Treating Complex Multilayered Cases, Part 2 In the October 2009 issue of Acupuncture Today, I wrote on how to use pulse diagnosis to distinguish patterns as excess, deficiency or complex excess with deficiency. I ended that article by saying that most complex layered cases that enter the clinic will show excess/deficiency patterns affecting the liver, stomach and spleen. Our job, as herbalists, is to evaluate the various stagnation and deficiency patterns and to apply the appropriate herbal formula.
Ed
Denning is the coordinator of the massage therapy program at Stark
State College of Technology in Canton, Ohio. He is a member of the
Massage Therapy Advisory Committee of the State Medical Board of
Ohio. He is a member of AMTA and ABMP. He serves on the Health Integration
Committee of ABMP. His Web site is all about coding and coding issues:
MassageCPT.Com. He may be
contacted by e-mail at
.
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:
Name of code
Medicare/Medicade
50%
75%
90%
Code 97124
$24
$40
$65
$84
Except for Medicare/Medicaid, there is no set fee for
97124; each fee is for a unit of 15 minutes.
The 50% column means that 50% of the physicians who
charge for that service charge $40 or less.
The 75% column means that 75% of the physicians charge
$65 or less.
The 90% column means that 90% of the physicians charge
$84 or less.
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?
Teacher
Lawyer
Factory worker
Sales clerk
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.
Become so good at what you do that those in pain flock
to you for relief. You can demand a higher price due to the demands
placed upon your business. Their fees are higher for cash customers
and for insurances.
Build a better mousetrap. There are average massage therapists who
are making fees well above the average due to their great business skills.
They have a knack for making good business decisions and attract more
customers because of those skills. They get to charge more because they
have greater demands placed on their businesses. Their fees are higher
for cash customers and for insurances.
Specialize. Find a niche that others have not filled.
Become skillful in that area and demand a higher fee for your specialized
service. Their fees are higher for cash customers and for insurances.
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
Stop buying into pie-in-the-sky schemes. Ask questions
of your teachers. Insist on documentation of their opinions, then
have it read by any accountant or lawyer.
If a business practice being taught has to be defended
as being legal, you can usually know that it is unethical.
Let your fellow massage therapists who are using
unethical business practices know you disapprove and that you believe
that they are damaging your business and future income. Be ready to
explain to them what is wrong with their practices.
Join a professional organization. Most have Codes
of Ethics and Standards of Practice documents that help us all to
know which are good business practices and which are not. Meeting
others and discussing business practices will help you know the positions
you want to support.
Ed
Denning is the coordinator of the massage therapy program at Stark
State College of Technology in Canton, Ohio. He is a member of the
Massage Therapy Advisory Committee of the State Medical Board of
Ohio. He is a member of AMTA and ABMP. He serves on the Health Integration
Committee of ABMP. His Web site is all about coding and coding issues:
.
