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The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
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 previous articles by Vivian Madison-Mahoney, LMT.
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