The Secondary Insurance Plan
I have a patient that has Medicare, but also has a secondary insurance plan that does cover acupuncture. How do I bill Medicare to get a denial so that I may bill this secondary payer?
Why Take X-Rays When You Already Have an MRI?
Let's clear up the issue regarding the efficacy of plain-film studies when an MRI study has already been performed. I review imaging studies primarily for chiropractors, and often their patients have been to other health care providers before finding their way to a DC.
The Certified Practitioner
Certified Chinese herb practitioners often identify themselves with the credentials "LAc" (Licensed acupuncturist).
#TechPain: Causes, Solutions
For the past several decades, the science of ergonomics has blossomed. The workplace is much safer and life is generally more pleasant thanks to the application of ergonomic principles.
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
The Classical Texts & Integrative Medicine
The acupuncture profession has been undergoing many changes in the past years. There has been a shift towards a more integrative approach to medicine as more hospitals include integrative departments.
The Hidden Hip in LBP: Critical Screening Tests
In 1998, Harvey used this test on 117 elite athletes and found excellent interrater reliability to differentially assess iliopsoas, quadriceps or TFL/ITB tightness.
Trending: CBD / Hemp Oil
A recent survey of DCs regarding cannabidiol (CBD) / hemp oil provides food for thought as to the viability of CBD-based products as a component of chiropractic patient care. Here are some observations from the executive summary of the survey:
"Community Care" for Vets: It's Really a Big Deal!
As a preamble, while I regrettably never served in the military, I have the highest respect for those who did and those who currently serve.
NCCAOM: A Route to National Certification
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is offering a route to achieve national certification—without having to take any of the NCCAOM exams. This is specifically for California licensed acupuncturists that meet the eligibility requirements.
Autoimmunity, Gut Health and Diet: Connect the Dots
According to the National Institute of Health (NIH), autoimmune disease is recognized in approximately 24 million individuals in the U.S., consisting of more than 80 various disorders that contribute to the top 10 causes of death in female children and women of all age groups.
Vaccines & Autism (Part 1)
It turns out chronic inflammation is the driver of autism expression. Unfortunately, those who emotionally embrace the vaccine issue rarely, if ever, consider this relationship, which hinders a rational view of the vaccine issue.
UnitedHealthcare Can't Seem to Keep Chiropractic Down
AA decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven.
Treating Pain With Nutrition
Back in 1910, when D.D. Palmer published The Chiropractor's Adjuster and introduced the world to what he called the "triad of health" – thoughts, trauma and toxins – he explained that the body can only be made optimally healthy if all three aspects of health are addressed.
Help Shape the New Neck Pain Best Practices Guideline
The Clinical Compass (originally the Council on Guidelines and Practice Parameters – CCGPP) has issued a call for interested chiropractic clinicians to help shape a new best practices guideline for chiropractic care of neck pain.
It's All About That Ki
As an industry are we shifting too much toward a Western mind set? We strive to understand how acupuncture works using imaging and extensive studies. We spend numerous hours of our training learning Western medicine and learning to speak their language. What happened to our core though?
Art of the Associateship: It's OK to Trust, But Verify
Trust is a valuable part of any business relationship. It serves as the foundation for all business operations and ultimately long-term success for owners, employees and customers. This is especially true in the world of health care.
Blockchain Health Records?
Keeping data secure has become a nightmare for the average consumer. Just consider general user account hacks on Yahoo (3 billion records compromised), eBay (145 million records compromised) and Facebook (87 million records compromised), to health record breaches involving Anthem Blue Cross (78 million records compromised) and TRICARE (almost 5 million records compromised).
A Resting of the Soul
In my pursuit of being a skilled health care provider, I focus on reading journals, attending classes, staying current on medicinal research, and choosing the correct billing codes. However, most of us would never have started down this career path if there wasn't something more.
CBD for Athletes: The Advantages of Cannibidiol
For athletes, pain is often part of their sport or activity. And to a certain extent, it is to be expected. However, after pushing themselves to the limit, soreness and fatigue set in, hampering their ability to perform and recover.
