Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
October, 2009, Vol. 9, Issue 10
An Issue of Reimbursement
By Vivian Madison-Mahoney, LMT
Most patients and massage therapists are not aware of the fact that "massage therapy" and/or "manual therapy techniques/myofascial release" is a covered service by most insurers, including Medicare and self-insured employer plans which fall under the Federal guidelines of ERISA (Employee Retirement Income Security Act).
However, there is a catch.
While insurance companies do pay for the services we perform, they do not directly reimburse us for our services. Instead insurers will pay PTs, MDs or DCs who have massage therapists on staff. (I might add at increased costs to employers and insurers.) Therefore, we are not faced with the issue of getting insurers to reimburse for our services; it is an issue of getting them to directly pay those who perform this hands-on, intensive, time-consuming work.
Patients typically must go through practitioners who have massage therapists on staff to receive full insurance coverage. But many practitioners do not have massage therapists/bodyworkers on their staff. In this case, a treating physician may write a prescription for medically necessary massage/manual services for the patient. However, because the patient is dealing with a referral (and a non-staff therapist), the patient will very likely have to pay out-of-pocket for the service. As a result, many patients will simply choose not to pay for the much-needed treatment.
I have no objections to physicians, chiropractors, etc. hiring massage therapists to perform work in their offices as an employee or independent contractor if this is what both parties prefer. However, more often than not, I hear that both the therapist and physician would rather work on a referral basis. Unfortunately, this is only possible now with liability type insurance and a few health insurance exceptions. Therefore, only very limited coverage is available to patients in comparison to what would be available if insurers provided coverage and direct reimbursement for all medical referrals to massage therapists.
The Time Is Right
Health insurance coverage is expanding as we educate insurers, legislators, employers and the public to the benefits of massage. Employers across the nation (including insurance companies) have massage therapists come to their offices to provide stress relief massage therapy to their employees and incorporate massage therapy in their wellness programs. They are beginning to understand and value the benefits of massage therapy when performed by those who are trained and licensed to provide this service. However, they do not yet realize the cost-effective savings of reimbursing massage therapists directly.
If insurers or employer group plans allowed direct reimbursement to state-licensed, certified or trained therapists to provide therapy for prescribed medical conditions through their health insurance programs, employees would be able to better stay on the job, return to work faster after injury, and be more productive. Reimbursing other practitioners for services provided by massage therapists only increases insurance companies' payments as they are paying a "middle-man", costing them more in the long run. If other health insurers, Medicare and the VA directly reimbursed state licensed and/or certified massage practitioners, their costs could be considerably reduced due to direct provider reimbursement. Direct reimbursement to those providing the services would also decrease patient's co-pays and in some cases, their deductibles.
As mentioned, most of us who have been accepting insurance cases have only been successful with liability type insurance cases such as auto, work, or slip-and-fall as well as some health insurance situations. When I began in this field in 1984 no one was billing insurance for massage. To my knowledge not many physicians knew about massage therapy as a benefit to their patients. Before I sold my practice, in one county alone, more than 172 physicians were referring patients to my office. Now they are doing it across the nation. They understand the benefits to their patients.
Now is the time to make insurance companies, self-insured employers, Medicare, VA and private health insurers understand the value of these services and savings to them as well.
I know, some are against direct reimbursement. Some worry that their fees will be lowered if insurance companies were able to reimburse them. But reimbursement would be an option; therapists would not be obligated to change their way of doing business or forced to accept insurance for reimbursement. We need to always protect our rights to choose as well.
But, I can say this: since 1984 when I began billing insurance and since 1990 when I began providing CE courses on insurance billing procedures, laws and rules to massage therapists, I haven't seen any massage therapist doing any worse because of it. If we were directly reimbursed by health insurance companies, working under the prescriptive orders of a physician and only able to make what the going Medicare or state workers' compensation fee schedules are, it would surely be more rewarding for those therapists losing business from out-of-pocket patient referrals.
I know for myself, we worked on volume, charging extremely low fees such as $58.50 and $65 per hour (or more), and built a massage practice earning a half million a year back in the late 80s and early 90s. There are many therapists who would be happy to make anything working in a field they love rather than wondering where the next dollar is coming from or searching for other forms of income as, sadly, I so often see these days. So if money were pretty much guaranteed, would it not be better to have the capability to accept or reject new clients/patients as your office (or hands) permitted?
When contacting an insurance company, many massage therapists hear the following: "We will reimburse a PT or MD to provide massage therapy or manual therapy services but not a massage therapist." "We do not allow massage therapists to become in-network or participating providers." While we may complain that this seems like discrimination, it will not change things as they are. We need to work together to change the way insurers reimburse for physician-prescribed services.
What's Your Take?
I realize reimbursement is not for every therapist. For those of you who command much higher fees, you may be concerned by this possibility. I want to hear from therapists on both sides of the issue.
As a health care advocate, I'm requesting feedback and possible future assistance from those interested in helping to reform the way health insurers, Medicare, VA and employer group plans reimburse for massage/manual therapy services.
Please email me at or send mail to: Massage Today/MPA Media, 5406 Bolsa Avenue, Huntington Beach, CA 92649.
Your input is welcome and appreciated!
Click here for more information about Vivian Madison-Mahoney, LMT.
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