By: The Olympian

We highly recommend this article summarizing the Public Employees Benefits Board meeting and their decision not to terminate Uniform Medical Retiree plan, (which is currently administered by Regence BlueShield). 

It's an excellent illustration and inspiration of how collaboration and forging alliances between advocacy groups, patients, providers and other stakeholders can work. 

Stay tuned as CPP plans to consult with Laurie Weidner, executive director for the Retired Public Employees Council (RPEC) on strategies to forge such alliances.

Please click on the link below to read or to listen to an audio version.

https://www.theolympian.com/news/politics-government/the-state-worker/article263196203.html

WA retirees protest when PEBB tried to take away health benefits | The Olympian Weidner explained that the process required a lot of public engagement with the issue before the board committed to the resolution last week to postpone a decision on UMP until Jan. 1, 2024. www.theolympian.com

by Elizabeth Jane Brooks, LMT, BCTMB

Last month, WSMTA asked our members if they were turning away insurance patients. In response, 20% said no (with some saying they would like more) while 73% said yes. Of those who said yes, 33% said they terminated some or all of their insurance contracts. These results lead to a recent board discussion on network adequacy and how some therapists have unfounded concerns over not taking new patients.

To begin, what exactly is network adequacy?

In order for an insurer to deliver their members medical benefits, they are required by law to supply a geographic area with an adequate number of in-network providers capable of providing those services in a timely manner. To do this, they create provider panels: listed as directories of contracted providers. If an insurer can show that it has an adequate supply of providers, it will close their provider panel and no longer issue new provider contracts. Because of this, it is important to let the insurer know when you are not accepting new patients. If medical providers inaccurately report that they are accepting new patients, the insurer cannot accurately determine if there is a need for additional providers.

When there is network inadequacy, it’s common to hear patients complain about how long it takes to get an appointment with their healthcare providers—and we’re hearing this more and more. With the proliferation of narrowing health insurance networks, it is vitally important for us to be part of the solution.

Some participating providers are concerned that if they report being closed to new patients it will negatively affect them and their contracts. To be sure, this is not just an issue for massage therapists, but for all healthcare providers. However, this concern is unfounded. Reporting that you are not currently accepting new patients will not harm your contract or reflect poorly on you. Instead, it will have the opposite effect: it will show that you and your services are in demand.

Faulty information impairs the entire system. In order for insurers to provide their members with the required number of providers, it is imperative that they have accurate information so that they can properly determine their adequacy. Accurate reporting and frequent status verification, therefore, is a best practice that helps insurers both credential a sufficient number of providers for their members and allows newer practitioners to become contracted. It helps everyone.

With all the issues facing insurance in our industry, accurately reporting our status is one critical way we can both encourage and reward good insurance practice.

Upcoming Event: Register Today

WSMTA Annual Meeting. June 26 2022 -Empowering LMT's and Clinic Owners in an Insurance Dominated Environment.

EVENT DETAILS:

Please join us for the 2022 WSMTA Annual Meeting, including continuing education! 

This year we have chosen to meet once again via Zoom. We have realized that this format has allowed us to reach LMTs well beyond the greater Seattle/I-5 corridor areas, so we are continuing in an online format. 

This year's theme is:

Empowering LMT's and Clinic Owners in an Insurance Dominated Environment.  

We have a lineup of three very knowledgeable presenters.  Here are the logistics of the Annual Meeting:

Day:  Sunday, June 26, 2022

Time:  9:30 am - 2:30pm PDT

Where:  Zoom

CE Hours:  4 hours

John Conniff, Attorney:

John Conniff combines his broad background and practical knowledge to help clients find workable solutions to difficult problems. For over 25 years, he has counseled individuals, businesses, professionals, legislators, and government officials. In addition to running a law firm, John is a serial entrepreneur. He has owned or co-owned small businesses including Healthy Patients | Healthy Lives, providing business services to small health care practices and a multi-media company – JJP Media.

