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Insurance Billing Manual for Massage Therapists
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1. Introduction:
Insurance companies are beginning to recognize that massage therapy is a vital part of rehabilitation from injuries and other health problems. All 50 states allow massage therapists to bill insurance companies for massage sessions on clients who are injured on the job (worker’s compensation/labor and industries) or when someone is injured in a motor vehicle accident. WA and Fl are the only two states at this time who widely accept massage therapists as contracted providers in the health care system. We are able to become providers with companies such as Blue Shield and Blue Cross. With this recognition, also come the issues and problems in dealing with insurance companies.
The process of billing insurance companies for your massage therapy services will be time consuming and often challenging. Each state and each insurance company in each state will require different paperwork and will allow different codes and will pay you different amounts for the same CPT code. Within each company, you will often find the procedures will vary greatly from policy to policy. I can guarantee that no matter how many manuals you read or classes that you take on billing that you will still have problems collecting the money that is owed to you. With this wide range of acceptance, it is impossible for any one person or class to provide all the information necessary for you to process insurance claims without any problems. In order to reduce the headaches that you have, you need to know the right questions to ask the insurance company, the client, the attorney and anyone else involved so that you can get paid. In order to know what questions you need to ask, you need to learn everything you can about the insurance industry and how to communicate effectively about what it is you are doing with each client. Working with insurance companies will be a constant learning experience. It will be a process that will challenge you to learn more and ask for more for yourself. You will find yourself need patience, strong boundaries and the willingness to make a stand against the insurance industry.
With this in mind, I am writing this manual with the intention of providing you with the basic information that you will need to know to start working with decide if it will be worth it. You will need to know what codes you can bill for, how to fill out a HCFA billing form and some ideas on what you can do if you are not getting paid. The key to working with insurance companies is learning what to ask each party involved.
Some of the challenges you will be faced with include:
· Being asked to reduce your fees for your services
· Waiting 1 month to 3 years for payments
· Having to call each month to see where the check is
· Having to call each month to see why payment has been denied
· Resubmitting bills because they were lost or incorrect and waiting another month or so for payment
· Waiting on hold to talk to a customer service representative
· Being told the check is in the mail
· Learning what you need to do with each company in order to get paid
So if you are ready for the challenge, the first step is to decide if you want to take insurance as payment.
Is it worth it?
Will your business profit?
Will your profit increase?
Will you enjoy the challenge of dealing with insurance companies and attorneys?
Would you rather spend your time writing out bills, calling insurance companies and waiting for payments than actively building your cash practice?
One of the first things you will need to do is to figure out your cost per client. That will help you determine if taking insurance as payment will increase your profit and income. If it does - Great. If it doesn't then just spend all of the time that you would have spent in dealing with insurance companies in building your practice.
If you decide that you do want to continue, learn everything you can about it. That way you can learn to set boundaries and choose what clients you want to work with. You will be able to tell those cases that will be most difficult to settle or prove medical necessity. You can choose not to work with any that you find are questionable. This is one of the most overlooked keys to building a successful practice. Sacrificing your values and accepting money just to make money when it goes against your values will create stress and increase your risk of burnout. You don’t have to accept every client who calls. You can focus on working on clients who value your work and are compatible with your beliefs.
While you can have a successful massage business without billing insurance companies, knowing how to bill will come in handy when your favorite client gets in a MVA and wants you to bill the insurance company for them. You also can build a practice totally dependent on insurance cases and work with integrity when you know all the rules, regulations and issues.
The purpose of this manual is to share what I have learned in 17 years of doing massage and billing insurance companies so that you can begin to learn how to do it in your own practice. I also feel that the more massage therapists who learn how to bill insurance companies will begin to see the effects it will have on our profession and allow us to find ways to participate that support the profession by paying us what we need to be making and allowing massage to become a part of preventative medicine.
Chapter One is an expanded Introduction to the issues involved in billing insurance companies.
Chapters 2-5 will teach you the basics about the different types of insurance coverage. Motor vehicle accidents, Provider Networks and worker’s compensation.
Chapter 6 deals with the billing form that is used by most carriers the HCFA 1500 and how to fill it out correctly to get paid faster.
Chapter 7 covers the codes that you will need to know to be able to fill out the form correctly.
Learning to chart a client’s progress is covered in Chapter 8.
Chapter 9 is some of the tricks you need to be aware of to get paid.
Chapter 10 teaches you how to build a network of referrals.
Chapter 11 is a list of the questions you will need to ask the insurance company, the client and the attorney to help eliminate problems in getting paid.
There is a complete glossary of terms to help you learn what the insurance companies are talking about.
The appendix has a chart for figuring out your cost per client, intake forms, insurance verification forms, progress reports, billing tracking form, ICD-9 codes and a list of resources for more information on billing insurance companies.
And Remember… You can also opt not to take insurance even though you may be feeling the pressure from clients and the profession to jump on the bandwagon. I wrote a guest editorial for Massage Magazine in the Nov/Dec. issue that you can read online. In it, I challenge the profession to look closely at what is going on in the insurance world and look seriously at how or even if we want to get involved with insurance companies. In general, we are getting paid less each year by each insurance company and they are constantly delaying payments, lowering allowable benefits and doing anything they can to not pay us. From what I have seen going on here in WA State, the future of billing insurance companies for our services is not to bright. It is not only the massage profession, but also every profession.
To read more about what is going on here in WA
http://www.thebodyworker.com/challenge_to_the_massage_profession.htm
The way out of being a slave to insurance companies is to build a practice focusing on an ideal client who values your work and understands the benefits of massage. This can and will be achieved when more massage therapists refuse to participate in the insurance industry and work to educate clients to build a cash practice. This will require that massage therapists have enough self-confidence and belief in their own value. One of the ways that this can be done is with the process of Supervision. It is the process of looking at ourselves first to discover our own wholeness and learn to stay aware of it as we work with others who are looking for wholeness themselves. It is the process of becoming aware and staying alive while others are in their story of pain. Our stories are where we have come from and what builds our defenses and limits us. It is finding out what our stories are so that we can know when our story is having us rather than knowing that we are in our story. Building a community of peer supervision groups and seeking out individual supervisors where we can share our stories and come to know our stories better, are the key to getting away from managed care and building a profession that is accepted by the public. It is the key to creating successful practices – a practice that is financially rewarding, emotionally connected and spiritually alive! You can build a successful practice without billing insurance companies if you are willing to look do the work to build your ideal practice.
You can learn more about supervision in the massage profession at www.massagepracticebuilder.com
Let me know if you have any questions about what is in the manual.
You can contact me
The Massage Insurance Billing Manual
Written by Julie Onofrio, LMP
Author/editor of
I have been a massage therapist for 18 years here in
Seattle. I have been in practice full time and have my own office in downtown
Seattle (www.massageseattle.net)
You can read more about me at any of the above websites.
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