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 »
October 28th, 2006 Julie Onofrio
In 2005 I wrote the latest addition of the Insurance Billing Manual.
After some thought about what I want to be doing with this blog and my websites, I have decided to put all of the manual online for free for some various reasons:
- I am phasing insurance billing out of my practice because I no longer want to be a slave to insurance companies who are deciding our future. They are making steps to define medical massage by requiring special training above and beyond what is required for State Licensing. Our profession just sits and takes it.
- Here in WA as a contracted provider for HMO’s and PPO’s like Regence Blue Shield and Premera Blue Cross, I am paid less than my going rates and they are constantly reducing their allowable fees again because they can and no one is standing up to them with any success.
- One of the reasons things like this are happening is because massage therapists do not understand the severity of the issue. People in other states go where they are only allowed to bill for MVA’s or L&I are being paid fair amounts (and in my opinion -too much) for their services. Massage therapists are continually seeking to be accepted by such companies because they think it will be an easy way to get clients - it may help get clients but at what expense???
- It also has become more difficult to work with people who are on insurance as they don’t really understand that it is not for their stressful lives that causes the muscle tension and pain. They think the insurance companies should be responsible, but in reality it is the client who should be taking more responsibility. (This does not include people who are really hurt or injured)
- Insurance companies require that we “fix” clients and be able to prove it which really is not about healing in my opinion. Sure injuries have to repair themselves but what is the meaning of healing?
- Insurance companies are reducing their allowable fees, reducing benefits and delaying payments.
- Insurance companies do not take into account the power of the therapeutic relationship. They are attempting to eliminate so called “relaxation” massage and other types of massage that does not directly influence the injury or problem. This will eliminate many types of touch that are healing from being covered.
- Have you tried to find a good doctor lately? Most are opting out and taking cash only. They long ago got sick of having to spend so much just to keep a patient. It is happenind for Physical therapists and others too
- Personally, I do not want to be a part of such a system and hope to be instrumental in teaching massage therapists about what they are getting into when they want to accept insurance.
So for these reasons, I am making the insurance billing manual available so everyone can learn how to bill and experience it first hand so they can decide for themselves.
personally feel that the cost of playing with these insurance companies far outweighs the cost of getting new cash clients and teaching clients how to accept more responsibility for their health.
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October 19th, 2006 Julie Onofrio
Here in WA state we have something called the Every Category Law which tells insurance companies that they have to allow massage therapists, naturopaths and acupuncturists to be contracted providers for HMO’s and PPO’s.
As contracted providers we are very limited in having any say in such issues as what we get paid. All of the insurance companies except one in particular pays less than my going rate of $75.00 for cash clients and doesn’t even come close to my medical massage rates of $100.
This is the law.
This is some info from the insurance commissioners office.
And an article from massage today
The every category law is constantly challenged and each year we have to defend our right to be contracted providers and I am not sure it is worth it to be able to bill insurance companies who don’t pay us and respect us. They are actually in the process of creating a definition of a medical massage therapist for us because we don’t have anything defined as a profession.
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October 4th, 2006 Julie Onofrio
The new buzz word in the massage profession is “medical massage”.
There seems to be a branch evolving who want to separate so called “medical massage” from the rest of the massage profession.
To me “medical massage” is only the ability to bill insurance companies and get paid which I have been doing quite successfully for 17 years with a basic 250 hours of education in my initial massage training and of course a number of CEU’s through the years.
There seems to be a movement to require more education in order to be able to work with insurance companies that seems to be coming from the massage profession as well as the insurance companies themselves. The insurance companies want to increase the number of hours of education so they can eliminate some massage therapists from being able to participate which is the same as “they don’t want to pay any one any more than they have to” in my opinion. The reason why insurance companies are setting these policies is because they can. And the massage profession has yet to define “medical massage” so the insurance companies will.
