Massage Therapy and Insurance Fraud

An unfortunate trend seems to be rearing its ugly head in the massage therapy profession in Nova Scotia, Canada. Could fraudulent billing by businesses and massage therapists be the beginning of the end of insurance coverage for massage therapy services?

In most areas of North America, and Canada in particular, the massage therapy profession has long been promoting itself as a viable and legitimate health care modality. For several years massage therapists belonging to professional colleges and associations in Canada have been privileged to have our services covered by private and motor vehicle insurance, allowing us to build our practices upon an expanding base of savvy health care consumers.

In the recent months, however, it has come to the our attention as a profession that BlueCross insurance is rightfully investigating allegations of insurance fraud, and has gone so far to revoke direct billing rights of some businesses found to process fraudulent claims. BlueCross has also gone so far as to re-establish the direct billing Terms of Use agreement by massage therapists – but the general fear is that if this privilege continues to be abused it will eventually be revoked, leaving many of us out in the cold with a client base who will no longer be able to afford, or be willing to pay for, our services.

What is insurance fraud?

For our purposes, a simple definition of insurance fraud (please see my source FraudEducation.com) would be “criminal act requiring a material and intentional misrepresentation in order to obtain a benefit.”

This intentional misrepresentation regarding massage therapy services could possibly encompass:

1) Billing an insurance company for a therapeutic massage treatment that never happened (for example, a therapist or clinic bills insurance for a missed appointment)

As I have mentioned in my previous article Massage Therapy and Preventing Missed Appointment by Clients , I prefer to let one missed appointment go without penalty to the client, but in the event that it happens a second time, you need to be prepared to stand strong in case your client refuses to pay. Under no circumstance should the therapist allow these missed appointments to go by without bringing it to the client’s attention. Clients must understand that a therapist or clinic is unable to “just bill insurance” and you will not commit insurance fraud to let them off the hook. If a client won’t pay the fee, then it is better to discharge the patient from your care and document the events leading up to the dismissal.

In the case of a patient undergoing treatment in a motor vehicle insurance claim, it is necessary to document not only subjective and objective findings, but their compliance to your treatment plan and home care. If you find that a client is always late, misses appointments and doesn’t do suggested home care, you can discharge a patient for “non-compliance”. Clients should be informed up front that being discharged for non-compliance will not work in their favour, and that any further requests for treatment will not likely be granted, as the insurance company will not take the request seriously. After all, if a client is unable or unwilling to follow a previous treatment plan, then he or she is unlikely to be compliant in the future.

2) Performing treatments which are excessive and unnecessary.

There is a difference between what we think is necessary and what is considered excessive treatment – this is difficult, as a massage therapist working on MVA clients may identify a need for more treatments than the insurance tables deem appropriate. However, very few people need treatment more than a couple of times a week, unless you have specialized in a therapy such as Manual Lymph Drainage (aka MLD or Lymphatic Drainage), which is most effective initially in several treatments in a shorter time frame. I would have to say that if you can’t document objective findings which demonstrate an improvement in your client’s condition, or you can’t propose a reasonable treatment plan, you will probably find that your client will get limited treatments approved by insurance.

As massage therapists are not considered primary health care providers, our clinical impression is often trumped by a diagnosis of physician, chiropractor or physiotherapist. There’s not a lot we can do about that, but the reality is that in the past there have been therapists who have treated insurance coverage like a cash cow, instead of a tool to help their clients get needed treatment. (Not only is this fraudulent, but it is also unethical on the part of the therapist.).This quite rightfully has led insurance companies to view the profession with a bit of trepidation and suspicion, which is why a primary health care provider’s opinion will be taken over a massage therapist’s.

3) Billing an insurance company for a “massage therapy treatment” but performing another service (for example, a body treatment, such as a mud wrap. This has been alleged to be happening in Nova Scotia in spa settings.)

4) Using the billing number of a registered or licensed massage therapist by another party to perform services.

In the case of billing spa or esthetic treatments as “massage therapy”, or an unqualified practitioner using a therapists billing number, this is absolutely inexcusable. This practice has resulted in several spas being investigated. To my knowledge, there is at least one spa in Halifax that has had BlueCross direct billing privileges revoked, with several more under investigation.

Unfortunately for some of the therapists involved, this fraudulent billing has happened without their knowledge, and while I know this may seem little suspect, I really believe that a lot of therapists have been put in a no-win situation. In most spas and some clinics, therapists do not have access to the system which allows them to process the charges, so they sign a waiver allowing the business to do this admin work on their behalf. If a greedy business owner wants his or her cut of the action, they may instruct admin staff to bill a mud wrap or pedicure as massage therapy. If a client is aware that this is happening, then the client is every bit at fault as the therapist. I would also like to point out that a therapist signing a waiver does not imply that they are in agreement with fraudulent billing practices, and many are not offered a choice of refusing to sign.

