March 18th, 2007 Julie Onofrio
I am going to be writing all week about the seminar that was put on by AMTA WA by two attorneys Pieck and Conniff, who specialize in working with insurance companies and providers.
One of the phrases that John Conniff used was very telling of the massage profession - he called it the “practitioner pissed off system” of working with insurance companies - meaning that massage therapists who were doing things like charging more for their insurance clients than there cash clients were only doing so because they were pissed off. What are they pissed off about? I think it goes much deeper than the issues of having to deal with insurance companies. I think massage therapists are starting to depend on the insurance companies for their income. I think massage therapists are not able to build cash practices and have enough income from cash clients that they are pissed off when they get involved with insurance companies and they expect just because the insurance company is this rich conglomerate that they should be paid fairly.
When you start blaming others such as the insurance companies and you lack of cash clients as the reason for not being successful, you are setting yourself up as a victim and not taking the necessary responsibility. Taking responsibility is a very humbling experience as it is that moment that you finally admit that you are in charge of your destiny - your thoughts, feelings and action. You and you alone are responsible for your success or lack of success - not anything and insurance company does or the economy or the lack of cash clients or your boss, or whatever other excuse you try to use to explain why your practice isn’t doing as well as you would like. It is a hard thing to swallow.
After attending the seminar more than ever I believe we need to focus on building cash practices because the risk of doing business with insurance companies is too great in my opinion. The penalty for insurance fraud which is a Class C Felony is punishable by 5 years in prison and $5000 in penalties for every count -which I think means every date of service or it may be every client- either way the cost of defense it too great for most massage therapists and not worth the risk. The other thing is that the only way that the insurance companies will ever change and start paying our regular fees and paying for wellness massage is if we focus on building our cash practices.
Posted in Insurance Billing | 3 Comments »
March 17th, 2007 Julie Onofrio
I just went to a presentation of John Conniff and John Pieck who are attorney’s who have been hired by the AMTA Washington to look into the legalities of doing business with 3rd party payers - insurance companies.
Here in WA we are allowed to become contracted providers with insurance companies such as Blue Shield and Blue Cross and others.
With that I feel compelled to inform others about what is happening here in WA State because so often I hear that massage therapists around the country want to be able to be contracted or at least get paid by insurance companies. But most do not understand the risks of doing such business and there isn’t enough information and support as a profession to be able to work with these insurance companies.
The biggest things I learned are:
- There is a fine line over the issue of whether or not it is illegal to be charging cash clients one thing and insurance companies another. It borders on insurance fraud. Many massage therapists try to explain it by making medical massage different from relaxation massage which can be debated from both sides. The bottom line is that you have to be able to prove that medical massage is different from relaxation massage and be prepared to pay an attorney to help you defend yourself if you ever have to.
(I for one think the whole medical massage thing is questionable. What would you charge a cash client who comes in with a stiff neck? When you do a relaxation massage and find a tight muscle do you ignore it?) You can read about it more in their article “The Business of Caring“
- When you work for a chiropractor or other business and they pay you a percentage of the fee of the massage, you have to do this as an employee. You cannot do this as a independent contractor or subcontractor. If you rent a space and pay a percentage and you pay the chiropractor a percentage of your income it is a kickback and it is illegal. If you rent space by the hour and pay only for the time you take each day it is also a kickback. A kickback is anything that is influenced by patient volume. I am not sure if this kickback thing is only in WA or is a Federal thing and am looking into it more.
Basically, we can only complain to the insurance companies about the low rates of pay, delays in payments or any other problems. It is illegal to talk about problems and you can’t say to another massage therapist that you would not recommend signing a contract or you can’t discuss fees or it would be a conspiracy. The only way you can work with insurance companies is through a formal association of massage therapists who talk to the insurance companies. Our massage profession does not have enough manpower or money to stand up to these insurance companies.
There were some other things that are pertinent only to WA State massage therapists such as because we are licensed as a health care provider, you are required to write chart notes for everyone. I will be writing more on this in the next few days as I make more sense of it all. What I do want to say is that every massage therapist needs to understand all of this if they want to get into billing insurance companies. It is not all cake and ice cream.
