Seattle Massage News

Premera Asking for ICD / Diagnosis Codes

2005-08-03T09:39:00.000-07:00

I'm a massage provider for Premera Blue Cross. This morning I was verifying massage therapy benefits for a patient when the customer service rep at Premera asked me for the diagnosis codes (ICD) from the doctor's prescription. This is the first time I've had this happen. I don't know whether I got a new customer service rep or whether they're always supposed to have been asking for this or whether this is a change in the way they operate. In any case, it's a good reminder to have all of the necessary information (CPT code(s), ICD code(s), treatment plan, statement of medical necessity, etc.) before beginning massage treatments for a new patient.

Massage and "The Listerine Effect"

2005-07-28T10:25:00.000-07:00

I've thought a few times recently about "The Listerine Effect" and massage. The effect referred to is the idea that if something is uncomfortable it must be good for you. Listerine's TV ads show a guy scrunching up his face and enduring the pain of his mouthwash so that he gets its germ-killing benefits. A lot of people seem to think that massage has to hurt in order for it to benefit them. This is sometimes true, but usually not. It's true when I and the client have together made the decision to go after a gnarly adhesion or other lesion with aggressive deep tissue massage or myofascial techniques. In my practice, this doesn't happen that often. More often, I am doing deep tissue massage aimed at mobilizing soft tissues, improving circulation, etc. In deep tissue massage on fundamentally healthy tissues, there should be no pain, and this is what I'm doing about 80-90% of the time. If I suspect that a treatment might cause pain I always discuss it with the client or patient first, and I always stay on the safe side of their pain threshhold. I think I have disappointed some folks who were hoping to get roughed up during their session, but I'm not going to inflict unnecessary pain just to address someone's preconceived ideas about what massage should feel like.

Massage Marketing Idea

2005-06-20T10:51:00.000-07:00

At this morning's meeting of the Medical Massage Alliance, Larisa tossed out a great marketing idea for massage therapists. Just as you see your dentist regularly to make sure your teeth are healthy, and just as you see your chiropractor to make sure your bones and joints are healthy, you should see your massage therapist regularly to make sure your muscles are healthy. I love this idea. It gives both me and my clients something beyond the "it feels good, so let's keep doing it" rationale for regular wellness massage. We all understand the benefits of massage, but this idea is a good reminder of a fundamental reason to get regular massage.

Why You Need a Prescription for Massage Even if Your Insurance Plan Says You Can Self-Refer

2005-06-17T14:50:00.000-07:00

You always need a prescription for medical massage, even if your plan says you can self-refer. Here's why. It's not in my scope of practice as a massage therapist to diagnose, yet the insurance billing forms require a diagnosis code before they will pay. If I were to just make up a diagnosis code and put it on the form, I could probably get paid, but I'd be breaking the law and putting my cherished massage license at risk. So I always need a prescription from your doctor before commencing medical massage treatments. Also, virtually all insurance policies now require that massage be "medically necessary," which is another judgment that is outside of my scope of practice, and they almost all require a "formal, written treatment plan" from your doctor. The quickest way to take care of all of these requirements is to have your doctor fill out my "Massage Therapy Referral / Prescription / Treatment Plan" form.

Unfortunately, the different arms of the typical insurance company don't do a good job of communicating with each other and/or they don't understand the laws regarding the scope of practice for massage therapists, so you are very likely to get a customer service rep on the phone insisting that you don't need a prescription or referral to get them to pay for your massage. Sorry, but that's just not correct.

Updated Policy for Insurance Patients

2005-06-17T14:19:00.000-07:00

Insurance companies continue to closely monitor reimbursements for massage treatments. I've got a couple of patients whose payments have been suspended until they file an appeal. All of these appeals (and other disputes/issues with insurance companies) keep coming back to the same issues: medical necessity and treatment plans. To help both my patients and me avoid bureaucratic hassles down the road, I will now require (in addition to the usual prescription or referral) a statement of medical necessity and a "formal, written treatment plan" (that's the language in most policies now) from your doctor before beginning medical massage treatments. The quickest way to take care of this is to have your doctor use the "Massage Therapy Referral / Prescription / Treatment Plan" form available on the Seattle massage referral info page my web site. This one form includes all three elements: prescription/referral, statement of medical necessity, and a treatment plan.

Sports Massage for 3 1/2-Mile Swim August 13th

2005-06-14T10:36:00.000-07:00

Got a call from Ryan Moore with Junior Achievement of Washington. He's looking for volunteers to do sports massage at an event later this summer. On Saturday August 13th, 2005, a hundred or so (maybe more) swimmers will brave the 51 degree waters of Puget Sound in support of Junior Achievement. Each swimmer has pledged to raised at least $2,500. Participants will swim the 3.5 mile channel crossing from Bainbridge Island to Alki Beach in West Seattle. Don't worry, they'll be wearing wet suits. But they will be very hungry and likely in need of some sports massage when they get to Alki. If you're interested in volunteering to do some pro bono sports massage late morning/early afternoon on Aturday, August 13, call Ryan at 206-296-2628 or e-mail him.

