resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
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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