Reducing Hip, Knee & Shoulder Replacements (Part 2)
In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation.
End of Life Treatment
TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
Why the Automatic Denials for Modifiers 25 and 59?
Your experience is one shared by many chiropractic providers who bill through those plans. It appears to be the national trend, but by far is more prominent in Texas and Illinois.
Valuable Adjunctive Therapies
Based on the latest CDC statistics, more than 795,000 Americans have strokes per year, 140,000 of which are lethal. Approximately 87 percent of all strokes are ischemic with an estimated health care and missed work cost of $34 billion annually.1
Confessions of a Former Drug Rep: Statins Are Endangering Your Overweight Patients
As I sit at my desk on the sixth anniversary of my successful liver transplant, I can't help but reflect on what caused that life-threatening ordeal. Looking back on my personal situation, I want to offer my insight into what is happening routinely to many patients.
Facebook Marketing 101
Many of the health care practitioners we work with have smaller practices. The provider tends to wear many hats – office manager, salesperson and healer.
News in Brief
WFC Among Founding Members of Global Rehab Alliance; HealthSource Selects GoChiroTV as Exclusive Digital Signage Partner; Western States' Online Degree Programs Among Best in the Nation; Logan University, University of Missouri-St. Louis Forge Partnership.
Doc, Are You a Social Media Holdout? Your Future Is Now
Whether you like it or not, to compete in any business, even chiropractic, you really should know and consider using social media. It is no longer a small, sleepy, local world we live in; it has become a far-reaching community.
A Bold Strategy to Take Chiropractic to New Heights
Building public awareness of an entire profession requires strategic planning – especially when it pertains to the exploration of ground-breaking marketing tactics that target new audiences with key messaging about the value of chiropractic care.
February, 2013, Vol. 13, Issue 02
Massage Therapists and the Detection of Skin Cancer in Clients
By Massage Therapy Foundation Contributor
Contributed By April Neufeld, BS, LMT, NCTMB; Sandra K. Anderson, BA, LMT, ABT
Have you ever noticed strange moles or lesions on your patient's back? This is important because skin cancer is the most common cancer in the United States, with more than 3.5 million cases diagnosed annually. Since massage therapists see a great deal of client skin on a daily basis, they have a unique opportunity to recognize potential skin cancers.
This month, we at the Massage Therapy Foundation (MTF) are reporting on a study by lead author Shannon M. Campbell and colleagues called "Skin Cancer Education among Massage Therapists: A Survey at the 2010 Meeting of the American Massage Therapy Association." It was published online on August 23, 2012 by the Journal of Cancer Education, August 23, 2012.
"While non-melanoma skin cancer (NMSC) accounts for the majority of cases, melanoma is responsible for more than 75% of skin cancer deaths. Between 1992 and 2004, melanoma incidence increased 45%. In the United States, one in 52 men and women can expect to be diagnosed with melanoma in his or her lifetime. The back is the most common location of melanoma in men, while the lower legs are the most common location in women. Prognosis of melanomas is related to anatomic location. The 10-year survival rate for melanomas on the back is around 68% while the 10-year survival rate for the lower legs is 82%," write the investigators.
These statistics indicate that early detection of skin cancer is an important public health initiative. While the majority of interventions have been through detection by medical professionals, recently attention has been turned toward the ability of non-medical professionals, such as hair dressers and massage therapists, to assist with skin cancer detection. These professional massage therapists see and palpate large areas of clients' skin, including the back and legs. In addition, massage therapists may also frequently observe areas of the skin not examined by healthcare providers, such as the scalp and soles of the feet, in addition to backs and legs.
The purpose of this study was twofold. The first was to describe the skin cancer education massage therapists receive during training and second, to evaluate massage therapists' comfort levels in identifying suspicious lesions and communication with their clients about them.
