be dotted and your "t's" be crossed. Without specific situations, I only can say the following:
Too many therapists are obtaining a CODE or a FORM from somewhere then try to piecemeal it all together and then expect to be reimbursed.
A few of us pretty much invented that wheel in the first place and crossed those bridges one step at a time. That is why I am here trying to help you to avoid those pitfalls.
Many therapists who wish to begin working with medical referrals and insurance cases are not aware that to do so has legal ramifications and requirements. They need to be informed of laws, rules, guidelines, warnings and other specific situations, especially those where insurers are not required to or are not going to provide reimbursement.
Many therapists will bill for types of cases they cannot or will not be reimbursed for under any set of circumstances. They need to know that working in the insurance industry and with medical referrals requires specific training in and of itself, and should be willing to make an additional investment in training, just as they did to become a massage therapist or bodyworker in the first place.
Those who have done this, find working with insurance easier, more enjoyable and certainly very profitable. Often, a therapist will e-mail or call me for a code or specific form or piece of information. While I am ALWAYS more than willing to help, it's also imperative they understand the importance of making an investment in materials, courses or other valuable information to prevent denials, delays and financial losses, as well as major disappointments.
I know I am not alone when I say that I wish more schools would incorporate more of this, or other business-related training in their curriculum so therapists would have a better sense of direction when ready to go out into the business world.
Click here for more information about Vivian Madison-Mahoney, LMT.
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