Latest Comments by nurseyperson

nurseyperson 4,401 Views

Joined: Feb 21, '99; Posts: 98 (4% Liked) ; Likes: 8

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    Congrats on starting yoiur own business! When I started my own business 4 1/2 years ago, it was slow. The best advertising is word of mouth, but that takes a while. I continued to work as an RN part time for a few Years until I got too busy doing massage. I ended up working about 5 or 6 days a week, two to three 12 hour shifts as a nurse, and then the other days at my office, and sometimes only see a few people a day or week.

    A few questions. How big is your town? If it is small, flyers in other businesses will help. You can also type up newsletters, brochures, etc. to the medical personnel around town. Unfortunately, advertising is still the biggest expense I have. I prefer to be in the yellow pages of all the phone books of the area. Phone books stay around for years, and I spend a little bit more to let them know that I am different than the regular massage, always putting that I am an RN, Nationally Certified and it is for Pain Relief.

    Of course there are ads in the newspapers, radio and TV. I don't do Radio or TV, it is expensive and people hear it a few times (maybe) and then it is gone.

    One thing I do is to give free treatment time to my clients who refer others. I have a space on my history form for them to put how they heard about me. If they write someones name, I send them a postcard for 15 free minutes. Also, you can give your people certificates to sign and to hand out to their friends, and when the new patients bring it in, the referring patient gets free time. Word of mouth is the best Positive advertising.

    Also, when I started out, I had a booth at Health Fairs and Home Shows, County Fairs. You can have hundreds of people walking by and taking your business cards and brochures. I gave free Samples of Biofreeze, and the first year gave free 5 to 10 minutes massages. That about killed me!!! I learned after that. I charged about $5 for 10 minutes. And I was still swamped. You get a lot of exposure from places like that. The cost of a booth can be anyting from free to $500 or more, but if it is exposure to thousands, it is worth it.

    One more thing..depending on whre your place of business is, a LARGE sign outside is like an ad every day. People drive by and see it who won't see ads at other places.

    If you belong to the AMTA American Massage Therapy Association, they have manuals call the Massage Therapy Careeer Guide. 5 manuals
    1) Planning your career
    2)Establishing your practice
    3) Managing your practice
    4) marketing your practice
    & 5) Growing our practice.
    You can also contact your Small BusinessAdministration in your State for a Resource guide and information on Business development, Loans, Women's Assistance, and different programs.
    take a small business/ Tax workshop.
    Keep every receipt for everything. You can decut SO MUCH for your business.

    get certification from the National Certification Board for Therapeutic Massage and Bodywork

    It all takes money, and it may take 6 months to 2 years to get it going.

    Good luck. If I can give any additional info (this is just from my own personal experience) let me know.

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    :Melody: Hey everyone. Has been a while since there is any new thread, so this is one for any info anyone has on associations, web sites, classes, books, videos, etc. Anything that you want to add to share information.

    I found a web site that is called Massage Register and has an online store, a list of massage associations, find a practitioner, and regulation laws, agencies, schools, etc. and Links to more. http://www.massageregister.com/


    Be sure to look at the site for the National Association of Nurse Massage Therapists. http://www.nanmt.org/

    If I haven't answered your PMs, Sorry! Try again. I am staying busy at work and at home and haven't haad time to devote to the computer. Let me know if I can help!!!

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    Quote from yves
    hi i just took a course in lymphedema. i was supposed to work for a doctor indepedently when i got done but he feels he doesnt have the office space. i know i can bill some insurances but i really want to work with cancer pt which are mostly medicare. should i look for a physical therapist partner or should i look for anothers doctors office. where d i look or get help with billing hey nurseperson could you help maybe email or phone me or vice a versa. i need some guidance. you know we should write a boodk or manual for nurses to go into their own practise and billing issues. yvonne i need help need to get started!!!!