His wide range of experience provides him with insight into the complicated connections between business and law. He has worked extensively on employer issues, business contracting, insurance regulation, information privacy and security, health care regulatory

compliance, ERISA, and business transactions. John is a local attorney who has a decades long history with healthcare law and massage. He will be presenting on the topics of:

• Competition law and healthcare networks

• Antitrust and related business practices law

• Supply and demand (with regards to massage)

• Network adequacy and directory accuracy

B.J. Erkan, LMT:

While serving in the US military in 1990, B.J. hurt his back and experienced a musculoskeletal injury from the patient’s point of view. He was referred to a naturopath that had been previously trained in bodywork. Extremely skeptical at first, B.J. had a life changing, perspective shifting experience. Realizing he was meant for different things, he and his family moved to the Seattle area in 1991.

B.J. graduated from the Brian Utting School of Massage in 1994. Soon after being licensed, He had the opportunity to treat an MD with severe low back pain, and became known in the Kirkland area as a therapist who could effectively treat musculo-skeletal pain. In 1997 He began teaching massage anatomy and physiology at Bastyr University. In 1998 B.J. moved from Kirkland to Bothell and opened Bothell Integrated Health (BIH), LLC. Since then he and the BIH staff have given over 200,000 massages to people from Bothell and the surrounding areas. He also enjoys teaching CE classes to the BIH staff, and other therapists, and has taught, by request, at other medical massage clinics. BJ will be discussing:

• History and economics of the massage business and how this relates to the formula of price setting and the importance of the collection of data of actual overhead costs in a variety of settings. 

• The downside of signing contracts for low pay and how that affects the entire profession. 

• The power of “collaboration and solidarity” amongst massage therapists, massage clinics, massage profession associations and other allied professional associations.

• How to empower providers and our patients to create positive change in reimbursement rates.

Jane Brooks LMT:

Jane runs a private therapeutic massage practice dedicated to injury treatment and chronic pain relief. She is a board director with WSMTA, educator, writer, business consultant and the inventor of a patented seamless face cradle cover. As a seasoned therapist who has successfully navigated poor economic times, decreasing insurance rates, excessive demand for service, and Covid-19, she has a keen interest in helping others create their own sustainable and lucrative practice. Jane has been strategic in growing her practice to include multiple streams of income and moving from an insurance to a cash-based practice—all while charging premium prices, working fewer hours, and teaching others how to do the same. Jane will talk about:

• How to increase revenue and stability with your insurance based practice.

• How to transition from an insurance-based practice to a cash-based practice.

• Ideas for potential additional financial streams and strategies.

ADDITIONAL INFORMATION:
Zoom attendance is 100 participants. We plan to record the meeting for later access and viewing.

 WSMTA Raffle Prizes for June 2022 Anual Meeting.pdf

by Dagmar Growe LMT

There is an ice axe on the wall above the row of cash registers at my local REI store. A sign next to it explains the significance: A bunch of decades ago, some NW mountaineers decided to band together so they could negotiate better prices for their equipment – like ice axes. I wonder if any of the folks involved imagined their little co-op becoming the retail giant it is today!

It is stories like this that I want to keep in mind when dealing with situations as frustrating and overwhelming as massage therapists’ struggles in dealing with insurance companies. We have written in the past about the problem with “negotiating” collectively: US antitrust law which was created with the goal of protecting consumers against large and powerful companies, in a perverse twist of circumstance, is now protecting large and powerful companies against consumers (who can’t find a massage therapist to work with them) and small business owners.

And yet, just like those ice axe purchasers we can still marshal the power of the collective in a legal way. A great example is the collective purchase of legal services. Some Regence contracted LMTs had concerns about the latest contract that was sent out a few months ago by Regence. A respected and highly experienced healthcare attorney, John Conniff, provided the Washington State Massage Therapy Association (WSMTA) a legal review of the new Regence agreement We all know that legal services are expensive, and this lengthy contract and regulatory filings (228 pages) required many hours of work and resulted in a 13 page legal review  that details the commitments that therapists enter into, the inconsistencies, and the conflicts with Washington statutes that exist in the contract. If WSMTA was charging hundreds of dollars in membership fees per year like other professional organizations (Chiropractors, PTs) we would gladly make the review available as a membership benefit. Given our current membership price, we have to handle legal reviews like the ice axe guys: Everyone pitches in and we all win. The review will be available to members for $100 – the cost of 1 massage (well, not an insurance massage) If you are not currently a WSMTA member you can go to our website, become a member for $40 and then be eligible to purchase the review for $100.. Your payment helps us to continue to provide services like this in the future.