Posted in Building Your Practice, Insurance Billing | 4 Comments »
February 19th, 2007 Julie Onofrio
I just wanted to let everyone know that I one of the reasons I am so passionate about the insurance billing issues going on is because they have directly affected my private practice that I have had for 18 years.
The issues I talk about are quite controversial and things are happening here in WA State that will influence other states. In WA we can become contracted providers with HMO’s and PPO’s which is quite different from just doing mva’s or L&I. It requires that you become credentialed with the insurance companies and sign a contract in which they do take control of you and your work. They determine what they are going to pay and what codes you can use. You will also have to deal with proving medical necessity which isn’t anything unusual, but the thing is they don’t provide any treatment guidelines or rules as to what they do and don’t allow.
When I first became a contracted provider and started billing HMO’s and PPO’s in about 2000, the insurance companies were paying $90 or so 1 hour session (4 units). The benefits were gracious. Clients could get unlimited sessions or a decent number of sessions for their health concerns. It was easy to get paid, clients could find you easily through the networks and life was easier.
Each year they have reduced our allowable fees, restricted the number of sessions, have asked us to prove medical necessity (which should be up to the doctors since we can’t prescribe), have made it harder to get paid. I have had to raise my rates for my cash clients to subsidize my insurance work. I have to work more hours and get paid less, meaning I have to see more patients and do more paperwork just to get paid the same as before all of this insurance stuff started.
For awhile I sold an Ebook called “The Massage Therapy Insurance Billing Manual” and recently made it available for free online (but with the presence of ads). My intention is to hopefully teach as many massage therapists how to bill insurance companies so they can begin to see first hand the issues involved in doing so. Then we will be able to define ‘Medical Massage’ for our profession and respond to what the insurance companies are doing rather than reacting. Right now we do not have the cohesiveness of a group to stand up to the insurance companies to ask for what we want and to be paid a fair wage.
For more on the insurance billing issues:
Issues and Ethics of Billing Insurance Compaines
What is the future of billing insurance companies? Do we even want to be able to bill insurance companies -Guest editorial 2005 - Massage Magazine
Insurance Billing section on www.thebodyworker.com
Posted in Building Your Practice, Insurance Billing | 1 Comment »
November 19th, 2006 Julie Onofrio
One of the jobs I hate as a massage therapist is SOAP charting. I have taken a class in it and have read a few books on it and I still never really know what to say.
The reason why SOAP charting is so important is because it is the only way to communicate with the medical profession. They will understand massage better when they can see the improvement that massage brings each session.
Diana Thompson is the “Queen” of SOAP charting with her book “Hands Heal” and her classes on soap charting.
I have some basic information on my website:
SOAP charting for Massage Therapists
What should SOAP charts say?
Functional reporting.
One of the things that Diana said in her class on charting is that we need to be charting for every client even if they are not going through their insurance. She said that since we are considered “health care providers” here in WA state that it makes it be required for our profession.
SOAP charting can also be helpful in your learning process and understanding the process that each client goes through. As a profession we also need to be writing up more case studies about our work so that everyone - medical professionals and general population can also see what massage can do. Charting is at the center of case studies.
I hope to be having a section on the website soon that will allow people to start posting their case studies. If anyone has any to post now, please send them to me!
Other resources:
WinCity Soap charting software - also has some articles and lists Diana Thompsons classes. I haven’t tried the software. Has anyone?
Some simple samples
Posted in Insurance Billing | No Comments »
October 29th, 2006 Julie Onofrio
If you are going to be billing insurance companies next year you will need a National Provider Number.
Vivian Madison Mahoney outlines the process in this article for Massage today.
You will also need to start using a new billing form called the CMS 1500 for most billing by March of 2007.
I haven’t taken a look at it yet and am hoping I won’t have to as I am planning on getting out of doing insurance work soon!
More info on NPI numbers
Posted in Building Your Practice, Insurance Billing, News | No Comments »