    hey there! i haven't checked the site for a while, sorry! i would try mostly working with a physical therpist if you can. you would get more consults thru more places rather than just the one doctor. and they would be more used to the codes you would use for billing. you also have to make sure you do the complete decongestive therapy for lymphedema, not just manual lymph drainage. the patients have to be diligent about using compression devices, sleeves, etc. to keep the edema out of the extremities.
    make sure that the pt is a provider for medicare for billing. insurance may not pay for a lot of the supplies for decongestive therapy, but does pay for the mld. and pts may like having you there. many that i know would rather do rehab, joint mobilization work, and not the tedious mld. you also have to take care not to step on their toes. define what you will do - massage, soft tissue mobilization - and you should be fine.

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    i work on a lot of people with Fibromyalgia. What you do totally depends on the person. Some people are so tender you have to more stretching and Myofascial release - lighter stuff. Some are so used to pain and have lots of trigger points that you can work deeper and release those and they feel better because of that. I never do only one thing...it is always a combination of neuromuscular, trigger point, and myofascial work and adapt it to how the person feels. I always ask for lots of feedback during the treatment. And also keep in mind that people with Fibro, even those who act tough and are used to the pain, can actually think they are feeling ok with the pressure until the next day when the pain hits. So better to err ont he side of caution with these patients, especially the first treatment.

    MLD, Manual Lymph drainage, actually is for lymphedema, the accumulatoin of lymph in the tissues. It is true you get the fluids moving in any massage, and it certainly would help anyone with a buildup of toxins in their system. But MLD is actually more specific for edema. Any kind of light efflurage (light strokes and especially to the heart) would help increase circulation, lymph flow and the release of toxins. Just depends on how technical you want to get!!!

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    Quote from yves
    i have an appointment tommorrow with a local doctor about the need of a lymphatic massage therapist in the area I live. I also need a Dr to be under to do my billing even tho my massage will be at home. I am hoping to have massage therapy with lymphedema pts and exercise nutrition and education.

    I am nervous and excited about the potentials.

    Yvonne



    Yvonne, please see the post to you under the heading of "Massage Therapy Questions" where you have a longer post about this. As I stated in the message, I doubt if you can do this in your home...but you need to look further into the insurance/medicare/medicaid aspect of it before you even get started and make sure you are going to a schoo that meets the requirements for LANA..................SEe other post.

    Good luck

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    As a nurse I will need a Doctor to order and bill I think. But I have been told that I will be able to do this from home. I am looking into having supplies they can buy or rent such as the compression pumps dressings hoses. I will have exercise classes while waiting to get their manual massage. Also many will lack in poor nutrition and i will carry a line of supplements and have quality snacks . I am looking at placing a steam room in my bathroom. My husband says it is very easy to do. There is some that do hot and cold hydrotherapy to help increase the circulation.
    **********************************************

    yves.....
    You have some good ideas, and will understand more once you get into the classes. A few things you need to know...

    You need to make sure the school you are looking into teaches Manual Lymph Drainage (MLD) and Complete Decongestive Therapy. And make sure the school meets the requirements for Lymphatic Association of North America certification. (LANA) The father of this kind of therapy is Dr. Vodder, and his techniques are the most taught.

    Look under "manual lymph drainage" in google to see info on many schools, programs, etc.

    ALSO.....about working out of your house...YOU PROBABLY CAN'T!!!!
    Info I have from Medicare in the state of Kansas (Run by Blue Cross and Blue Shield) states that you must have a provider number to get reimbursed for insurance. That would be the Doctor, clinic, etc. And they also stated that you must work for the provider ( as evidenced by with holding of social security, etc) and MAY NOT BE CONTRACT LABOR, AND HAVE TO WORK AT THE PROVIDERS LOCATION. So I could not even work out of my office one block away from the clinic!!! And the clinic/doctor won't just "bill" for you. It is costly and time consuming. You will have to pay in some way. I pay 20% of my income for my room in the clinic and for the billing department to do my billing.

