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.

By Dagmar Growe, LMT

Thanks to the many LMTs who responded to our recent informal survey. We appreciate the time you took to write.

First off, I want to clarify a point that  some respondents seem to have misunderstood: WSMTA has no position as to whether therapists should be requiring patients to be vaccinated or not. This is a decision individual business owners need to make for their business.

Not surprisingly, there is a shared sense regarding one’s autonomy about healthcare issues. On the one end of the spectrum are those who for a variety of reasons are choosing not to be vaccinated, on the other are those who fear for their own safety, and the safety of vulnerable family members or patients when exposed to unvaccinated patients. I heard from a therapist who works at a spa where a sizable number of patients ask to be seen by vaccinated therapists only. Most therapists are ok working with unvaccinated patients, as long as masks are worn (see article regarding mask requirements).

A number of respondents asked  if refusing to work with unvaccinated patients is legal. A business owner has the choice to refuse service, unless the service is rendered under a health insurance contract. That contract will contain a non-discrimination clause, and insurances will look at the refusal as discrimination.

Some responses seemed to indicate a certain lack of tolerance for those making a different choice regarding vaccination. I would like to remind all of us that the right to make a choice regarding our own health goes in all directions: To receive the vaccine, or to not receive it, both for therapists and for clients, to expose oneself to unvaccinated patients or to unvaccinated therapists.The patient who chooses to not see an unvaccinated therapist deserves as much respect as the therapist who chooses (again for whatever reason) to not receive the vaccine. We can accommodate our patient’s choice by developing referral relationships: Those who are not willing to work with unvaccinated patients can provide names of therapists who will, therapists who are not vaccinated can refer to vaccinated therapists. Our strength lies in being a diverse community of massage therapists - by working together we can accommodate many different choices and needs.

By Dagmar Growe, LMT

Nicole Chryst, business consultant, owner of Ballaura Wellness Spa in Olympia, and presenter at WSMTA’s recent annual meeting, made an interesting comment during her presentation. Massage therapists, she suggested, generally base their pricing on what others charge, rather than figuring out how much they need to charge in order to have a viable business which provides the income they need or desire. Not knowing the full financial picture of one’s own business can keep us from taking early action to remedy problems, and to intentionally move our business in a direction that we desire.

Many of us are great healers, but not everyone has a past in business or accounting. Here are some easy steps you can take to assess the health of your business.If you have a pretty clear idea of the numbers below for your business: Congratulations! If not, I challenge you to spend a little extra time to find out how well you really are doing.

Expenses per Massage: The easy way:Take the total expenses from last year’s taxes, adjust for any changes (like having been closed, or a rent increase), and divide by 12 month. Then figure out the average number of massages your business provides in a month, and divide your expenses by that number. This is what it costs you to provide a massage.

However, it may be worth the extra time to break your expenses down into fixed and flexible expenses. Fixed expenses are those you have to pay regardless of how many massages your business provides. Rent and utilities, a receptionist hired for a set amount of hours, marketing expenses. Make sure to include expenses that are due annually, like your license, your insurance, and if you own your business location, property taxes. Flexible expenses are those that change depending on how many massages your business provides. Expenses for employees who get paid per massage (include payroll taxes), laundry and PPE expenses are examples. The interesting part is that the portion of fixed expenses per massage will decrease  as the number of massages in a month increases, and vice versa. This information is important when you are trying to figure out solutions to potential problems

Income per Massage: Total your massage income over a period, and divide it by the number of massages your business provided during that time. This is your average income per massage. However, you may want to look at it a little more detailed. How many of your clients pay the full price? Maybe you offer discounted rates for packages or membership or friends. Do you offer a sliding scale? Do you bill health insurances, and receive various reimbursement rates depending on which insurance? Tally your various payment levels so you know exactly how many massages you provide for each payment level.

Now you know exactly what it costs you to provide a massage. Are any of your rates below the combined fixed and flexible costs per massage? YOU are paying for those clients to receive a massage from you or your staff. How many just barely cover their cost? Where do you make money? You may find that you need to limit the number you offer of certain payment levels. Knowing the numbers allows you to identify the weaknesses and strengths of your business, and guides you to where changes will be most effective.

