Posted under General & Marketing Massage for Special Populations & Massage for Elders
I’ve been exploring this question: Does Medicare reimburse for massage therapy– and what are the implications? It’s no secret that our health care system is in a state of flux and every kind of service provider is holding their breath about this. Besides being a massage therapist, I’m also an occupational therapist and recently recieved a call to action request from the national OT board (NBCOT) They are concerned about current Medicare caps for OT reimbursement. I’m often asked the question from my students,” Does Medicare pay for massage in long term care or hospice?” Well there is not a simple yes or no answer to this question. I’m writing to really see what’s on other people’s minds about the issue of Medicare reimbursement and to prompt a discussion about it. If you are working within eldercare or hospice has this subject come up for you? Has anyone found a successful way to navigate the Medicare waters? What do you think the ramifications are for massage therapists if Medicare reimbursement becomes more available for our services? I’m a bit jaded about it myself because in the 25 years I worked as an occupational therapist I experinced a lot of change in how I was able to go about my work and clinical decisions became so tied to reimbursement. Don’t get me wrong– I’m willing to view this issue with an open mind. What’s on your mind?
Take care,
Ann
Eileen on 24 Feb 2010 at 9:02 pm #
I also wonder about medicare reimbursement. This sounds great – but when you are tied to the government they have more to say about the type of services that you provide and how much. I’m sure the reimbursement would be great but the paper work would be very durdensom for the therapist. I would hate to see all that you have worked so hard to bring about would be taken over by burreaucracy and mounds of paper work – again taking away for the very thing that we wish to accomplish focused compassionate touch to elders that need to feel love and compassion.
Eileen
Ann Catlin on 25 Feb 2010 at 8:08 am #
Hi Eileen,
Thank you for your insightful feedback on this issue. What you describe is what I experienced as an OT and I agree that when services are tied to a regulated reimbursement system we risk losing the very nature of true service to the people we are caring for. Good to hear from you! Ann
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Leticia on 03 Mar 2010 at 7:30 pm #
I just recently started working for a hospice as a LMT and I dont actually get paid through the hospice. My salary comes from a foundation run from donations, fundraisers, etc. My assumption is that it is because medicare wont cover massage or that it is such horrible to mess to deal with that it isnt worth it. I feel that it should be covered by medicare, it is such a positive thing for both the patient and the family. If the point of hospice is to keep the patient comfortable and to manage their pain while they know they are passing wouldn’t massage be one of the best therapies to offer?
Kim on 03 Mar 2010 at 7:45 pm #
Hi Ann,
I have been working with elders and clients that fall under hospice care for the past 10 years. I read your article and the comments posted and am in complete agreement. When the government and any sort of regulated reimbursement become involved it changes everything and usually not in a positive way. Lets keep our work filled with compassion, fluid and true.
Kim
Rebecca on 03 Mar 2010 at 8:23 pm #
I am an LMP and work as the office manager in a small outpatient OT clinic. I handle all the billing. In our state (WA) OT requires referral from a physician, even on a cash basis.
I keep thinking that one of the benefits of massage is that the client can self refer if he or she wishes to pay cash. The OT that I work for does bodywork and it is billed to Medicare under the manual therapy code. I assume that PTs can do the same. It makes me wonder then, why not LMPs? We can bill MT under other insurances.
As an LMP I am proud that massage is an alternative to western medicine practices and sometimes I really hate to see our profession pushing the ability to bill insurances and to be more accepted by western medicine practitioners because it allows external influences to change the face of the profession so much. And I believe it is happening in ways that practitioners aren’t recognizing, and when they do the impact will already be there and it will be too late to stop.
In some ways it’s a good thing to be recognized and accepted, but I fear in the long run it will mean increased restrictions in our ability to do what we do best. As other insurances commonly follow rules set and started with Medicare, would it be beneficial or in the long run hurt more to be able to bill them?
Though it is not quite the same topic, I am seeing more and more OTs that are also LMPs. Since my boss practices doing primarily bodywork, I wonder why the dual licensing and which did you have first?