    AND...........the cost of many of the supplies that you would like to provide may not be covered by insurance, such as the compression dressings, sleeves, etc. LOOK INTO ALL OF THIS BEFORE YOU GET STARTED!!

    It is a good idea. There is a need, but I don't think you can do it on your own. Look into your states medicare and insurance requirements. I'll help you all I can with what I know.

    Good luck!!!!

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    I have 2 of the Ralph Stephens "Seated Therapeutic Massage" Videos. Volume 1 is the Back and Neck, and Volume 2 is the Shoulder (whcih actually shows more than just the shoulder, because so many muscles attach above and below)

    I think they are pretty good. His work is purely Western, Medical Massage, the St. John's Method of Neuromuscular Therapy, Active Isolated Stretching, etc.

    I have done seated chair massage at the hospital/clinic for nurses day,
    At the school for teacher appreciation day, and for small businesses as
    a gift from their boss during their breaks. Great advertising and I get a lot of the the patients later in my clinic.

    A few other videos that I have
    Ralph Stevens Medical Massage the for Lumber Region
    Ralph Stevens Medical Massage for the Cervical REgion

    Sean Riehl, Deep Tissue and Neuromuscular Therapy, The Torso
    Sean Riehl, Deep Tissue and Neuromuscualr Therapy, The Extremities
    These two both include little booklets with trigger points and treatment instructions for specific muscles.
    With these 2 videos, you can send in (for an extra fee, of course, and I don't remember how much at this time) and get a workbook and test and get 20 CEUs each for NCTMB category A.

    I also have 2 Myofascial Release Videos,
    Beginnning and Advanced withSean Riehl. They are also OK. They include Postural analysis, assessments, and techniques whcih are crucial for doing medical and neuromuscular massage. (The assessment, that is)

    I am happy with all of these videos.
    OK got to go to work. Connie

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    Quote from goldentxnurse
    ok.. I went to school and got my license in masssage therapy back in 2002, and now this December i will be graduating from nursing school. I'd love to work in a rehabilitation area of some kind so I'd be able to use both of my licenses, and I would also love to take some classes and maybe later get certified in medical massage? Do they have CEU classes specifically for CEU hours? Or how would i go about doing what i need to do? The school I went to focused mainly on swedish massage, so I feel that i need more training...

    I got a lot of CEUs in Medical Massage from Ralph Stephens, CMT. He travels all over the country. Web site is http://www.ralphstephens.com/
    I have also gotten lots of info from
    American Medical Massage Therapy Association http://www.ammta.org/
    They have tons of infor and CEUs on all aspects of medical massage and billing. And you can get Medical Massage Certification. Contact them for info on their courses.

    Stevens CEUs are probably the easiest and cheapest to get, and AMMTA is probably the most comprehensive. Connie

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    Quote from nightngale1998
    Here in CO, Massage Therapy is not licensed. As a Nurse, Nurseyperson, do you think I would be able to bill through a Dr. without the certification?

    I have been providing chair massage at a local senior center free of charge.

    Niightngales 1998, Sorry it has taken a while to answer. What kind of education do you have? You must be hired by the provider (doctor, Chiropractor/hospital, etc) You are working under their license (provider number, in insurance eyes) and they ultimately have the responsibility in this situation to determine your ability, accountability, and if they want you to take care of their patients.
    Of course, you are responsible for yourself, also!!! You must have liability insurance, malpractice insurance. And you must have graduated from an approved school to get that.

    Massage Therapy isn't regulated by the state of Kansas yet, either. But I have National Certification from the National Certification Board of Therapeutic Massage and Bodywork. NCBTMB. There are many stipulations to billing for massage therapy. I got my info from Blue Cross and Blue Shield Insurance of Kansas, because they are the main Insurance company here and they also run Medicare and Medicaid in Kansas. You have to check for your state. A few of the stipulations were I had to work for a provider, be paid by the provider ( NOT contact labor), do the treatments at the hospital/clinic, not in my own office. The treatments had to be specifically ordered by the doctor. ETC.................