Now, of course, you wonder: why would you want to know everything that is wrong with this contract, as you don’t have the power to negotiate a different contract with Regence’s non-existing provider service. We will share one bit we learned from the review upfront: The contract states that it is a confidential document. Not true, according to Mr. Conniff, healthcare contracts like this have to be filed with and approved by the Office of the Insurance Commissioner, and then are placed on their website, which makes them public information. This means we can legally talk about the contract. You also might want to know which parts of the contract are legally enforceable, and which are not! And then, depending on your circumstances, you can make an educated decision on whether to sign or not, or if you already signed, if you want to cancel or not.

This is but one example of how LMTs can exercise  some power in a healthcare system that favors large companies. BJ Erkan, LMT and clinic owner will share more ideas at the upcoming WSMTA Annual Meeting on June 26. And the next time you go to your local REI store, look around:This is Power of Collaboration! Let’s make it our own power.

WSMTA Member Store Link 

Navigate to the Store from the navigation bar. Store is only visible and accessible to members. Be sure to login to access the Store

by Elizabeth Jane Brooks, LMT, BCTMB

Here at WSMTA, our goal is to promote and ensure the accessibility and financial viability of massage therapy as a reimbursed healthcare service and to provide resources to support practitioners. We have a strong desire to protect your interests and assist where we can.

Whenever we work with health insurance companies, use our computers for patients, work from our homes, or are injured on the job, there are some vulnerabilities that we’d like to bring to your attention—and their possible solutions.

Working with Health Insurance

In Washington State we are quite fortunate in being able to contract with health insurance companies. This is especially beneficial for our patients, as it can significantly reduce their out-of-pocket costs—and it is also great for massage therapists, as it may expand their practice and provide a steadier paycheck. For those early in their career, it can be of particular benefit: being in-network with an insurance company can bring many referrals, providing ample experience and filling your practice with new patients. Even experienced practitioners might use insurance as a stepping-stone, switching over to cash once they no longer need the referrals and demand allows for better pay.

However, working with insurance does have costs: lower rates, overworking, and post-payment audit risk. 

To work with insurance, we must sign contracts accepting a reduced rate for our services in exchange for the many referrals that come from being one of their listed providers. These referrals are a definite benefit, but we are not able to enjoy this benefit to the same degree as a physician, nurse practitioner, or physical therapist who can see numerous patients in any given hour. In contrast, our work is physically taxing and takes at least one hour with the patient on the table—with additional time for the patient to get dressed, take payment, and rebook; extensive cleaning and disinfecting; resetting the room for the next patient; charting/report writing and billing. Several of our WSMTA members estimate that for every hour of work on the table there is often roughly one hour off the table.

Consequently, for many practitioners the major advantage of contracting with health insurance is how the referrals give us greater job security. As we gain experience we build up long waiting lists, and often end up unsustainably working nonstop for these lower reimbursement rates in an attempt to keep up with the demand. Fortunately, some of these patients will turn into cash clients when they have exhausted their benefits, or when coming in for a non-covered service (such as relaxation or maintenance massage).

When we contract with health insurance carriers, we agree to post-payment audits where the carrier can request chart notes and supporting documentation going back, on average, 1–2 years, and occasionally up to 10 years. During an audit, insurance auditors review your chart notes to see if everything charted matches with the referral and all necessary information is on it. Should the audit show any discrepancies or missing information, you are asked to retroactively repay the monies for the particular charts in error. If a massage therapist has been charting incorrectly in some way for years, the repayment for the incorrect charts can be so costly that the therapist’s practice may not survive.

Post-Payment Audit Insurance

This potential is the reason behind the search for post-payment audit insurance, also known as medical defense insurance. While common coverage for a physician, it has been difficult to find for massage therapists because we are relatively new to billing health insurance. Washington is one of the few states that allow us to bill health insurance companies, but as massage is increasingly recognized as effective healthcare, more states are positioned to join us, and more insurance companies are hopefully coming on board soon.

