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Insurance Billing Manual for Massage Therapists
Please also check the
insurance billing manual updates and the
blog for more information.
2. Personal Injury: Motor Vehicle Accidents/other accidents.Massage Therapy can greatly decrease the healing time of injuries due to a motor vehicle accident. Generally, the sooner the patient is referred to massage therapy, the more completely the injuries are healed. Since massage therapists are not allowed to diagnose conditions it is necessary to have a referral/prescription from the treating physician. Some insurance companies will tell you it is not needed. I would advise getting one in any situation. This protects you if the case ever goes to court, arbitration or mediation. The first thing you need to determine which insurance company is paying. Most often, the clients Personal Injury Protection (PIP) will pay for your services. These policies usually have dollar limits and time limits. When those run out, occasionally the person who hit the client (if at fault) will have to start a claim with their insurance company. When those benefits are exhausted, the claim is usually resolved in a settlement from the insurance company of the party at fault. You can still treat the client but you won’t get paid until the case settles. (At that time you may want to consider a lien.) This usually but not always, involves lawyers for each party negotiating the settlement. Laws vary state to state regarding statue of limitations, settlements etc a. Liens. A lien is a written agreement between the involved parties (lawyers, the massage therapist and the client) to ensure that payments will be made when the case is settled. Where you file a lien depends on which state you live in. You only need to file a lien if you take a third party claim or if PIP benefits or Med-Pay benefits run out and you have to wait until the case settles before getting paid. Check with your attorney or county clerks office to determine what needs to be done to file a lien. It could be with the county auditor, the lawyers’ office and/or the patient depending on what is required. Send a copy of the lien to the client, both insurance companies and any attorneys that are involved. After the case is settled, you have to remove the lien or the client will have credit problems. (Personal opinion: I have never filed a lien in 17 years of working with motor vehicle accidents. I usually work with cases that have hired attorneys or have adequate amounts of PIP that pay up front for sessions. Filing a lien is totally up to you and for your own protection.) Settlement could take 1-3 years or more depending on the statue of limitations in your state. You will not get paid until the case settles. You can choose not to accept cases that will delay payment for such a long time or ask that the client pay as they go. b. Working with lawyers. Building a professional relationship with a few personal injury lawyers in your area may be beneficial to getting paid and in building your practice. I had a client who was such a lawyer when I first started out in business. He connected me with a chiropractor that he often worked with on claims and he often referred clients to me for treatment. Contact local law firms with a letter of introduction and some business cards or flyers. They are usually looking for contacts to build their business too (see also: Networking). Call the attorney when you begin working with a client to find out what they will require of you as far as paperwork, insurance benefits and settlements. Most attorneys have legal assistants that can be of great assistance to you when it comes to getting paid. You can write a letter to each attorney and introduce yourself and ask them what they will need from you. You may be required to send them copies of the bills, copies of chart notes and copies of the prescriptions for massage therapy. You will usually need to have the client sign a release of records form to allow you to send medical records to each party involved.
It is not necessary for all clients that have been in a MVA retain a lawyer. A client may wish to hire a lawyer if the injuries are severe, if the client can’t work due to the injuries or if there are difficulties getting the providers paid or settling the case. Cases can be settled without attorneys. Attorneys can also be influential in getting the doctor to refer to massage therapists. Most attorneys get paid based on a percentage of the settlement. While they often may have the clients’ health in mind, they may also want to increase the amount of the bills to increase their income from the settlement. There is often a very fine line of determining medically necessary health care. I recommend working with physicians and attorneys who have the same values as you do when it comes to this issue. There may be some time in your career that you will have to appear in court or in an arbitration or mediation to determine the settlement. You will be able to charge for your appearance. You will also have to be prepared and have detailed progress notes to help prove medical necessity and how the injuries have impacted the clients’ life and health.
c. IME’S- Clients in a MVA or other accident may be asked by their insurance companies to go to an Independent Medical exam (IME) to confirm their injuries and healing. The insurance company often requests this when they start thinking that the case is costing them too much money and they want to start limiting treatments and verifying the condition of the client. This usually means they are trying to settle the case. The client is sent to a doctor that usually works for the insurance company. They have the right to be examined by a physician that has the same credentials as the referring physician. (If the referring physician is a chiropractor, the IME doctor should be a chiropractor) Treatment is most often terminated, but occasionally more tests are requested. I highly recommend that the client retain an attorney if an IME is called for to protect the clients’ rights. Often someone from the attorney’s office will accompany the client to the IME. If a person refuses to go to an IME, benefits are usually automatically terminated.
Please also check the
insurance billing manual updates and the
blog for more information.
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