    And of course, just because it is ordered doesn't mean insurance will pay for it. That is in the contract between the insurance company and the patient. The diagnosis and treatment have to match in their eyes. For example, they might not pay for a soft tissue mobilization for a diagnosis of Asthma. And it depends on the patient's contract. Maybe it states they won't pay for any type of out patient treatment!!! THEY need to know what their insurance contact says.

    OK, let me know if you have any questions.

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    Here are a couple more web sites people need to know.

    http://www.ncbtmb.com/
    National Certification Board for Therapeutic Massage and Bodywork

    http://www.ammta.org/
    American Medical Massage Therapy Association

    Happy surfing!!!

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    FYI, to all, and 5150dx.
    The codesyou refer to are most often used by Physical Therapists, but they are not all restricted to use by PTs.

    First of all, the codes I use for evaluation are Nursing eval codes. I can do this because I am an RN, along with a massage therapist. I do NOT use the codes specifically identified for use by PT And OT. In the Special instructions section of the guidelines for coding, it does say "To be used only by Registered Physical Therapists".

    The decision on what needs to be done to the patient is based either on the doctor or the physical therapist. If the MD writes a specific procedure, then that is what the PT must do. If the MD writes "Evaluate and Treat" or something in that way, the PT may do whatever they decide from their evaluation. But it is not only the PT who does those things. There are also Physical therapy aids, assistants, etc. who often actually carry out the procedures. MDs, Chiropractors, and Nurses may also do these things. So saying that a Massage therapist cannot do the procedures is not right. But it certainly does depend on the MT and the certification, education and experience she has. An MT also must be employed by the Provider (which is the doctor, clinic, or hospital) cannot be contracted, must do the treatment at the provider site, and many other stipulations, which I follow.

    My MD writes "Therapeutic Medical Massage", and that is what I do.
    But what is included in a Therapeutic Medical Massage? Certainly not just a simple massage. There is Soft Tissue Mobilization, Myofascial Release which is coded. Under the description of the procedure, it states "The Clinician" performs the procedure. It does not specifiy Physical Therapist, as it does in other descriptions or special instructions.

    ALSO, if you would like information from the American Medical Massage Therapy Association, www.AMMTA.org on their multitude of classes whichare available to become a Certified Master Medical Massage Therapist. These include eval and treatment of the entire spine, pelvis, extremties, and so much more.
    There are also specific classes for Neuromuscual Re-education Therapeutic exericse, Manual Therapy Techniques, (All of which are coded)
    and extensive classes on Insurance Reimbursement.

    I have also not had ONE claim denied in two years. I often talk with the PT about my patients and ask advice. The info I have written about PTs came from them. We work well together.
    Our education is different, and of course there are things a Massage therapist should not be doing, but there are those of us that are doing things right, have a good education and see significant results in our patients. After all, that is what everyone in health care should strive for.

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    Crouton, Sorry it has taken me a while to reply. I have been extremely busy at work, home, ill family, etc.
    OK, I got lucky and found a medical massage school that only did that, not swedish, spa stuff. They also had classes that we would do a lot at home, and attend Intensives (12 hour classes for 5 days in a row, Thurs thru Mon) and get our time in.
    I was the only nurse. Whe looking for a good school, make sure they are recognized by the AMTA, American Massage Therapy Assn, a COMTA school, Commission on Massage Therapy Accreditation, or by the NCBTMB, National Certification Board of Therapeutic Massage and Bodywok, &/or approved by the state board of education of your state (if they are over massage schools) or the State board of Regents. Legit schools may have any of these, but I would look for NCBTMB or COMTA.
    As for a good school, really look to see if they have what you are interested in. Research massage, Neuromuscular therapy, spa massage, Swedish, Shiatsu, etc. Know what you are getting into and what you want first.