With so few companies providing this coverage, the quest has not been easy. The author of this article, for example, spent over a year communicating back and forth with different insurance companies trying to convince them to cover massage therapists. These included ABMP, AMTA, MMIP, Hands on Trade, and many more companies less known to massage therapists. She eventually found an excellent insurance agent, Christina Haranda at American West Insurance Agency (listed in the resources below). Christina went above and beyond in finding the coverage we need. She found MEDEFENSE coverage through Tokio Marine HCC, which is protection for healthcare professionals covering exposures—such as billing error proceedings through both government and private payers, as well as HIPAA and other regulatory proceedings.

MEDEFENSE coverage includes reimbursement of defense costs, fines, penalties, shadow audit expenses, including qui tam actions (filing false claims for funds from the government programs), HIPAA proceedings, EMTALA (Emergency Medical Treatment and Advanced Labor Act) proceedings, and STARK (self-referral and anti-kickback law) proceedings. Coverage limits go up to $1,000,000 each claim and a policy general aggregate up to $5,000,000. The minimum deductible is $1,000 and there is a minimum premium of $1,200 for a one year policy. Full prior acts coverage is also available.

In short, MEDEFENSE covers the defense of an audit, but not any monies due to be repaid to the insurance company due to fraud, errors, and/or omissions. This coverage includes a shadow audit—an audit where you hire an independent auditor to go over your charts, which can reduce the amount needed to repay an insurance company. It will also reimburse legal fees, fines, penalties and the previously mentioned proceedings. It is expensive for the average massage therapist; however, in the event you are wrongly accused of fraud, errors, or omissions and the insurance carrier is asking for $25,000–$100,000, it would be money well spent.

Another suggestion is to hire an independent auditor to review your charts before you are audited—it can be especially helpful if you can find an auditor experienced with massage coding and charting. To find an auditor, many have found it helpful to search local hospitals or large clinics.

Cyber Liability Insurance

Tokio Marine also offers cyber liability insurance coverage which can be bundled with MEDEFENSE or purchased separately. Cyber insurance covers your business liability in case of a data breach of sensitive patient information—this can be a breach of any files containing personal identity information, health and/or financial records. Additional items covered are legal expenses, negotiation and payment of ransomware demands, plus restoration of data. It should cover both your business and third parties (i.e. your patients). Some questions to ask yourself to determine your vulnerability are:

• Do you email medical information?

• Do you keep any patient medical information on your computer, tablet, or cell phone?

• Do you keep any patient financial records on your computer, tablet, or cell phone?

If you answered yes to any of the above questions, cyber liability insurance is worth considering.

Homeowners & Renters Insurance

There are quite a few LMTs that work in their homes rather than in a business office space. Some insurance companies have a problem with this, as the lines between what is business and what is personal can become blurred, potentially increasing claims. In these situations, the insurance company is concerned with patients injured on the premises pursuing both our business liability insurance and our homeowners/renters insurance, and because of this it can be difficult to find coverage for these circumstances. Thankfully, the following insurance companies are favorable to those of us that work from home (sometimes through an additive “umbrella” policy): MetLife, Travelers, Country Financial, and in some cases Allstate.

Disability Insurance

Disability insurance can be difficult to find as a massage therapist because the injury rate is significant in our field. However, Crump Disability Solution Center has stated they have carriers that will cover massage therapists, including Assurity and Mutual of Omaha.

Should you be unable to work for a period of time due to illness or injury, most disability insurances pay between 50–70% of your pre-disability gross salary. For therapists with S-corporations, it will be important to check if their passthrough income can be included. 

To be covered, most plans require a minimum of a 30-hour work week to qualify, which for massage therapists can be made up of such things as massage, cleanup, setup, billing, education, and purchasing supplies. With this minimum met, costs will depend on a variety of factors such as age, health, and income. 

Some questions to ask yourself:

• How long can I manage my monthly expenses without my paycheck?

• Do I have personal savings or a retirement plan I can dip into if needed?

In Conclusion

WSMTA is providing this information for you to consider for your protection and that of your business and patients, along with some possible resources. If you are aware of other resources, please send them to us at info@mywsmta.org.

Resources

Medical defense, cyber liability, homeowners/renters, and auto insurance:

Christina Haranda

206.218.8980

christina@americanwestins.net

American West Insurance Agency, Inc. 