Does Fraudulent Billing = Professional Misconduct?

Any one of the above mentioned situations is not only considered fraudulent, but may also be considered professional misconduct by a professional college or association. Part of required client records according to the CMTO is a financial record – this includes not only the date and time of the treatment, but also of the treating therapist, duration, the fee, and how it was paid. Any falsification of client records is considered professional misconduct.

If a therapist’s billing number is fraudulently used, should the therapist have to reimburse the insurance company? Or should it be the spa or business’s responsibility? Who is culpable of fraud?

I have discussed this at length with several friends and colleagues of mine. While I do agree that it is a therapist’s responsibility to oversee his or her account with the insurance company, I do not necessarily agree that a therapist should be held responsible for reimbursing the insurance company if the spa or clinic fraudulently billed it on his or her behalf and the therapist did not receive the money. This places many therapists in a very difficult situation as they often don’t have access to the company system to review the billing. It will be interesting to see how this all unfolds and if it results in criminal charges of fraud for spas and businesses, and professional misconduct of therapists.

For further reading, please go to the post “Massage Therapists – Prevent Insurance Fraud”.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Where can I find a great Massage Therapy job?

Knowing your job options BEFORE you embark on a massage therapy career can help you better decide if this is the profession for you.

Start your own practice – this is a great option for those who are entrepreneurial minded. It means you can call all of the shots, but be forewarned, if you don’t already have entrepreneurial experience, you have quite a learning curve. You’ll have to know when to take off your therapist’s hat and put on your business one, and keep it separate. It can be done, many therapists successfully own their own clinic.

Join a clinic that hosts a variety of treatment modalities. This could be anything from physiotherapy, chiropractic and massage therapy to a naturopathic or holistic clinic or doctor’s office. It’s a wonderful thing to be surrounded by people who are passionate about integrated health care. You will have the benefit of working with other professionals who are highly trained, and you will participate in the care of patients with a variety of conditions, from common injuries to extensive rehabilitation.

Start a mobile massage service – if you don’t like the idea of being stuck in a small room all day, and like to get out and about, this could be great for you. The key is to be organized – time management is really important in this business, and it is even more so when you are mobile.

Go corporate! Many large companies provide employee benefits that include massage therapy, and the coverage is usually great. Corporations provide these benefits because they realize that employees who use stress management tools such as massage therapy miss less time and are more productive. Even better if the therapist is on site, then employees miss less time going to and from appointments.

Health or Fitness facility – massage therapy is a great adjunct to fitness, so many club owners are wising up to having a massage therapist available. They realize that having qualified therapists on hand enhances their professional image by providing an additional service to clients seeking optimal fitness performance.

Sports teams or facilities – this is a little more intense than your average health club. This is where you will find budding stars with huge performance goals – as a result, you, too, will have to be at the top of your game whenever you are needed. Unless you have a sports medicine background or contacts in the business already, you probably won’t get into this right out of school, but that’s not saying it’s not a possibility. Work hard, get your sports massage certification (there are different programs available in Canada and the United States), volunteer, and it could just happen. What a great way to combine a love of sports with a passion for health.

Spa – not all spas employ licensed, certified or registered massage therapists, but many do, and the number is growing. If esthetics and hydrotherapy interest you, a spa could be a great place to start learning in that capacity. Medical spas are also growing in number, with treatments being a little more therapeutic in nature – let’s think lymphatic drainage after cosmetic procedures. Either way, a bonus is that you may get discounted or even free esthetic services, which is really great. Pedicure, anyone?

A resort or cruise ship – Depending on the location of the resort or cruise line, either one may give you the opportunity to rub elbows with a high end clientele. Your accommodation may be provided, and will definitely be part of the plan when you are on a ship. In the case of working for a cruise ship, while the hours are long and the pay is not so great, tips can be fantastic, everything is provided for you, and if you have a bit of wanderlust, working for a cruise ship could be your ticket to the world.

Hospitals or palliative care. It takes a special type of person to work in these environments, but if you have “the stuff” to do it, then it can be a very rewarding career path. Whether the service you provide is in a rehabilitative capacity with a physiotherapist or bed side with palliative care patients, you will be providing human contact to people who may be touch deprived. You may not be able to make a living per se, but you can improve the quality of life for someone, even if (in the case of palliative care) it is only for a brief period of time.

Senior’s centres – with a growing aging population, the need for extended health care grows as well. Your clients can range from a vibrant “80 years young” to a senior with a few more health concerns. Once again, a lot of times it’s about providing company and human contact to the elderly more so than the massage itself, which is a very compassionate way to enhance the quality of life for someone.

