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

By Dagmar Growe, LMT

I have recently come across a number of questions regarding billing codes. In my early days of insurance billing, I remember being  told by more experienced therapists about a few numbers to be entered into certain fields of the HCFA form, with no understanding on my part, and possibly theirs, about the meaning of any of them. Some things have gotten easier with electronic billing as pull-down menus offer explanations, for example for “Place of Service” (POS). However, there are 2 codes that are essential to understand:

• ICD-10 (International Classification of Diseases, Edition 10): This is a numeric expression of a diagnosis -  what we treat. Since it is outside of the scope of practice of massage therapists to diagnose, we will need to have this code supplied to us by a healthcare professional who is licensed to diagnose. Even if insurance policies do not require a referral, we still need an ICD-10 code to fill out the HCFA form and get paid. It is also important to note that some insurances will not pay for certain codes, for example fibromyalgia, myalgia, or certain headache codes. If you get a referral with one of those codes you’ll need to call the doctor’s office and request a different code to be assigned.

• CPT (Current Procedural Terminology): This is an expression of the “procedure” we are performing--how we treat-- and it determines the amount of reimbursement. In theory, LMTs should be able to bill for any CPT code that covers techniques or procedures which are part of our scope of practice. However, many insurances will only pay for 97124, which stands for “massage, including effleurage, petrissage, and/or tapotement”. Other possible codes include 97140 (manual therapy) and 97112 (neuromuscular reeducation). However, if using these codes, it is of utmost importance to understand what these codes describe, and to document your treatment accordingly. Also, be sure that you can show you have been trained to perform these techniques. If you get audited and your documentation is deemed insufficient you may be required to return insurance payments. More information on codes can be found here.

By Dagmar Growe, LMT

(Updated CE requirements Link)

While hands-on continuing education (CE) requirements are suspended for now, LMTs need to continue to report 24 hrs. of CE every 2 years with their license renewal. With the loss of income due to the COVID19 pandemic, many LMTs are struggling to come up with funds to pay for continuing education. Here are some low cost and free options

1. Professional Associations: ABMP and AMTA offer free and lower cost CEs for members.

2. Service on massage related boards or committees: Volunteer with WSMTA and receive CEs for your service.

3. Self-study: Up to 2 hrs. per reporting period. A 2 page synopsis of the studied material is required.

4. Teaching: Consider offering a class – the first time you teach it it will count toward your own CE.

5. Local networks such as North Cascades Massage Connection or South Sound LMPs offer low cost CE. If there is no network in your area consider starting one. We will be happy to support you.

6. Subscription Services:  These often offer a large amount of online CE for a low flat rate.  This is a buyer beware category, so do your research.

7. As a member of WSMTA you may earn up to 3 free continuing education credits by attending WSMTA’s Annual meeting.   

Find the regulations regarding CE here, and the Board of Massage’s proclamation temporarily suspending hands-on CE can be found here: CE requirements. Plan ahead - don’t wait until the month before your CE is due: Spread your CE over the 2 year period, and take advantage of affordable and interesting opportunities.  

By Dagmar Growe, LMT

While hands-on continuing education (CE) requirements are suspended for now, LMTs need to continue to report 24 hrs. of CE every 2 years with their license renewal. With the loss of income due to the COVID19 pandemic, many LMTs are struggling to come up with funds to pay for continuing education. Here are some low cost and free options

1. Professional Associations: ABMP and AMTA offer free and lower cost CEs for members.

2. Service on massage related boards or committees: Volunteer with WSMTA and receive CEs for your service.

3. Self-study: Up to 2 hrs. per reporting period. A 2 page synopsis of the studied material is required.

4. Teaching: Consider offering a class – the first time you teach it it will count toward your own CE.

5. Local networks such as North Cascades Massage Connection or South Sound LMPs offer low cost CE. If there is no network in your area consider starting one. We will be happy to support you.

6. Subscription Services:  These often offer a large amount of online CE for a low flat rate.  This is a buyer beware category, so do your research.

7. As a member of WSMTA you may earn up to 3 free continuing education credits by attending WSMTA’s Annual meeting.   

Find the regulations regarding CE here, and the Board of Massage’s proclamation temporarily suspending hands-on CE can be found here: CE requirements. Plan ahead - don’t wait until the month before your CE is due: Spread your CE over the 2 year period, and take advantage of affordable and interesting opportunities.  