Medical Defense:

Tokio Marine MEDEFENSE Plus

Cyber liability insurance: 

Travelers Cyber Insurance

RPS (Risk Placement Services) 

Tokio Marine Group 

Umbrella insurance: 

Travelers

Liberty Mutual

Homeowners/renters insurance: 

MetLife/Farmers 

Travelers (homeowners)

Travelers (renters)

Country Financial (homeowners)

Country Financial (renters)

Allstate

Have you been receiving unsolicited emails from what looks like it could be a Regence email address? Is it real? Or, is this part of a cyber attack? Could it be both?

The answer to this question seems to depend on who you talk to at Regence and how far the representative is willing to dig into the question. Some providers who have called Regence Providers Relations and spoke with a representative have been told “Yes it’s real. The website says Regence is switching all individual provider agreements with a new, standardized Professional Services Agreement and must be in electronic format.” Other providers who have called Regence have spoken with representatives who have dug-in a little deeper, (beyond the first page of their website), and have been told they can not find anyone at Regence who will take responsibility for sending these emails out to providers. 

So what do we do?

Cyber Security 101 tells us to never click on any links contained in unsolicited emails we may receive. 

At the very least, here are some of the precautions a provider should take if receiving such emails:

 

• Be cautious of any emails that use exclamations like “URGENT”, “MUST RESPOND”, or mention some sort of penalty if you don’t respond immediately. Typically, these emails are not from any legitimate source. 

• Be suspicious of any emails that have spelling or grammatical errors and dates that haven’t been updated to the current year.  

• Double check email addresses and make sure they match previous legitimate email correspondence. Look for slight misspellings and differences. 

• It is easy for malicious operators to download logos, contact information and text to look like the real thing.

• If you are unsure, consider looking on your secure Availity portal to see if you have any alerts or messages. 

• Always go directly to the providers' website, contact information or secure portal to look for updates and current information. 

• Double check to see if your Regence provider contract is still current or due to expire. 

• Consider calling Regence Provider Relations before filling out any information online. 

Regence is in the process of updating their contracts and moving renewals online. After ensuring any email communication from Regence is legitimate, here are a few things to consider with a new contract.

 

• Read and compare your new contract to any previous contracts.

• Is this the same contract or does it have changes other than moving to an electronic format? 

• Am I willing to take on the responsibility that this new contract requires of me and my business?

• Have I checked with the OIC to see if this contract has been approved?

• If I sign this new contract, could it still be binding even if the OIC has not approved it?

• Should I have an attorney review the contract BEFORE I sign?

• What are the ramifications if I don’t sign this new contract?

Do you have questions regarding this new contract? Please send your questions to us as soon as possible.

We have reached out to an attorney who specializes in reviewing provider contracts. Our goal is to have him thoroughly review & clarify the contract(PSA) language including any  additions/changes from prior contracts and research approval by the OIC. (Office of the Insurance Commissioner)

Are you interested in helping share the costs and the results of this legal review/consultation. Please let us know along with any questions you may have. 

By Dagmar Growe, LMT

In our quest to determine the rate we need to charge for our services versus simply charging what everyone else does, we have looked at the actual cost per massage, and our needed and desired income. The method we used to determine cost per massage can of course be applied to all other services we offer.

In this last segment we will put the numbers together and see how close we are to having a financially stable and successful business. We will also look at some additional considerations.

Your real hourly income:

Maybe you work in a setting where a 1 hour massage consists of 50 minutes, and you walk out of the office after your last massage with no further worry. Otherwise, it’s important to look at how much extra time you put in. Client calls, insurance billing, promotion, bookkeeping, business management all need to be compensated by your massage income. If you make house calls, this includes your driving time. If you have employees there is all the time you spend managing them. Keep track for a week or two of how much time you spend outside of actual massage time. Maybe you find that for every massage you provide you spend 1 ½ hours work-time, meaning you have to divide the net income per 1 hour massage by 1 ½ to determine your hourly income.

Self-employed vs. Employed: 

Generally, employed therapists have less extra duties than self-employed therapists. However, requirements can vary greatly from one place of employment to the next. If you interview for a job be sure to ask about all the additional work you are expected to perform. Will you be paid per hour of shift time? Per massage? What happens when a client does not show up, or an appointment does not get filled? What benefits are offered? What are the rules when you decide to leave - will you be allowed to take your clients with you? What restrictions are placed on you by your employer?

