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Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
June 14, 2004
Teaching Unethical Business Practices Must Stop
By Ed Denning, MEd, LMT
It is time to stop teaching unethical business practices to massage therapists. Those who teach the unethical business practices outlined below do so to capitalize on the greed of massage therapists who do not think about the consequences of their behavior.Those consequences are now beginning to exact a price, which all massage therapists will pay.
Unethical Teaching of Code Selection
One of the teaching practices I am talking about is the inclusion of highly questionable Current Procedural Terminology (CPT) Codes. Many more codes than is appropriate are presented in literature and seminars. These folks carefully point out that the massage therapist is responsible for selecting the correct code (which means that the authors or seminar prenseters are not liable for what they teach), then list a large number of codes, most of which no massage therapist is qualified to use.
Those they teach are encouraged to interpret for themselves the meanings of the codes and whether they are qualified to use them. In most cases, the selection of a code is driven not by the meaning of the code and the massage therapists' qualifications, but rather by the fee that code pays.
The result of that kind of teaching is significantly higher fees and much greater income for the massage therapist, which is what drives the massage therapist to resort to questionable coding decisions. Did you know that an indentation of wording in the CPT coding manual carries with it an addition to the definition listed?
Did you know that a semicolon has a meaning, which is different than a comma when reading the codes? If you do not know those things, then you are incapable of using the American Medical Association's (AMA) CPT coding manual correctly. Stay out of it.
Certain insurances in Colorado are now restricting the number of CPT codes that a massage therapist may use to one code. They are also setting a specific maximum amount that can be claimed for that code. This is occurring because 95 different codes had been used by massage therapists making claims to their company. There are only three codes that the vast majority of massage therapists are able to use. That is not opinion, that is fact. The insurance companies are protecting themselves from unprincipled abuse on the part of the massage therapists. The massage therapists have abused those companies because of what they were taught.
Unethical Teaching of Fee Setting
Fee setting is a complicated and imprecise subject. One of the ways some teachers abuse this imprecision is to not include some very important information in their teaching. There are books that list every CPT code. They include information on usual and customary fees for service. The one I have organizes information in this way:
Except for Medicare/Medicaid, there is no set fee for 97124; each fee is for a unit of 15 minutes.
When you take into account the number of years of training, the overhead of the professional office, insurance to practice, and other miscellaneous costs of doing business, the physician has a right to charge a fee significantly higher than the massage therapist. And yet some who teach about fees would choose the $84 fee as though that ought to represent the usual and customary fee.
Realistically, a physician's usual and customary is higher than that of a massage therapists. Fifty percent of the physicians charge less than $40 for that service; therefore, a massage therapist's fee most certainly ought to be below $40.
Another small problem: If I tell you what the fee is for a service, then I have committed price fixing; that is i1llegal anywhere. We must each set our fees according to our own set of values and conditions. There is no legally correct fee. You could charge $150 per unit, and it would be legal to do so. So, why not choose the higher numbers?
Unethical Teaching of Business Practices
Consistency is the principle by which you can judge whether your business practices are within an ethical framework. Do you always charge the same fee for the same service? Please note: the amount charged is not the issue, it is the application that counts.
Which of the following should be charged a different fee than the others?
The answer, of course, is that they should all be charged the same fee. Can you make exceptions? Of course. I was a former teacher. Perhaps I wish to provide a special discount to teachers. I need only be up front regarding my prejudicial behavior toward teachers. My fee differential ought to be readily available for all to question.
What about insurances? An insurance company's client is an individual. Individuals all ought to be treated the same according to the example above. But there are additional expenses to billing insurance. Shouldn't we be able to charge a higher fee due to the higher expenses? The answer is "Yes".
However, there is no CPT Code for that expense by a massage therapist; therefore, it is not now possible to charge insurances for that work. Be patient. Such codes will be forthcoming.
There can be a large difference between legal and ethical. Helping to place that gap in perspective is the concept of "usual and customary." When trying to determine what is the usual and customary fee for a massage therapy service, you would want to know what a particular service would cost the average customer. Not the discounted price or special price, but the amount which the customer parts with before going out the door.
Earlier I asked a question: Why not choose the larger number? This had to do with the fee schedules that are published by the AMA.
The reason you don't charge the higher number is because it does not represent your "usual and customary" fee honestly and accurately. You choose a number that represents the reality of your behavior. No tricks with wording or fancy ways to sidestep an honest appraisal. If a cash customer would always pay $55 for a service then that is the "usual and customary" fee. Apply the "usual and customary" concept to the figures from the AMA and live with it.
Acceptable Ethical Models To Command Higher Fees
How can you earn a higher fee and avoid all of the previously mentioned problems? Actually for some it is quite easy.
There are many more ways to earn substantial incomes as a massage therapist. All of them require dedication, perseverance, education, good judgment, personal growth and hard work.
Ending Unethical Teaching
Ed Denning is a licensed massage therapist in Ohio. He is coordinator of the massage therapy program at Stark State College of Technology, and also serves on the Massage Therapy Advisory Committee of the Ohio State Medical Board.
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