resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Blaming the Gluteus Medius, Overlooking the Deltoid
The gluteus medius (Gmed) is commonly written about, strengthened and blamed for many conditions, and rightfully so. After all, the Gmed plays a role in pelvic stability, hip motor control and lower-quarter dynamic movements.
Help Patients Achieve Optimal Vitamin D Levels
Much research has been done on vitamin D levels and their impact on health; optimal levels have been correlated with a reduced risk of developing numerous conditions.
Saying No to Medicine
An interesting article recently appeared in Men's Journal titled "When to Say No to Your Doctor." The article begins with the summary statement above and effectively arms readers with information that will help them "take more responsibility for your own health care, because you can't be sure anyone else is.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Understanding and Identifying Pediatric Growth-Plate Fractures
In general, fractures in children heal well with little intervention as long as the alignment is good. Fractures involving the growth plate, however, are a different issue. In fact, growth-plate injuries are the primary reason for the subspecialty of pediatric orthopedics.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Talking to Patients About Healthy Aging
I've noticed that a particular category of patients seems to make up more and more of my practice – they work out, but still experience lots of degenerative joint disease (DJD) issues.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Web Marketing: Content Is King
Google's sweeping updates to its search algorithms over the past few years have brought a paradigm shift in how you can optimize your chiropractic website to gain maximum marketing leverage.
5 Ways to Occupy Occupational Health
Despite the progress that has been made to better protect workers, occupational health and safety remains a priority area for many national governmental organizations due to the widespread problem of occupationally related morbidity and mortality.
Calcium Helps Prevent Colorectal Cancer
Over the past 25 to 30 years, studies have suggested calcium may confer protection against colorectal cancer.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Transparency and Accountability: Q&A With the CCE
Every profession needs an organization dedicated to upholding the quality and integrity of its degree programs and educational institutions.
February, 2008, Vol. 08, Issue 02
A New Year Brings New Changes
By Vivian Madison-Mahoney, LMT
Well, last year was certainly a busy one. I have answered around 1,800 to 2,000 phone and e-mail questions from massage therapists, presented 23 seminars, sold hundreds of manuals and home study courses, and wrote several articles for massage publications. All of that and yet I can't seem to scratch the surface of getting information out to all therapists who are interested in working with and accepting referrals from physicians and directly billing insurance for their services.
I will be making changes this year in that I am beginning a consultation service rather than answering questions for free, as in the past several years. While helping massage therapists increase their income and cut their losses is my pleasure, I feel certain you will understand that I should be earning a living for my services, just as you expect to be paid for yours.
My next three articles will be based mainly on FAQs, beginning with this issue. I also will be conducting some informal surveys and asking for your assistance to gather information or stories on the efficacy of massage directly from your clients and your first hand experiences.
1. How do I go about being a provider for insurance companies?
Don't waste your time calling insurance companies asking to be a provider. You do not have to be a provider to bill insurance, unless you live in Washington state or Florida (and then only with those companies who allow or require you to be an "in-network" or "participating" provider). Most insurance companies do not yet accept massage therapists as in-network or participating providers. Services we provide are out-of-network or as non-participating providers. Policyholders or subscribers of the policy or plan most often must pay higher co-pays and deductibles.
Florida Blue Cross requires an LMT to obtain a provider number mostly for identification purposes but does not allow in-network or participating-provider participation. Blue Cross Blue Shield does not directly reimburse massage therapists in most states at this time. Do not confuse this with affinity or discount programs where they require you to be credentialed to be a "provider" in their programs. These programs most often do not offer payment directly by insurance companies for medically necessary and prescribed treatment. They only require that you give a discount to subscribers/policyholders. Their premise is that if you provide discounts, you will increase your client/patient load from subscribers of the insurance plans with which they are contracted.
My personal thoughts on this are that you have shown the insurance company just how low you are willing to drop your rates. I have yet to see where someone is able to significantly increase their income by participating in this type of program. However, I personally have seen where this type of participation has caused thousands of dollars to be lost when a company such as this crossed over and provided your discounted contract to other insurance companies, thereby causing several insurers who previously paid your fees to suddenly and without notice cut all payments by .25 percent for a full year.
2. Do I have to be a "certified medical massage therapist" to bill insurance?
No, it's your licensure/certification and the insurance company, policy or plan itself that makes the difference, not whether or not you are certified in any particular technique or program. Certification programs provide certificates to prove you have had additional training in a subject. Certifications and additional training are imperative to your learning skills, which in turn creates more clients and referrals. However, at this time they do not make the difference in whether or not you are reimbursed by insurance companies.
3. Can I bill Medicare?
Absolutely not! Please go to www.coalitiontopreservepatientaccess.org for more complete information on this subject.
4. Do I need a prescription to bill insurance?
Yes, you need a prescription because insurance companies do not pay for services that are not medically necessary. To prove medical necessity, the treating physician must diagnose a patient's medical condition because diagnosing is out of our scope of practice.
A physician must prescribe your services for a diagnosed condition on a written prescription for you to be reimbursed by an insurer. There are exceptions per some insurance company requirements, but they are few and far between.
5. Do all insurance companies pay for massage therapy?
Possibly. Almost all insurers reimburse for massage therapy services. The most upsetting part is that most will pay for massage therapy services but will not pay the provider most qualified and trained to perform massage. They WILL pay for massage therapy services when provided by a doctor or a physical therapist. This is about as uneducated as one can get.
However, this leaves us with an open-door opportunity where we need to get busy training the insurance adjusters, employers and the powers that be about what massage therapy really is, how it can save them money and how it most benefits the patient. They also want to know about massage therapists as professionals in the health care arena. How about making this the year to get busy with this project?
6. If most insurance companies will not reimburse a massage therapist directly, why would I want to consider accepting insurance for reimbursement?
You might want to accept insurance for reimbursement because those companies, policies and types of cases that will reimburse you are extremely valuable to your increased income levels. Another reason is because you will be increasing the number of patients you can be helping who could otherwise not receive your services.
Even if the insurance were to not reimburse your services, or if the patient's benefits become exhausted, these patients are coming to you by referral and are learning how effective massage therapy is for their health and overall well-being. They get excited to be able to receive services from someone who takes time with them, listens to them, consoles them and makes them feel better. Guess what? They go back and tell their physicians what a great therapist you are, what a great session they had and how much they were helped. Then guess what?
Their physician - happy that they have pleased their patient - refers more patients, some of whom have insurance that WILL reimburse you. Do you get these types of referrals from your non-medical, time-of-service, paying clients? Even if their insurance does not reimburse, you have "advertised" where it counts. Some will even continue to return while also referring friends, family and co-workers.
Had you not been willing to accept insurance for reimbursement, whether or not you are paid on specific cases, these physician-referred patients would have never known of your services. They would never have told their physicians how great your service is. We are keeping our profession alive within the insurance industry, constantly showing them and causing them to acknowledge (whether they admit or not) the need for our services in the medical field.
Look at insurance as a game: take it one step at a time, learn the rules, play to win, win some and lose some, cut your losses and keep moving forward.
Click here for more information about Vivian Madison-Mahoney, LMT.
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