Self-employed therapists generally have more freedom to set their own schedule. With that comes the extra work of managing one's own business. Think about which jobs are worth the expense of hiring out. Bookkeeping? Laundry? Insurance billing? This is not just a money question, but also one of skill, time constraints, and personal preference. If you really hate bookkeeping it might be worth the cost of a bookkeeping service - I prefer to do my own so I can stay on top of my business finances month-to-month. Also keep in mind that you will owe quarterly self-employment taxes, which are double the social security tax that an employee pays - the employer is responsible for the other ½. On the up side, for most self-employed therapists the biggest expense is office rent. As this is often a fixed cost, the cost per massage will decrease with more massages given. This makes it easier to increase one’s income if needed.

Insurance or Not:

Insurances claim that their lower reimbursement rates are made up for by the larger number of clients they provide to your business. This makes sense only if you cannot generate enough business without those referrals. You may be willing to fit insurance clients into your busy schedule to make massage therapy available to patients who could otherwise not afford it. But you also will need to look at your cost per massage, and in fact your hourly income per insurance massage as insurance work often requires significant extra time. You may find that the reimbursement rate does not cover your cost or leaves you with a ridiculously low hourly income.

My Story:

All of these considerations play out differently in different phases of our lives. I started massage therapy when employment was rare. Initially I tried to build my own business, but found it difficult to generate enough clients. I switched as an independent contractor to a local massage business which provided me with lots of clients - great for a new LMT to “practice”. I then found a place of employment which provided me with health insurance for my growing family, and allowed me to take extended maternity leave without having to worry about my practice. Eventually, my relatively low hourly pay created financial hardship for my family, and when my employer discontinued offering massage I jumped at the opportunity to be self-employed. My income immediately increased significantly. I worked from home, which meant very low cost per massage (and allowed my kids to appreciate how hard their mom was working - not a bad lesson for children). After a few years of working on my own, I joined a local clinic part-time. I had not even realized how isolated I had become in my home office. Now that my children are on their own, I appreciate the opportunity to take off as much time as I want. I still work part-time at home because of the low cost, and part-time at a clinic because the interaction with peers is important for my quality of life. I am constantly decreasing my insurance availability because the reimbursement rates do not afford me the life choices I am making.

Your story:

I hope these articles have been of help in looking at the facts of your business and considering the options you have. Like with my story, different options may be better than others at different times of your life. With the current shortage of LMTs this is an excellent time to carefully consider all the facts, and make continuous choices in the direction of your dreams.

Good Luck!

By Dagmar Growe, LMT

There has been a lot of buzz around the increase of the maximum number of massage therapy treatments allowed through Uniform Medical Plan. Uniform Medical members are calling massage clinics and asking to schedule “their” bi-monthly massage. However, as is generally true, things aren’t as simple as they seem, especially when you read Uniform Medical’s fine print.

First of all, it’s important to note that this change only affects Uniform Medical, not any other plans administered by Regence. Uniform is a self-insured plan which means it can make up its own rules, including offering higher limits on allowed visits.

Second, according to the Uniform Medical Plan(UMP) Certificate of Coverage a prescription is still required. This means a physician’s order for a service (or a procedure) that is needed to treat a specific condition, specified by a diagnostic code. In other words, Uniform continues to require medical necessity in order to pay for treatments. If a future audit finds that massage services were not provided as treatment for the condition indicated by the prescription, the massage therapist might be faced with a demand to repay insurance payments received for those massage treatments.

Unfortunately, the benefits summary is not specific about any of this, physicians frequently provide very general prescriptions at patient’s requests, and massage therapists are left in the uncomfortable position of explaining to patients the unexpected limit of their benefit. Be sure to carefully and correctly document the treatment nature and medical rationale for any massage services you provide, especially for treatments that are reimbursed by health plans. Your treatment records are your best, and likely only defense if you are facing an audit.

by Robbin Blake

September 30, 2021 was the last day M54.5, lumbago (low back pain), was a valid and billable ICD-10 diagnosis code. Beginning October 1, 2021, all healthcare providers should have changed this code to one of the newly created back pain codes which are:

• S39.012, Low back strain
• M51.2-, Lumbago due to intervertebral disc displacement
• M54.4-, Lumbago with sciatica
• M54.50, Low back pain, unspecified
• M54.51: Vertebrogenic low back pain
• M54.59: Other low back pain

There is also a warning that S39.012 “Strain of muscle, fascia and tendon of lower back” should not be used with any other diagnosis beginning with M51.2-, M54.4-, or M54.5- as it will likely result in claim denial. 