 A few years ago I did the math for my own business. When I added into my calculation the time spent on scheduling, room changes and billing, I realized that certain health insurance reimbursement rates would amount to an hourly wage close to minimum wage. I decided to cancel those contracts. I now track these numbers monthly. It does not add much work as I have set up an efficient system for it, but it gives me the confidence to know that I am on track.

To be continued….

By Dagmar Growe, LMT

We want to hear from you:

Over the course of the last year, massage therapists and clinic owners have figured out how to practice while keeping ourselves and our clients safe. Mostly this involved a combination of sanitizing protocols, PPE, assessment of health status and lifestyle choices. However, as vaccines have become widely available, we are faced with a new set of questions. Do we require vaccination, for our patients, for our staff? Do we change our protocols for vaccinated patients? Do we require masks when both patients and therapists have been fully vaccinated? Do we feel safer with vaccines, or do we feel less safe as social distancing practices decrease? These are some of the questions massage therapists face during this next phase of Covid-19. And likely there are others that you have been considering or dealing with.

We would like to hear from you! What are your thoughts, concerns and policies? We want to share your questions and solutions with our members so that we can continue to practice safely. Please email me at info@mywsmta.org

By Elizabeth Jane Brooks

Substitute Senate Bill 5169 -- PPE Reimbursement

SSB5169 enables all healthcare providers to seek reimbursement for personal protective equipment during the state of emergency related to COVID-19. This bill adds a new section to chapter 48.43 RCW and provides a contingent expiration date and declares an emergency.

The Washington State’s legislature finds that since the delivery of healthcare services is essential and maintaining patient safety during this pandemic is paramount, healthcare providers are incurring substantially increased costs in following state and federal regulations to minimize the risk of viral transmission. These costs are associated with obtaining personal protective equipment. Since these substantial costs have not been factored into our contracts with health carriers, the State Legislature found this bill necessary to alleviate the burden on healthcare providers. 

Many healthcare providers do not have a way to recoup the costs of personal protective equipment since many contracts with health carriers prevent the billing of supplies to patients and their health insurance providers. Therefore, the legislature finds that to help ensure patient safety and continued access to personal protective equipment, it is necessary that health carriers reimburse healthcare providers for costs associated with personal protective equipment.

A new section is added to chapter 48.43 RCW to read as follows: 

For the duration of the federal public health emergency related to COVID-19, a health benefit plan shall reimburse a health care provider who bills for incurred personal protective equipment expenses as a separate expense, using the American Medical Association's current procedural terminology code 99072 or as subsequently amended, $6.57 for each individual patient encounter. For purposes of this section, cost sharing is limited to the covered service according to the terms and conditions of the health benefit plan and does not apply to an expense for personal protective equipment. This section is not intended to apply to health care services that are not provided in person.

This act took effect on April 16, 2021 and will be in effect for the duration of the federal state of emergency related to COVID-19 and will expire when this state of emergency is over.

So, What Does This Mean?

Healthcare providers treating patients in state-regulated commercial health plans who have incurred costs for PPE will be able to bill the newly created CPT code 99072 and be reimbursed $6.57 per patient encounter as recommended by one of the American Medical Association's committee.

The law operates prospectively, meaning that carriers are not required to reimburse this code for dates of service prior to the law’s effective date; but moving forward and continuing for the duration of the federally declared state of emergency relating specifically to COVID-19, they must reimburse for it.

Given that it can be difficult to know whether a health plan is subject to state regulation, or is exempt from state laws, the Washington State Medical Association recommends billing the code liberally in appropriate circumstances as those health plans which are not subject to the law may opt to reimburse the code. 

In contrast, the Washington State Chiropractic Association (WSCA) recommends just billing state regulated plans (which do not include self-insured plans or those subject to ERISA) as this is a state law and ONLY applies to state regulated plans. They have produced a very helpful video Q&A that can be found here: https://www.youtube.com/watch?v=LTAwY3Pa4N0

You can read, (and you should read), the bill in its entirety here: http://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Session%20Laws/Senate/5169-S.SL.pdf?q=20210423145331