The research method involved surveying two separate groups of attendees at the American Massage Therapy Association (AMTA) annual convention in 2010, in Minneapolis. One group of 179 completed the survey at a booth in the exhibit hall; the other group of 114 were participants who attended a skin cancer education workshop at the convention. Thirty-one surveys were excluded because the respondents were either from Canada or had not completed their entry-level training. Therefore, the final sample was 262.
The survey consisted of demographic questions such as gender, age and ethnicity. Participants were also asked the number of years the subject worked as a massage therapist, the state in which they practice, age range of clients, number of clients they treat per year, average number of visits per client annually, how many clients the massage therapists have recommended see a healthcare provider over the past year for a suspicious lesion, and if they ever detected a lesion on a client's skin that was confirmed to be skin cancer.
Participants were also asked to give detailed descriptions of their skin cancer education both during entry-level training and through continuing education. Descriptions included the name of continuing education courses, numbers of hours, textbooks used, academic credentials of the course instructor, types of skin cancer covered, testing and education about how and when to discuss a suspicious lesion with a client. Additionally, participants were asked to describe their comfort level recognizing and discussing a suspicious lesion with a client, as well as recommending a client see a healthcare provider for a suspicious lesion. All comfort level questions were assessed using a scale of "not at all," "a little," "somewhat," "quite" and "extremely." Frequency questions were assessed using a scale of "never," "sometimes," "usually," "often" and "always." The observed frequencies and percentages were calculated using Statistical Analysis System (SAS) version 9.2.
Results of the survey indicated that 60% of massage therapists received skin cancer education during their entry-level training, 25% received it afterwards and 16% received both during and afterwards. The majority of participants stated that melanoma and non-melanoma skin cancers were reviewed during both entry-level and continuing education courses and that when and how to discuss a suspicious lesion was also included.
Whereas 12% of participants reported a personal history of skin cancer, 72% reported knowing a friend or family member with a skin cancer diagnosis. Of those surveyed, 43% reported wearing sunscreen usually or often on sun-exposed skin and 83% reported performing self-skin exams (SSEs) at least every 1 to 2 months. Participants also reported examining their client's skin regularly, with 44% reporting that they always do so. Massage therapists who examine their own skin at least once a year were more likely to examine a client's skin. Most of those surveyed recommended at least one client see a health care provider for a suspicious lesion over the past year.
Most participants reported being quite or somewhat comfortable recognizing a suspicious lesion, being quite comfortable discussing it with the client, and being quite or extremely comfortable sharing medical knowledge and recommending the client see a healthcare provider about the lesion. Additionally, massage therapists who perform SSEs, had detected a lesion on a client that was confirmed to be skin cancer, and who examine their clients' skin on a regular basis, and who referred clients to be seen by a healthcare professional are more likely to be comfortable recognizing a suspicious lesion.
"This study has several limitations," write the researchers. "It is an observational study that does not allow for cause and effect relationships to be identified. The sample population was from a select group at a national convention and the results may not be indicative of all massage therapists. Additionally, 114 of the 293 participants completed the survey prior to participating in a workshop on skin cancer," which means they may have a greater interest in skin cancer prevention and detection. "Further studies on a larger scale with a more representative sample are needed to confirm the data. Because many years may have elapsed between training and completion of the survey, participants may have incorrectly recalled details about their education and practice. However, this study serves as a valuable introduction to skin cancer education efforts within the massage therapy community. Additional studies should focus on improving massage therapists ability to recognize suspicious lesions and collecting data directly from massage therapy schools regarding their skin cancer education."
So what does this mean? It means that massage therapists who are already checking their clients' skin for suspicious lesions are providing a valuable and necessary service, one that can potentially save a client's patient's life. Massage therapists who are unsure of their ability to detect a suspicious change on a client's skin, and are unsure of how to discuss it with the client, would definitely benefit from a course that covers this information. It could make all the difference in the world to someone they know.
Editor's Note: Want to hear more great research all in one place? Attend the International Massage Therapy Research Conference – Presented by the Massage Therapy Foundation April 25-27, 2013, in Boston, Massachusetts. Registration is now open. Learn more at www.imtrc.org.
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