Dual Operations Guidelines for Manual Therapists
Dr. Gregory Lawton American Health Source
DUAL OPERATIONS GUIDELINES FOR MANUAL THERAPISTS I am frequently asked about how to establish dual business operations in a manual therapy practice. Manual therapy includes massage, naprapathy, chiropractic, acupuncture, and other forms of hands on health care. By dual business operations it is meant that a solo practitioner or a group practice will establish a strictly medical side to their practice of manual medicine and a completely non-medical side of their operation that is focused on wellness. In the material to follow I will outline how you, as a manual medicine and therapy professional, can create a practice that accomplishes both a medically based and a non-medically based practice. The first step to creating a dual operations plan for your professional practice is to divide your practice into two separate areas of operation: 1. Medical Care Operations - One area of operation is based upon the treatment of patients who present with a medical diagnosis and a need for corrective and restorative care. 2. Wellness Spa Operations - The second area of operation is based upon providing services for clients where there the client is self-presenting and requesting for wellness services. Medical Care Operations Medical care is defined by, and based upon, a medical, chiropractic, naprapathic, or naturopathic diagnosis. The health care professional who is providing the diagnosis must be licensed in the state where the diagnosis is provided, and the patient’s condition and treatment must be within the physician’s legal scope of practice. Medical care results when there is a diagnosis as is identified in the AMA diagnostic code book, ICD 10, and when health care for the condition is provided by an authorized health care provider which includes a chiropractor, a naprapath, a naturopath, massage therapists, or an acupuncture practitioner. Always document the medical diagnosis and the source of the diagnosis. Medical care requires, by law, standard medical recordkeeping and patient record retention. In manual medicine care includes providing the patient with corrective and restorative physio-therapeutic care which may include manipulative and manual therapy (97140) and therapeutic procedures and modalities. In order to bill health care insurance the professional who is providing medical care must meet two criteria. The first criterion is, there must be a medical diagnosis. The second criterion is, there must be demonstrated and measurable results from the treatment that is provided to the patient. Page | 1
On the medical operations side of a practice the professional who is providing treatment should use the CPT codes allowed for their professional practice such as E/M codes, manipulation codes, the manual therapy code 97140, and therapeutic procedure and modality codes. You may also you may accept cash, check or credit card payments or bill medical and health care insurance. You may choose to directly bill a patient’s insurance carrier, or you may have the patient pay you at the time that the care is provided and then the patient submits the bill for reimbursement from the insurance carrier. You may be authorized to bill Worker’s Compensation or an automotive insurance carrier. Some patients have a health care savings account and they can pay you directly for your professional fees from that account. Health savings accounts are legally established for valid medical and health care expenses. You will need to establish a fee schedule based upon reasonable and customary fees for AMA CPT codes. Wellness Spa Operations The second area of operation is the non-medical side of your business or the “Wellness Spa”. Use the term wellness spa or any similar non-medical terminology. The key here is that you want an identity and branding that is non-medical. On the wellness side of your business you do not have patients, you have clients. Wellness is defined as “A quality or state of mind of being healthy in mind, body, and spirit”. In your “Wellness Spa” you will create a client menu of services and a fee schedule for these services. Create unique names or trademarks for the services that you provide. This is called “branding”. Unique non-medical names and descriptions for your services will further separate your wellness spa activities and services from medical practices and procedures. Many wellness centers and spas create “signature” names and trademarks for their client services. Examples include: Anti-Aging Relaxation Massage Hot Stone Ritual Massage Aromatherapy and Stress Massage Deep Fusion Massage Acupressure Massage Cupping Massage Reflexology Massage Stress Free Massage Herbal Relaxation Massage Infusion Energy Boost Massage Detoxification Massage Holistic Massage
