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News and Greetings from our Founder and President, David Luther :: Welcome Friends, Most of us are up for renewal of our membership. I thank you for your support and encouraging words. Without your membership dues we couldn't continue on. Things are speeding up in the medical massage world. Please stay involved. I hope you all have had a most blessed holiday. I find myself each year, at this time, reflecting back over the past year. Asking myself what I’ve learned and what I can do better this year. One case in point was the State Farm case in Pennsylvania. First we won, and second, we got an incredible response from the other side of the fence. By the way, here is the actual verbiage of the Case: DECLARATION "It is hereby ORDERED, ADJUDGED and DECREED that State Farm Mutual Automobile Insurance Company (“State Farm”) may not, as a policy, practice and procedure, deny bills submitted under the CPT Code 97140 pursuant to Pennsylvania’s Motor Vehicle Financial Responsibility Law 75 Pa. C.S.A. 1701 et seq. (MVFRL), solely on the basis that it was not submitted by a licensed physical therapist. Rather, State Farm must consider each individual bill and determine whether that specific provider provided the services outlined under that code. Thus, medical massage therapists may submit bills under CPT Code 97140 and receive payment pursuant to the MVFRL." Last year we mentioned in our newsletter that we had won the case against State Farm and they were using the term “Medical Massage Therapist.” Well the crazys from the other side got a hold of that and wanted to put a halt to the Judge using the term Medical Massage Therapist in the declaration. They barraged the judge from every angle, and were relentless in their attack on us. Well it didn’t work and the judge wished them to go away. The impression that these Therapists left was embarrassing to say the least. The judge and attorneys felt they had shown their lack of understanding in the case. Lesson learned. Keep my information close to the vest. I will tell you as much of the information as I can. As a result of that victory, we are pursuing two other class action lawsuits. I just can’t tell you in which states or which insurance companies. I also have a big meeting coming up with one of the top 5 companies on defining Medical Massage. They invited us. This last year has had some very unsettling events happening in our industry. We’ve seen a large group of therapists arrested and prosecuted for patient brokering in Florida. Therapists being fined and shut down for practicing medicine without a license, accused of Diagnosing and Prescribing, Insurance fraud, over utilization, Practicing outside of their scope of practice, and using equipment that is not within our scope of practice. Therapist had to pay insurance companies money back, (called recouping). Therapists were brought up on charges of violating the Physical Therapy Practice Act. When we were relatively small they ignored us, but now they’re really starting to watch us and some of the changes they’re making are really serious. BC/BS in Florida just lowered the boom on LMT’s and cut them to $42-$43 per session. What I’m saying is: We had better unite and change our ways or they will be more than happy to do it for us. I fear to make this plea any louder but the Florida therapists are banging down our door to help with the BC/BS ruling . It could have been avoided or a great deal easier than what it’s going to take now. Remember, I said last year "The sky is falling, the sky is falling.” Wake-up and look up. There are many exciting things happening at TMMO. Take a look at our new facility currently under construction on the beach in NC. Space is limited so get in touch with us today! (visit www.tmmo.biz for details). Sincerely, David Luther Current Coding Guidelines.... We recommend billing 97124 (Massage Therapy) and 97140 (Manual Therapy), but not combining them. We have seen numerous cases of downcoding and denials when these codes are combined. There is a growing trend of insurance companies downcoding 97140.

To the medical profession, massage therapists are, in general, lumped together with: ”those other crazy people who don’t know what they’re doing.” To the insurance industry, massage therapists are increasingly considered an ever greedier expense that needs to be eliminated, especially as more of them claim the “right” to bill as much as 4 times their normal cash client rate for work of dubious effectiveness and benefit to their policyholders. Massage therapists in turn raise their heckles, puff out their chests, light their candles and incense burners and call the medical profession “ a bunch of quacks who don’t understand the human body” and the insurance industry a “ club of nasty, blood sucking leeches that only want to make money.” To top it all, these same three groups are supposed to recognize each other as professionals and play together, not only on the same playing field but in the same game, with the same rules. The cry that emanates from the USMMA is not just one of exasperation at this sorry state of affairs but also one of extreme anguish as they recognize that very soon, and probably very quickly too, without a significant change in attitude and understanding, by all three groups, the massage therapists will be by far the biggest losers as they are sent off the field of play and told that they may watch the game but not play anymore. Why should it be that massage therapists become the biggest losers? Why not the doctors or the insurance companies? Because it is their playing field, their game, their rules and, by the way, their ball too.

Since its inception in 2003, the USMMA has been almost a lone voice crying out to massage therapists, the medical profession and the insurance industry to be heard. In that same year, the most influential people in the medical profession gathered to discuss, at the behest of the White House no less, the significant rise in people’s use of alternative health care and how best they could incorporate it into their world. The President of USMMA was invited to address them, which he did. Massage therapy, chiropractic and acupuncture are the three most commonly used alternatives, with chiropractic and acupuncture having a massively greater acceptance by both doctors and insures. Why is that? Because they are better organized, are standardized in both educational and testing requirements and are already considered part of “the team”. Massage therapists, on the other hand, are not. We have no consistent educational, testing or licensing requirements, ranging from 100 hours in one state (California) to 1,000 hours in another (New York) and 2,000 hours in Canada and eight states that actually require none! Compare that to 5,000 hours and up for a medical doctor and you might begin to understand why they look on us as a group with such poor regard. Anyone who thinks that between 100 to 500 hours of training qualifies them to be considered in the same sentence as someone who has spent 10 or more years training for their specialization is, frankly, delusional and should seek medical help (sic). There are, however, a number of massage therapists out of the quarter of a million or so in the United States that certainly do qualify to be considered part of this team through their dedication to learning, practicing and testing their knowledge and skills over many years, putting in the time and money needed to bring them to a level of competency that is clearly demonstrable. The USMMA has, and is, fighting very hard to get for these massage therapists, with the proven knowledge and skills to work in a medical setting, the recognition, status and income that such knowledge and skill deserves. The medical profession opened its doors to massage therapists in 2003 and offered us the opportunity to prove to them that we should be part of their patients care team. It is up to us to prove to them that we are worthy of their trust and respect, not the other way round and it is the USMMA, together with the MMNCB that are leading the way through that door.

The insurance industry, at least the part of the insurance industry that concerns us, is in the business of providing medical benefits to the general population at a cost that allows people to seek medical care when they need it. They rightly monitor these expenses very closely to ensure that they get the most “bang for their buck” and to ensure that fraud is severely constrained or, better still, eliminated altogether. It seems odd that as individuals we complain bitterly at the high premiums we pay to the insures but as a group, we expect them to pay us handsomely whether we are qualified or not. Anyone in our industry that naively believes that this will continue unchecked has not been paying attention and should open their eyes and their ears because the signs are very clear. The USMMA is constantly talking with the insurance industry and educating them about the very real differences between a qualified medical massage therapist and one who is not and is very prepared to support the insurance industry where fraud occurs.

Blue Cross Blue Shield (BCBS) in Florida has just reduced all massage therapy payments to a flat $43.00. Why? Because of massive over utilization by massage therapist. Indeed, they went further and are demanding repayment from those who were over charging. The howls of complaint from the therapists concerned was risible. How can we expect respect and acceptance by both the medical profession and the insurance industry? By ensuring that those massage therapists that involve themselves in medical massage and insurance billing are fully, demonstrably and consistently competent to do so. The USMMA together with the MMNCB are helping to provide that assurance but I can see the storm clouds gathering and hear the winds beginning to moan. Is anyone listening out there?