You can find more detail about M54.5 and S39.012 at:

• Webpt.com (major physical therapy biller, scheduler, charting company  https://www.webpt.com/blog/m54-5-is-no-more-the-scoop-on-icd-10s-low-back-pain-code-change/

• Icd10data.com (primary ICD-10 code website) https://www.icd10data.com/ICD10CM/Codes/M00-M99/M50-M54/M54-/M54.5

by Elizabeth Jane Brooks, LMT, BCTMB

With open enrollment just around the corner, some helpful information for your consideration is below. This information will help self-employed individuals choose a healthcare plan that is best for their needs in the upcoming year. Open enrollment begins on November 1, 2021 and ends on January 15, 2022. A few things to consider:

• The 4 categories: Bronze, Silver, Gold, and Platinum

• Type of plan you like: HMO, PPO, EPO, or POS

• If you want a Health Savings Account (HSA)

• Your total out-of-pocket cost

The 4 Categories

	Bronze	Silver	Gold	Platinum
Insurance pays	60%	70%	80%	90%
You pay	40%	30%	20%	10%
Premium	Lowest	Moderate	Higher	Highest

• Bronze plans are a good choice if you want to pay a low premium and only want to be covered for major illness/accidents. Since these plans are eligible for a Health Savings Account, your routine care (which is not covered by the Bronze plan) could be paid from the HSA.

• Silver plans are a good choice if you don’t mind a slightly higher premium and have more routine care coverage. They are also eligible for a Health Savings Account.

• Gold plans are a good choice if you use a lot of medical care and are willing to pay a higher premium than the Silver plans, and are wanting more costs covered. These plans are not eligible for an HSA.

• Platinum plans are a good choice if you need a lot of medical care and are willing to pay a high monthly premium. These plans are not eligible for an HSA.

Types of Plans

• Health Maintenance Organization (HMO)
  With this type of plan you must stay within their network. A primary care physician manages your care and will give you the necessary referral to see a specialist if needed. If you see a provider that is out of network, you will have to pay the full bill yourself (e.g. a cancer specialist, a favorite cardiologist, etc.).

• Preferred Provider Organization (PPO)
  You have the freedom to see any healthcare provider with this plan but you will pay a higher percentage for out-of-network providers. In addition, there is usually a higher deductible for out-of-network providers.

• Exclusive Provider Organization (EPO)
  This plan only covers in-network providers, and there is no need for a referral for specialists from your primary care physician. It’s important to know beforehand whether all of your providers (e.g. your anesthesiologist during a surgery) are in-network so you are not surprised by a high bill. 

• Point-of-Service Plan (POS)
  You can see both in- and out-of-network providers with this plan; however, you will pay a higher portion for out-of-network. Your primary care physician coordinates your care and provides the referral if you need to see a specialist.

• Catastrophic Plan
  This is for those under 30 or those who qualify for a “hardship exemption.” This plan offers a lower premium, free preventative care, and 3 primary care visits, even if your deductible has not been met. This plan’s deductible is $8,550 for an individual and $17,100 for a family in 2021. After you reach the deductible the plan pays 100% of covered medical benefits.

• High-Deductible Health Plan (with or without a Health Savings Account)
  This is similar to the Catastrophic Plan in that it has a lower premium. The deductible begins at $1,400 for an individual or $2,800 for a family, but not more than $7,000 for an individual and $14,000 for a family in 2021. Preventive care is free even if you haven't met your  deductible.

Health Savings Account (HSA)

This is a savings account used for medical expenses when you have a healthcare plan that has a deductible of $1400 for an individual and $2800 for a family. Money left in your HSA account at the end of the year is not lost and will carry over to the next year. If you rarely go to the doctor, an HSA account can be used to build up savings as you are able to keep all monies invested until you decide to use it for medical expenses, tax free. With deciding plans, note also that out-of-pocket costs include deductibles, copayments, and other amounts (but not premiums).