Any way you look at it, there is a ton of potential with a massage therapy career. It is Ok to change course as well, and you may find that you like to try your hands in different capacities until you find the perfect one for you.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Is a vegan or a vegetarian diet REALLY healthy?

My response to an article “Cruising to Health” in Organic Spa Magazine.

Hello,

My name is Jodi Forsythe, and I am a Registered Massage Therapist (Canada) and the creator of www.WhyMassageTherapy.com. I wanted to first of all commend you on a fantastic magazine which combines two of my favorite things – organic living and spas.

Secondly, I would like to comment on the article in the August 2009 edition “Cruising to Health” by Judith Fein. I am always interested in hearing of new things which help people attain the highest quality of life possible, but I am concerned with the sweeping generalization in the article that a “vegan” lifestyle is the panacea for achievement of optimal health.

While I would not argue that there are numerous benefits to switching to a mostly plant based and/or raw food diet, I am concerned that in an article such as the one mentioned above, no further resources are mentioned which may help people make an informed and balanced decision. If I would have had proper information during my attempt at veganism 13 years ago, I would have done it a lot differently by consulting a health care professional who knew what she was talking about, or not at all. As it was, from the misinformation I read, all that I achieved was extreme suboptimal health which took a long time to heal.

During my healing process, I was struck by the reality that humans are omnivores, and that agriculture did not begin in earnest until about 5000 years ago, before which our species were hunter-gatherers. (notice that “hunter” comes first … ) I do not believe that a diet free of animal products is how our species has evolved over millenia, and I firmly believe that animal protein is necessary for humans to obtain optimal health.

Please note that I am not talking about the rampant over-eating and gluttony of processed and damaged food which is so pervasive in our society, including chemically processed and packaged food products. I am talking about eating food that is actually part of the food chain, which we can in theory “pick, hunt, gather, milk or fish” (Thanks to Dr. Diana Schwarzbein for that useful perspective). Our bodies recognize and assimilate the raw material as needed, and because we are receiving the nutrients that we require to thrive, we are not cursed with the chronic hunger and ill health which happens in an over-fed yet under-nourished society.

I firmly defend my decision to eat chicken, beef and fish, but I also believe in animal welfare and sustainable farming and fishing practices. Using animals for food can be done at far less of a humane and environmental cost than is currently occurring. For example, purchasing only meat, poultry and dairy products from farms and organizations which support animal welfare is the best way to start. I’m thinking grass-fed beef, which actually produces far less methane than their corn-fed counterparts, or free range chickens that are not factory farmed and stuffed with feed made from renderings of other dead animals.

On the flip side, if we are so concerned with the environmental cost of food production, we should also take a look at the prevalence of genetically modified crops such as soy, and the impact on human health and the environment. So recent is this scientific development that the gravity of our choices isn’t even beginning to be understood yet, and I am concerned for what is to come. And please, don’t even get me started by saying that switching to a plant-only diet would allow us to feed so many more starving people. It is a fact that food aid sent to impoverished countries often doesn’t make it to the intended recipients, but is rather diverted by hostile regimes for their own purposes. At this point in time famine has much less to do with a shortage of food than it does with politics, and that is the real crime.

In closing, while this piece was interesting and well written, I would like to see more articles with a balanced viewpoint on what a “healthy diet” really means; preferably from a variety of medical and naturopathic professionals who can then refer readers to accurate information and resources.

Regardless, I will continue to purchase and enjoy your magazine, and look forward to reading more interesting articles.

Sincerely,
Jodi Forsythe, BA, RMT
Registered Massage Therapist

http://www.whymassagetherapy.com

Massage Therapy – a tool for living well.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy Treatment Room Accessories – Floor Coverings

An eco-friendly, Turkish Style Area Rug made from recycled plastic is pretty, functional and easy to care for. After all, just because you walk on it doesn’t mean it can’t look nice.

Let’s face it, there are always challenges to knowing how to decorate your treatment room, be it a spa or a clinic, and there has to be a marriage between functionality and esthetics, and a reflection of your own taste. You are going to be spending a lot of time in your room, so you had better like it.

Footing is really important during a massage therapy treatment – the safety of you and your client both depend on it. What I have noticed during my years as a therapist is that I don’t really like to stand on a surface that is hard and makes noise as I move around the table. Surfaces such as tile, hardwood or concrete are noisy and can be rough on your legs as you stand a lot. Not to mention the fact that they can become slippery if you drop oil on it, and the last thing anyone needs is a slip and fall. (hello Whiplash!)
Most times we don’t have a choice in the treatment room of the materials our environment is made of, so we have to improvise.