    AS far as finding a job, I just started my own business. Depends on your area and what is needed. I am the only one in my half of Kansas that does Neuromuscular therapy, let alone combine that with being a nurse. I get people from all over this half of the state. And the pay is better than nursing, but it all depends on how much business you have. If you only work on one person a day, then of course you will make much less.

    Depends on how big of a town you are in, how progressive the doctors are, etc. on if you can work for them. Chiropractors often hire massage therapists. You can start your own business.

    It is a little expensive and you have to look hard to find a school that meets your criteria, if you can.

    Look at the old posts here on this bulletin board, under this heading, nurse massage therapy, to answer questions. Good luck! Nurseyperson

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    To healingtouchRN
    What is your triple certification? Sounds interesting!!!
    nurseyperson

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    To avoid lots of typing and repeating myself, look at my post under the subject "payment for services from third parties"

    I am an RN and a Nationally Certified MT doing massage thru the Dr. office/hospital/nursing home combination here in our small town. But I am not doing it as an RN, altho they really don't know how to classify me. I get paid whatever I bring in,
    (and that depends on what insurance pays... or the patient if insurance refuses or hasn't met their deductible or has a copay) ..........sort of a contract labor but they take out taxes.

    So I am not really working as an RN. If you can find a forward thinking facility that will allow you to do both, go for it. But I am sure they will pay you as an RN by the hour if you go by that title and will be stuck in that pay grade. So you may have to work under physical therapy to do massage as an MT, and that won't be combining RN and MT, except how you use your knowledge, and PT sometimes doesn't like massage therapists.

    I do use my RN / medical knowledge all the time, but I am not doing "nursing".

    Look around, ask around, Make your own rules and your own job. It never hurts to go for it!!! But you may have to set up your own program in the hospital, clinic, etc. and have to make the policies, procedures, etc. it you are setting it up.

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    OK, here is a copy of a post I put on another thread on this board

    I am an RN and Nationally Registered MT and work thru a clinic/Dr. office/hospital/nursing home combination, but only as a massage therapist. Altho in their system I am also an RN, but don't work as a nurse. So I am a nurse practicing massage in a medical facility, but as a massage therapist. Get it? The doctors order it just like physical therapy, and I decide how to bill it, as massage, neuromuscular therapy, soft tissue mobilization, myofascial release, depending on what I think they need. The doctor just orders "Therapeutic Medical Massage". They provide me with a room and submit the insurance and take out 20%.
    Getting started.....
    I had worked on the main doctor and his wife in the clinic, and so I just asked him if he thought it would work. He went to the board (Had also worked on a dentist who is on the hospital board) and we started it on a trial basis. It has worked well for everyone. I highly recommend it. There can be feast or famine, as I am working on my own, just as I am in my own office, doing the same thing for private pay. Sometimes I catch myself coming and going between my 2 offices!!!

    Yes, I think it is work the time and money. I am my own boss, can take off to go to my daughters school stuff, schedule patient appointments when I want (I do a few evenings and weekends because not everyone can come in 9 to 5) I pay for my car, gas, etc thru my business and write it off.

    And I never felt better than when I was going to massage school and getting worked on all the time. I also was in an MVA with whiplash, and nothing works better than Neuromuscular therapy, trigger point therapy, myofascial work, etc. It worked better than pain meds, muscle relaxants, physical therpy , chiropractic, TENS unit......I had it all!!!

    Check with your insurance carrier to make sure they pay for therapy. Car insurance is good about it. They may say they won't pay for a massage therapist, but that means in MY office. Insurance won't give a massage therapist a provider number. But they will pay in the doctors office, and the treatment has to be given there and you must be paid thru the provider (doctor, clinic)
    Just like a physical therapy aid can give treatments. The billing will go thru much easier and pay more if they bill it NMT, STM/MFR.
    Some people will say that is physical therapy codes, but you don't have to be a physical therapist to use them.

    OK, questions? Sorry I ramble, but this isn't a simple thing to start, do or follow!! So good luck!!!!


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