	Single Plan	Family Plan
Max contribution	$3,650	$7,300
Catch up contribution	$1,000	$1,000
Minimum deductible	$1,400	$2,800
Maximum out-of-pocket	$7,050	$14,100

Deciding Factors in Choosing a Plan 

• Health: How healthy are you? If you are very healthy, a bronze or silver plan may be sufficient for you. If you have a major illness you would most likely be better off with a gold or platinum plan which would give you more coverage.

• Medications: If you have expensive medications necessary for maintaining your health, you want to make sure those particular medications are covered by your plan.

• Networks: Do you think you may need any out-of-network providers for the upcoming year? Is your primary physician in- or out-of-network for a particular plan? You will want to make sure that your favored providers are in-network to reduce your out-of-pocket costs.

• Area of Coverage: People who enjoy backcountry sports, such as mountain climbing or backpacking, and people with significant health issues that may require transport to a city hospital in an emergency, need to make sure their plan covers them should they need airlifting. You don’t want to be surprised by a $20,000+ bill, so consider where you live, work, and play, and the ramifications of needing care in those situations.

• Total Costs: After considering your circumstances and individual needs, determine which category you would like (Bronze, Silver, etc.) and the type of plan you prefer (PPO, EPO, etc.). Then, take your maximum out-of-pocket expenses and add your annual premium expense. This number gives you the total possible cost for any plan. 

WSMTA hopes this article makes your choice for a health care plan a little bit easier for you.

Resources:

Health Plans

• www.wahealthplanfinder.org/

• www.ehealthinsurance.com/individual-family-health-insurance#start

Brokers

• www.washingtonhealthinsuranceagency.com/about-us/

• www.wahealthplanfinder.org/HBEWeb/Annon_DisplayBrokerNavigatorSearch.action?brokerNavigator=BRK

HSA allowable expenses

• www.irs.gov/publications/p502

• www.hsabank.com/hsabank/learning-center/irs-qualified-medical-expenses

By Dagmar Growe, LMT

Today we are continuing to pursue the question of how much we need to charge for our services. In Part 1 of this series, we looked at how much you earned per massage, and the structure of different rates in your business. Today we will take a step back from your business, and look at your personal financial picture. Today’s questions are: How much do you need to earn, and how much would you like to earn? And we will ask how much you want to work, and how you would like to structure your work.

How much income do you need? How much would you like to earn?

Unless you can answer these questions with a fact based dollar amount, I challenge you to sit down and do some math. Again, let’s first look at fixed expenses - those that are roughly the same every month. Make sure to include expenses paid less frequently, like property taxes, and quarterly taxes. Sort them into 2 categories: Needs (like utilities) and wants (like a gym membership or a Netflix account). Figuring your flexible spending is a little more tricky: If you generally pay cashless, you can go over your statements. You may want to log your cash expenditures over a period of time to average your needs and wants per month.

Because our income can fluctuate wildly from month to month it is important to have some reserves. Getting a realistic idea of your minimum expenses will help you with establishing an appropriate reserve for times of illness or vacation. Knowing how much it takes to cover your wants can give you guidance and peace of mind if you consider cutting back work hours.

How Much Do You Want to Work?

In a culture where more is better, determining what is simply enough can be a task of spiritual dimensions. Most of my friends never ask themselves this question as their jobs are all or nothing situations. One of the advantages of our profession is that most employers offer part time schedules. But there is a constant temptation to be lured into more hours - because our clients or our employer really wants us to or because we like the idea of earning more.

Massage therapy is strenuous work - how many massages per day can you do without injuring your body? How many days per week do you want to work? What are your family’s needs, and how can you best balance them with work? Do you like evening or weekend work?

Right now our profession faces a serious shortage of therapists. Clinics are looking for employees or contract LMTs, patients are looking for a new therapist because their previous one retired or left the profession. This is a great time to make the changes you would like to make for your own benefit. Do you want to change your working hours? If you are willing to work weekends and evenings you may decide to charge extra for those times as those appointments are difficult to find. Should you re-evaluate how much you are being paid per hour?

Part 3 of this series will look at putting the numbers together! Have fun playing with the numbers. I promise you some surprises, and some peace of mind if you follow through on this. You will be able to make decisions based on fact - or, as they call it in our field: Evidence based planning and decision making.