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Legal Business Structure All health care businesses should be incorporated. It is professional “suicide” not to be incorporated. The best way, and most legally defensive way, to organize your dual operations business is to run each side under a separate corporation, perhaps two different limited liability corporations. By having two separate companies each one is protected from something bad happening to the other one. By incorporating your practice, you are personally protected from risks, threats, and lawsuits that may occur in the business. You can choose to have one corporation but divide it into two legally formed dba’s (doing business as). You can file dba’s with your state’s corporation division. Having two dba’s under one corporation will afford you less legal protection, but perhaps it is adequate for your business purposes. To simplify your corporate income tax reporting talk with your tax accountant or CPA about running all business revenue through one corporation and not two. Dual Operations Manual Create a brief and separate “operations manual” for each of the operations. An “Operations Manual” can be two or three sheets of paper with a paragraph or two of copy on each page. It is important to have the “manual” but it does not have to be lengthy or complicated. Use a small folder or a three-ring binder and create an Operations Manual cover page. In the binder place a statement that describes your mission and purpose, your office policy and procedures, your billing policy and procedures, and your professional fee schedule. For the Medical Care Operations Manual use mission and purpose statements such as, “The medical and physio therapeutic treatment of a diagnosed medical condition (ICD10), with the measurement of a clinical response results from corrective and restorative care employing manual therapy, manipulative therapy, and therapeutic procedures and modalities (CPT).” Describe the medical area of your operations in medical terms and based upon medical and physio therapeutic treatment of a diagnosed medical condition, with the measurement of clinical results during corrective and restorative care. Include your professional fee schedule based upon CPT codes and standard medical insurance billing procedures. For the Wellness Spa and client services area of your operations describe your operations in non-medical terms such as "For general health promotion, stress relief, and wellbeing." Create a spa menu of services for clients. If you do therapeutic exercises, call it yoga, tai chi, dao yin, or Pilates. Do not use manipulative billing codes Page | 3
on this side of the practice. If you have to use a massage code use 97124 but document that it is for stress and relaxation purposes. If you need to treat a patient or if a patient needs an invoice or report for insurance purposes treat them through the Medical Care Operations side of your business. Do not mix the two sides together! Your Wellness Spa side of operations does not (should not) provide billable health care. Your Wellness Spa Operations Manual should include your mission and purpose statement, your office policy and procedures, and your spa menu of services and fees. Keep Your Dual Operations Completely Separate As stated above, do not mix the operations of the two sides of your business. Keep separate patient or client, business and financial records for each operation. Do not have one patient or client record or data base where you track appointments. Maintain your patient intake, medical history, case notes and treatment records for the Medical Care Operations business separate from the appointment schedule and fees for client services records and payment receipts for the Wellness Spa Operations business. If you are providing relaxation massage (97124) state massage law probably requires that you keep massage intake and case notes but keep those notes non-medical and focused on wellness, health promotion, stress relief and relaxation. Do not use a medical diagnosis but rather use statements such as, "Client requests relaxation massage for stress, or client requests general massage for tight muscles." Avoid any medical terminology and diagnostic language. If you use descriptions like low back pain, headache or muscle spasm you are diagnosing and describing a medical condition. Don't do that. Instead say "Tight right hamstring and client stated it felt sore”. Don't diagnose on the wellness spa side, instead write, "Client said has sore leg muscles from running." Always report why the massage is being conducted by saying, “The client said….” If you are providing spa services that do not fall under existing licensure laws such as massage therapy, then you are not required to indicate why the service is being provided. You might want to look at your state massage therapy law and review the “exemptions” for licensure and regulation. For example, in some state’s acupressure, shiatsu, tuina, and many other forms of bodywork are exempt from licensure and regulation. Use the non-regulated terminology when possible. Conclusion While I have been in various health care schools, training, or practicing for over fifty years, I am not an attorney, a tax accountant, or a CPA so the information in this article cannot be construed as legal or tax advice. For that consult with your attorney, tax accountant or CPA. I came up with these ideas on my own several decades ago and I Page | 4
ran them by my corporate attorney, my tax accountant, and my CPA. These guidelines are the best that we could formulate. I hope that they are of help to you and I wish you every success in your practice! Author: Dr. Gregory T. Lawton is a licensed naprapath, chiropractor, and acupuncturist. He is the founder of the Blue Heron Academy of Healing Arts and Sciences.
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