Federally Regulated Health Plans and Massage Therapy

by Dagmar Growe, LMT

There is a lot of confusion surrounding federally regulated health plans. The Every-Category-of-Provider statute requires that insurers must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits (WAC 284-170-270). Since this is a state statute it does not apply to anything which is regulated by federal law. This means that massage therapy benefits can either be excluded by any of those plans, or be limited by any number of arbitrary rules the plan chooses. Because the customer service representatives are generally not very forthcoming with information, it is easy to end up with unpaid claims.

This article aims to shed some light on the different types of federally regulated plans and what to be aware of.

1. Federal Employee Health Plans (i.e. US Postal Workers Health Plan): These never cover massage therapy. However, I have been told otherwise by a customer representative, just to be told later “only if performed by a PT”.

2. Self-Insured Plans: Large employers or associations like trade unions may opt to create a trust fund for health care expenses, rather than to buy coverage from an insurance company. However, they may then hire an insurance company to administer the trust fund. The best known example of this is Uniform Medical, which is a self-insured plan for WA State employees that is administered by Regence Blue Cross. These plans are regulated by ERISA (Employee Retirement Income Security Act of 1974, a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans). These plans may opt to provide massage therapy benefits, likely because of customer demand, but then apply additional rules which are generally not volunteered by customer service representatives. Here are some examples: “Yes, we cover massage therapy, but only if performed by a PT; but only if billed through a chiropractor, PT or MD office; but only if part of a PT treatment plan and the PT has to bill first”. Additionally, these plans may offer ridiculously low reimbursement rates, and in one case I saw only cover “up to 2 units”. 

3. Federal Health care plans like Medicare, VA healthcare, and Tricare: These plans never cover massage therapy. However, many Medicare insured people have supplemental plans that will cover massage. It is standard practice for supplemental plans to require a medicare denial before covering remaining expenses. The large insurance companies generally know that massage therapy is never covered, and that massage therapists are unable to obtain a denial, and do not ask for this. Some insurances (or some of their staff) do not understand this, and insist on the denial. In this case filing a complaint with the Office of the Insurance Commissioner will be helpful.

Delegating the research regarding plans to patients will not work, as it is important to ask the right questions. It may be helpful to ask if patients have had massage covered by insurance before, but it will not be a guarantee that a claim will be paid.

Interim Guidance on Personal Protection Equipment Rev 9/18/20

This document is an interim guide for massage therapists in making selections on Personal Protective Equipment (PPE) to use while in the treatment room or office. WSMTA makes minimum PPE recommendations for massage therapists and their clients, highlights the options available and how to choose the best option for your practice and your clients/patients.

What’s New: Updated information on facemasks and respirators as well as new information on how to obtain PPE from the WA State PPE Stockpile.

Click Here or on the title above to open the document link.

Interim Guidance on Sanitation Rev 9/17/20

The Sanitation document builds on the Interim Guidance on Personal Protective Equipment by providing more information on cleaning and disinfecting PPE, extending the life of it and storing it. This document also provides information on cleaning and disinfecting (the how, why and strategies for reducing the amount of time doing it) as well as many other important things related to the setup of a massage room or clinic while COVID-19 is an issue.

What’s New: Updated section on air quality in the treatment room and new information about aerosol, droplets, infectious dosage and viral load.

Click Here or on the title above to open the document link.

Interim Guidance on Practice Guidelines Rev 9/19/20

The Practice Guidelines document provides information on how to check for symptoms and signs of health in yourself and your patient/client. It takes all of the prior information the PPE and Sanitation guidance documents provided helps the massage therapist to put it into an infection prevention and control plan as well as provides strategies for before the massage session, during the massage session and after the massage session.

What’s New:  The section on “Blood Clotting and Best Practice Considerations” has been significantly updated to “Effects of COVID-19 on the Body and Best Practice Considerations” as well as other smaller updates throughout the document.

Click Here or on the title above to open the document link.

Breaking: Regence Providers

It has come to our attention that some Regence providers have received a contract amendment titled, "Regence BlueShield Data Access, Use & Transfer Addendum", sometime in December or early January. We advise you to take note of this amendment and read it carefully. WSMTA is working on clarifying some of the provisions with Regence, but we encourage you to do your own research.

WSMTA is committed to continuing this vital function and representation for Washington LMT’s.

We need your continued support with your membership and/or donations to support our operations at www.mywsmta.org.

Thank you!