Rico on 03 Mar 2010 at 10:54 pm #
if you accept insurance you are not tied to anything and there are no mounds of paperwork. the hcva form is not too difficult to fill out and if you do it online it is filled out once and then modified slightly for each visit if necessary. you do what you do the way you do it, how exactly does an insurance company change that? if you do more than what you get paid for you wont go to jail (maybe heaven but not jail). if you do less then you are a cheater and should be punished. if medicare covers then your skills go from alternative or complimentary modalities to medical procedures opening the door for all insurance companies to pay. at that point hire someone to do your schedule and billing.
Leslie Saxton on 04 Mar 2010 at 10:51 am #
Medicare reimbursement would be very helpful for those in eldercare, long term facilities or hospice. I was first denied to become a provider here in South Carolina but am awaiting a reply and have requested a hearing to follow through with the process because my professional medical massage practice is located next door to a long term care facility. I wanted to be able to provide this much needed service to the elderly population but I need to be reimbursed even at twenty four dollars per average session. I definitely want to see the elderly in these types of facilities served with professional massage.
Barbara on 04 Mar 2010 at 5:55 pm #
Funny you should ask. As a licensed massage therapist and an independent contractor to two physical therapy clinics, I have been told two different answers to the very same question. I pay rent for office space, see my self-paid clients and when they have an insurance patient, I provide the service at a contracted rate. I never do any billing. They do. One group is a physician’s clinic and the other is an independent group accepting patients from any referring physician. There, I am currently providing massage treatment to a half dozen medicare patients and while at the doctors clinic we refuse folks with Medicare, even with prior authorization. I cannot understand why the billing departments are giving different answers for the very same treatment.
The benefits should be there for patients after paying in to the system for a lifetime.
Ann Catlin on 04 Mar 2010 at 7:03 pm #
Leticia,
Many non-profit hospice organizations are finding creative funding like the one you work for. Although hospice services are a Medicare benefit the funds they recieve must cover every need the patient has; for example equipment; bandages; other services. I have heard from some massage therapists who work for hospices that find a way to use the Medicare funds to cover their service. Thanks for the work you are doing! Ann
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Ann Catlin on 04 Mar 2010 at 7:11 pm #
Rebecca,
Thank yor for your comments. You make several interesting points. Your comment about how many OT’s are also MT’s. I was an OT for 25 years before getting my certification as a MT. I can’t speak for the others, but my motivation was to perhaps open some new doors along the path of complementary services. I can see that OT and MT can blend nicely since both are, at their core, holistic approaches. Over the years, I saw reimburseable modalities used by OT were more and more related to the physical abilities of the patient. I can see massage being an appropriate adjunct to the other modalities in the OT’s tool box. Ann
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Ann Catlin on 04 Mar 2010 at 7:14 pm #
Hi Rico,
I appreciate your comments. I’m curious what setting you are working in– is it long term care or hospice? Perhaps you would be willing to share a little more of what your experience has been. I think we should be open to looking at it from all viewpoints. Ann
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Jody Hutchinson, nctmb on 07 Mar 2010 at 10:55 am #
In California many people call and ask if I take Medicare. I can’t. Last Monday, Medicare just threw down a 15% cut in reimbursements. Does anyone want to work more for less? This is why MDs are jettisoning their Medicare clients. It’s such a mess that I wouldn’t want to be involved in this system.
Eva Pendleton on 07 Mar 2010 at 9:13 pm #
Hi Ann,
It’s no coincidence that we wrote about this same issue within a few weeks of each other. With healthcare reform front and center in the news every day, we are constantly reminded just how challenging it is to attempt to work within the healthcare system. Those who are in it (doctors, nurses, PTs, OTS) aren’t happy, those of us who are excluded aren’t happy.
What I know about Medicare and hospice right now is that there is a big audit coming with some controversial elements: hospices will be required to reimburse Medicare for any treatment decisions that the auditors disagree with (i.e., admissions for inpatient care), and the auditors will be paid based on the amount of money they recover. It’s not looking good and some agencies will surely be destroyed.
I’m not optimistic about our chances of being included in a system that is facing this kind of massive crisis, but it is interesting to hear the ways in which some of the commenters here are trying to navigate their way into it.