Personally, I really like an area rug under my table, but it has to follow certain specifications to meet my expectations.

1) It has to be large enough so that when my table is in the centre, there is plenty of room for me to roll around on my stool – mobility is a huge deal for me, especially when working on a clients head, neck and shoulders when I am seated. Ideally, a minimum of 6×9 feet seems to work.

2) It has to be pretty. Whether it is plain or has a fancy design is very personal, but since my clients might spend a vast majority of time face down, it is best if it is pleasing to look at.

3) It has to be durable. Depending on how much your room is being used, it’s really easy for an area rug to wear out. Personally, I’d rather spend my business dollars on things like continuing education, so equipment or accessories that wear out easily are an expense I want to avoid, no matter how nice it looks when it’s new.

4) It has to be hygienic and easy to clean. My mom gave me a beautiful area rug that worked perfectly in my treatment room. Everything was great, it was big enough, pretty, easy on my legs, and helped to soundproof the room a bit. Great, except that it got stained from oil and gel being dropped on it, and wore out in a pattern around the table. It’s not so pretty right now (not to mention that it probably has some germs lurking around in it) and I won’t be able to use it in my living room. I wish I would have thought of that before I ruined it. Instead of being able to hose it off, I’ll have to get an environmentally friendly cleaner to steam clean it.

5) In my efforts to be eco-friendly, it has to be made from either a recycled material or from an ethically sourced, sustainably manufactured material. Usually this is the sticking point for people, as most people want to make an effort to be eco-friendly, but the expense can be prohibitive. There are cost-friendly options, you just have to know where to look. Gaiam has a great Turkish style area rug that is durable and pretty – and when you get tired of it in your treatment room, you can put it on your deck or patio.

6) Don’t forget that if you use an area rug, you should get a non-slip backing to put under it. Even though the weight of the table will pretty much anchor it, the backing will also help protect the flooring underneath – especially important if you are renting space with nice hardwood or tile flooring.

So many of us are concerned with the treatment aspect of the business, we don’t realize that a little forethought concerning our work space goes a long way. Trying to be green makes it a little more challenging, but it can be done.

© Copyright 2008-2009
www.whymassagetherapy.com
All Rights Reserved.

A Massage Therapy Career – What to Know or Do Before You Take the Plunge

Some points to consider before you embark on a Massage Therapy career.

Massage therapy is an interesting, rewarding and fun career. It is also growing considerably in North America – according to the United States Bureau of Labor Statistics, the profession is forecast to grow faster than average (20%!) between 2006 and 2016.

If you are interested in a massage therapy career, this is great news. I would suggest, however, that before you embark on a new career path and undertake the commitment necessary to become a massage therapist, you consider what the profession is really all about.

1. My first piece of advice is to get a massage!

It never ceases to amaze me how many people love the idea of becoming a massage therapist, yet have never had a massage treatment from a professional. Getting a either a relaxation or therapeutic massage is a great opportunity to know what it’s like to be a client, as well as to establish a rapport with a professional in the industry. I would advise that you go for a massage therapy treatment in the type of setting where you think you’d like to work …

2. Speak with several massage therapists currently in the industry.

You will find massage therapists in spas, sports facilities and medical clinics. You may also find them working out of their own home, or perhaps the massage therapist you know will have a mobile service, and go house to house visiting clients. Tell them that you are considering a career in Massage Therapy, and as them for the input. Also ask them to be honest, and discuss a “typical day”, as well as the pros and cons of the profession, everything from work environment to pay rates, and how they fit into the organizations in which they work. Once again, because everyone has a different experience of the profession, speak with several people to get a general idea of what life is like as a massage therapist.

3. Experience different types of massage

From relaxation and therapeutic massage to different modalities under the “massage therapy umbrella”, you have several excellent options, try as many as you can before you make your final decision on whether or not to pursue a massage therapy career. After your basic education is done, it is good to know that you have options where you can specialize as your experience grows.

4. Ask your new massage therapist friends where they went to school, and what their experience was like.

As professional therapists, they will be able to guide you where to go for the education you will require, as well as discuss the licensing requirements for the state or province where you want to practice and live. The massage therapy school you attend is your foundation and will set the stage for years to come, so choose wisely.

5. Don’t let the romance of massage therapy as a healing art mislead you!

To be successful in Massage Therapy, it must be treated like a business, albeit a caring one. You will have bills to pay, so don’t be misled by thinking that the money you charge per treatment is money that goes directly into your pocket. Once again, talk to massage therapists to get a reality check on the business aspect of the profession, it could save you a lot of heartache.

For more information on the realities of the profession, check out the main site, under Massage Therapy Careers. Taking the time to learn about the massage therapy profession before you commit your time, money and energy is effort well spent.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.