From what I have learned the drive from within the profession seems to be coming from one assocition in particular the “United States Medical Massage Association (USMMA), and it’s founder David Luther -formerly(??) of The Medical Massage Office & Associates (TMMO), a for-profit company and the owner of the Medical Massage National Certification Board (MMNCB), a for-profit company. His article awhile ago (August, 2005) in Massage Today explains his position. He also explains why he developed the medical massage company which I find very interesting.
Some of these so called medical massage professionals seem to just by Physical therapy or Osteopath want to be’s. Where is the line between therapeutic massage and physical therapy which requires a 4 year degree?
There is much more that a massage therapist can do by just staying present with a client who is in pain and helping them to deal with some injury or disease without have to know any more medically. It comes by just being of service and holding the space for healing.
There are also some other interesting articles at Massage today
http://www.massagetoday.com/mpacms/mt/article.php?id=13417
http://www.massagetoday.com/mpacms/mt/article.php?id=13245
http://www.massagetoday.com/mpacms/mt/article.php?id=13256
http://www.massagetoday.com/mpacms/mt/article.php?id=13294
Posted in Ethics, Insurance Billing | No Comments »
April 13th, 2006 Julie Onofrio
AMTA in their recent press release states that they are not making any plans to define Medical Massage.
Is AMTA Defining Medical Massage?
They go on to state that all massage is medical massage which I totally agree with. The problem is if we don’t define Medical Massage for ourselves, the insurance companies will and ARE already defining Medical massage.
American Whole Health Networks is in the process of creating a Clinical Massage Credentialing Process. It is not clear at this time what it entails, but they are setting up educational requirements and other criteria in order to become credentialed as a provider with them.
This is directly from their application form:
“Valid State or local license as Massage Therapist/Practitioner
q Entry level certification by the National Certification Board for Therapeutic Massage and Bodywork, or
equivalent State Exam *
q Attestation to at least 60 hours of documented continuing education course work in massage in past 4 years
q Copy of certificate of completion of at least one advanced massage training program of 25 contact hours or
more
q Documentation of at least two calendar years in active clinical practice
q Two Professional Reference Evaluations from health professionals attesting to personal and clinical practice
characteristics, at least one of which must be from a referring or supervising MD, DO, DC, PT, RN or from
an AWHN credentialed clinical massage practitioner who has supervised your practice.
PLUS
q Certification by a recognized national advanced clinical massage certification exam
OR
q Documentation of supervised contact hours** performing clinical massage
500 contact hours required for applicants with only a basic 500-hour massage education
OR
250 contact hours required for applicants with 1000 hour basic massage education that includes clinical assessment,
clinical pathology, and clinical charting,
OR
Postgraduate clinical training equivalent to 250 contact hours after their basic 500-hour education
With submission of verification documents for any postgraduate course, fellowship, preceptorship, or
clinically supervised practice
Please submit the following materials (obtain the forms at www.wholehealthpro.com):
q Completed AWHN network covered benefit and discount contract with signed agreement to business and financial
contract terms. If you are employed by an institution or group, your employer must contract for you as an associate.
q Completed AWHN credentialing or recredentialing application for clinical massage, this includes your online profile
listing for the AWHN web directories***
q Applicable credentialing fee
q Copy of your Published Fee Schedule
q Copy of your current professional liability (malpractice) policy face sheet
(At least $200/500,000 limits are required, GHC contracted practitioners must have 1Million/3Million)
q Copy of your current unrestricted state license and/or NCBTMB certificate
q Copy of the AWHN Attestation for Specialty Training and Experience form with supporting documents
q Send the Professional Reference Evaluation forms to your professional references to submit directly to AWHN, note
the names of the professional references on your credentialing application ”
So you see it may be too late already as someone else is defining our profession for us…
What do you think about the new clinical massage credentialing being set up by Whole Health Networks?
How should we as a profession define Medical or Clinical Massage?
Should any categories or modalities be restricted from doing medical massage? This one I feel should be a definite no - There should not be any restrictions on who is allowed to do medical massage. It would be like shooting ourselves in the foot. Who are we to determine what or what will not add to a persons healing process or health?
Posted in Insurance Billing, News | 1 Comment »
