Insurance Billing Manual for Massage Therapists
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.
