Insurance Billing for Massage Therapists
Putting
it all together.
So now with
all this information how do you figure out what
to do in your state and how do
you find out what insurance companies will pay you?
You will need
to call prospective insurance companies to find out what you need to do. You
can usually get a list of them at your State Insurance Commissioners office (see
appendix for list). You can also wait and do this when a client calls asking to
bill their insurance company.
How to get paid –Calling to Verify Benefits and Billing Procedures
Here is a
checklist of questions you will need to ask each company:
·
Do you pay for massage therapy services? Are massage therapy
services covered by this client’s policy?
·
Do I need to be on a provider list? If so what is the process for
becoming a provider?
·
What
CPT codes do you allow for massage therapy services? (Some companies only
allow certain codes to be billed by massage therapists.) How many units of each
code are allowed? (4 units = 1 hour: can you bill for more than an hour? –
usually not, but in some cases you can) You can also tell them what code you
bill and ask if they will allow this code and what is the allowable fee.
·
Can I bill multiple codes? What combination of codes can I bill?
Tell them what codes you use and find out if they will pay you for those codes.
·
What is the allowable fee per code? This is the amount they will
pay.
·
Do I need a prescription from the physician? (If they say no, it
is always a good idea to get one anyway.) If they say no, ask if a Diagnosis
code (ICD-9) code is necessary. If so, then point out that a prescription will
be necessary, as you are not allowed to make a diagnosis.
·
Do I need a referral? A referral may be different than a
prescription. It may involve the physician initiating the referral to the
insurance company and they send the referral to you.
·
Is there any restriction on the
Diagnosis code? Can you treat for all codes or will there be some that
won’t be allowed?
·
Do I need to send chart notes when submitting a bill?
·
Do I need to send the prescription when submitting a bill?
·
What is the normal processing time for payments?
·
Where do I send the bill? Do I need to send it to anyone’s
attention?
·
Is there any statue of limitations on the time allowed to bill for
services? If there are any problems with the bill and it is rejected, how much
time will you have to resubmit it. Most companies allow 6 months to a year.
After that time, you will not be paid no matter what. In some cases, it may
take that amount of time to get the bill straightened out.
·
What are the policy limits and benefits? Some policies have a
dollar limit or number of treatment limit or a time limit like 3 years.
·
How much of the available funds/sessions have been used? Has the
client had previous treatment from another massage therapist that used some of
the allowable benefits?
·
Is there a deductible? Has it been met?
·
Is there a co-insurance or co-pay?
·
Do I need to submit a W-2 form? This is often needed, as
companies will supply you with a 1099 form for tax purposes.
The other
things that can save you a lot of time are:
Have the
client call and verify benefits using the form in the appendix.
Send bills
registered or certified mail to ensure their delivery.
Double check
your billing forms to make sure it is filled out completely. Make sure all
information is correct.
Don’t work
without a prescription.
It is often
difficult to find the right person to talk to at an insurance company that will
help you. Most companies have a customer service representative for your area.
Keep asking if you are not getting your questions answered. Other people that
may be of help to you are the billing specialist (the person who actually keys
the bill into the computer), the claims adjuster, the case manager, the lawyer
or paralegal.
My guess
is that you will not be able to get all of your questions answered! The key to
getting paid is to accept the fact that you will have problems getting paid and
will have problems working with insurance companies!
