Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
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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