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Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
February, 2006, Vol. 06, Issue 02
Coding for Insurance Billing and Medicare Issues
By Vivian Madison-Mahoney, LMT
From the phone calls and e-mails I've received from massage therapists across the country and a recent survey taken by AMTA, it's evident there are a variety of CPT Codes being used by massage therapists for billing insurance.Many of those codes used include deleted codes, codes not in our scope of practice, codes that raise red flags with insurers for a variety of reasons and correct codes used in conjunction with incorrect codes.
Coding and billing requirements and opportunities have changed over the years. When I began billing insurance in late 1984, I billed by using code 97139, (an unspecified procedure code). I used the term, "soft tissue manipulation," eliminating the words "massage or massage therapy." This worked fine for several years until my first Blue Cross case.
It was an eye opener when Blue Cross only reimbursed $12 for a full hour session. After continued research and questions, I soon learned about the fifteen minute increment billing requirements by some insurers. In my desire to find ways to get massage therapists in the system so to speak, I began to do more research and began practicing with other codes. It was then I learned that Blue Cross would only reimburse for CPT Code 97124 (massage). Billing the way Blue Cross required I was then reimbursed $48 for the full hour. Getting an increase from $12 to $48 was an exciting time!
Workers' compensation in Florida, at that time (as with many states yet today), was way behind the times when it came to coding, so I had to bill differently with them using codes not used with any other carrier. Over the years, my office expanded the use of codes as we were reimbursed for them. However, as time went on and the reimbursement amounts began to increase, we began to reduce the number of codes we experimented with to simplify things.
Because I am a provider of CEU'S for insurance billing seminars and home study courses, I became a lot more conservative in order to protect you, who now bill insurance companies. It's now to the point where possibly the only available and necessary procedure code(s) are 97124 (massage) for basic Swedish massage, and 97140 (Manual Therapy Techniques), because it encompasses myofascial release, manual traction and manual lymphatic drainage and because reimbursement now is at a fairer rate in most cases.
There are many "techniques" of massage, but there are no codes to represent these "techniques." We must use those procedure codes available to us that are within our scope of practice. Of course, there always are those codes for modalities which might be used if within a therapists scope of practice, such as whirlpool, infrared, contrast baths, electrical stimulation, hydrotherapy, paraffin baths, etc. Be sure you know and stay within the scope of practice for the state you practice in.
Documentation is the key to getting paid for the time spent and the codes used. Following the doctor's prescriptions, billing for the same procedure or modality that is on the prescription and documenting exactly that, are the keys to being better paid without delays, denials or reductions, and only accepting cases that will reimburse a massage therapist. Not all types of cases are reimbursable to a massage therapist.
As time goes on, I am sure coding changes or definitions will work more in our favor but until it does, let's use common sense and don't try to go overboard as it only raises red flags with insurance companies that could set us back many years. Stick to your scope of practice and with what is written on the prescription. Make sure your progress (SOAP) notes reflect what the prescription calls for and that your bills reflect both the prescription orders and your documentation.
There is a company called Alternative Link/ABC Coding working on an entirely different coding system for each alternative provider. These codes ultimately would incorporate each technique used by a massage therapist or other alternative care providers. However, until these codes can be used by all therapists and accepted by all insurers, I will be keeping in close contact with them. I will inform you of any changes or abilities to use this coding system when it becomes available. For more information on this coding system please contact Connie Koshewa at: .
The Medicare Issue
For more information on the coalition to Preserve Patient Access to Physical Medicine and Rehabilitation, please contact me if you did not receive this information on my recent "Massage Insurance Updates" e-mail. If you are not on that list but want to be, please e-mail your request to me at .
Click here for more information about Vivian Madison-Mahoney, LMT.
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