Brian Utting School of Massage Sold to Cortiva

2005-06-12T10:00:00.000-07:00

Brian Utting has sold his massage school to Cortiva, a relatively new company that is buying up high-quality massage schools around the country. It sounds like this will be a good deal for massage students and BUSM alumni. Cortiva will give the school business resources while keeping the current faculty (Brian's announcement of the sale says that "the teachers and staff WILL be staying on, and so will [Brian]"). Current students will benefit from Brian's ability to focus on teaching and curriculum development, and we alumni will have access to Cortiva's national placement service and their network of graduates from other top schools.

Orthopedic Massage for the Upper Body, James Waslaski, Sept. 2005

2005-06-10T09:39:00.000-07:00

I met James Waslaski at the AMTA meeting in Nashville last fall and asked him when he planned to teach in Seattle. He didn't have plans, but was open to it. I hooked him up with the Brian Utting CE folks and he'll be here Sept. 9-11 doing an orthopedic massage workshop, which I plan to attend. On his web site it says that James is "past chair of the AMTA National Sports Massage Education Council, is an author and international lecturer who has pioneered deep, pain-free orthopedic massage and sports injury treatments." He has an eclectic approach, a broad background in all kinds of sports medicine, a stellar reputation, and seems like a really nice guy. More info on the course is available on the Brian Utting continuing education page. For more on James, see the Orthomassage.net web site.

AMTA-WA Panel Presentation on Credentialing and Certification

2005-05-26T22:57:00.000-07:00

Here are some random snippets from this panel discussion hosted by the Washington Chapter of the American Massage Therapy Association (AMTA-WA).

Whitney Lowe, NCBTMB board member
"National Certification: Current Credentialing Programs/Exams & Advanced Credentialing"
Helped sort out some of that acronyms created by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB):

NCETMB - National Certification Exam in Therapeutic Massage & Bodywork (exam you take to get nationally certified)

NCETM - National Certification Exam in Therapeutic Massage (same as NCETMB but without Asian medicine)

NESL - National Exam for State Licensing (same exam as NCETMB but omits the NCBTMB credentialing requirements; it's a test that states can use to assess license applicants' preparation)

NCTM-A - National Certification in Therapeutic Massage - Advanced (slated for 2006 roll-out - details still being worked out, but it will be a broadly informed, scientifically valid certificate, unlike some medical and therapeutic massage certifications that are offered now, and will probalby require at least 500 hours of education, 3 years or 3,000 session-hours of clinical experience, and a license to practice in your legal jurisdiction; there won't be any CEU requirements, but will be recommendations)

Whitney also talked a bit about the differences between specialty certification (e.g., St. John's NMT, Upledger's CS, etc.) and general advanced certification (like the new NCTM-A). In the Q&A session, someone referred to this difference as "Big C" (national certification) vs. "little c" (certification in a modality).

Jennifer Bressi, Washington State Board of Massage Program Manager
From 1975 till 1987 massage therapists in Washington were known as "massage operators." Since 1987 we have been called "licensed massage practitioners."

Mark Nolting, American Whole Health Network
Talked a bit about the new CMP (Clinical Massage Practitioner, click here for application form) program which will be required by Group Health as of June 2006 and will likely be required by other payers in their network soon thereafter.

Robert May, Alternare
Says that Alternare's acquisition by AWHN is no biggie - they've been acquired a few times before and things have always sorted out. Neither he nor Mark would speculate on implications of the acquisition.

Susan Rosen, founding member of the NCBTMB
Talked about how a "job analysis" - a broad survey of how people actually work in a field - is the foundation for identifying the common elements of a profession. As I understand it, this is how you objectively determine what you should measure before you issue a certification of competence in a field. She also helped me understand some of the different entities fit into our profession:

the state can issue you a license so that you can legally practice

networks screen providers for their customers and can credential you and you can contract with them to get access to their customers; they can establish criteria (within certain guidelines)

Susan also pointed out that you don't have to participate in health care networks. If you want to contract with them, that's fine, but it's your choice what kind of practice you want to have.

John Conniff, panel moderator, an attorney who is a former Deputy Insurance Commissioner for Washington State
Pointed out that there are two main reasons for licensing practioners of any kind:

to protect the public - to assure public safety - the state does its best to ensure that practitioners will do no harm

to create barriers to entry - to make it hard for competitors to enter the market and take your customers

John also pointed out that Washington State law specifically says that insurance companies can be choosey about which providers they select - they can choose some, but aren't required to accept all, eligible providers (I guess this would explain why it's so tough to become a Group Health or Regence provider).

Massage Research Presentation at University of Washington

2005-05-18T14:02:00.000-07:00

Ravensara Travillian, Sylvia Burns, and Cynthia Price did a brown-bag lunch talk on massage research, "What Does Body Work Have to Do with It?: The role of touch therapies in health and healing," at the University of Washington. Raven talked about the lack of randomized clinical trials (RCT) that demonstrate the efficacy of massage, but she cautioned us not to withhold treatment just because it hasn't met the gold standard of an RCT. "Don't deny a possibility to your patient," she says, just because a trial hasn't proven the efficacy of a treatment. Raven also talked about the problem of "external validity" in massage research - that is, the level of certainty that you can have about how actual clinical practice will match up with the way something was studied in a clinical trial. It seems to me that by its very nature clinical massage care will never line up in lock step with a procedure tested in a clinical trial, since virtually every practioner has a unique education and their own way of doing things.