Archive for Massage Insurance Billing

Screening Massage Insurance Clients

February 6, 2010 Julie Onofrio Massage Insurance Billing

Screening massage insurance clients can help you to provide better service and get paid more quickly when you bill insurance companies for massage services.   Part of the screening questions will have to come from your boundaries that you set up around taking clients that have insurance.   It is a process to learn what works best for you and you will often be learning the hard way by first finding out what doesn’t work.

Since each state, city and insurance plan is different here are some general questions to ask before deciding to take a massage client that has insurance.

  • Who is your insurance?
  • What coverage do you have?
  • Did you call to ask what massage therapy benefits are available?
  • What type of injury do you have?
  • Is it from a fall, car accident or other activity?
  • Who was at fault?
  • Is there a claim manager?
  • Do you have an attorney (if it was at work or in the car or other liability)

After you get some basic information you can then call the insurance company to verify benefits.  I also ask the client to call them to verify the benefits too and ask them to fill out a sheet with the information on it.

You will then need to call the insurance company to verify benefits and find out what you need to do to bill the company.

  • Are there massage therapy benefits available?
  • Is a prescription needed?  (Most always is.  I get one even if they say no.)
  • What information is needed from the doctor on the prescription?
  • What information do I need to provide to the insurance company to get paid?  It is usually a bill using the CMS 1500 form, the prescription and sometimes chart notes or other reports.
  • If there is a case manager they can usually give you more information.
  • Find out what benefits are available.  It is usually some number of sessions or dollar amount.  Find out how much has been used if any and what benefits are remaining.  Find out what limits are place on the massage services if any.
  • Find out how long it will take to get paid.  Make a note of it and call around that time to check on it’s progress.  You may also want to call in the beginning to check if they received the bill shortly after sending it.
  • Get your client involved in the process of making these calls so they are informed about the case and their responsibilities.

As I said before, billing insurance is a process and it will take time in developing your own boundaries (policies and procedures) around what your needs are for financial reimbursement as well as your emotional/mental and spiritual needs.

Billing insurance can help you to fill in time slots that are otherwise empty and you can even focus on creating a  business working with doctors and billing to create a niche for yourself.

I do have more information on massage insurance billing on the website.   As with anything,  this information being provided is a stepping stone to helping you figure out what you personally need to do.  Each state and company are so different – it is just a matter of learning what questions to ask.  This is just the very beginning.

See more on questions to ask clients and insurance companies.

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Massage Insurance Reimbursement

July 31, 2008 Julie Onofrio Massage Insurance Billing, News

With the prospect of a troubled economy, some massage therapists may feel more compelled to explore the path of billing insurance companies for massage therapy services.   Massage Insurance Reimbursement is a very controversial topic and a very difficult path but having clients coming in regularly with an injury or condition and having someone else (the insurance companies) pay for their massage session can seem very appealing.  Done correctly, billing insurance companies can be very lucrative.

Some of the things that you have to know about working with insurance clients is that insurance does not cover palliative (unnecessary) treatments or preventative treatments.  Massage will be covered by most auto insurance policies in some way when there is a motor vehicle accident.  Massage may also be covered by most states labor and industries or workman’s compensation policies for people who are hurt on the job.  In WA and FL massage is actually a part of the major medical insurance companies.  In WA massage therapists are able to become contracted providers with companies like Premera Blue Cross and Regence Blue Shield to name a few.  WA is one of the first states to accept massage therapists so there is much to be learned from the WA State if you are looking for your state to become part of the medical system.   When it first started in about 2000 I think it was, insurance companies paid fairly well and paid without question for the most part.  Each year clients benefits gets reduced meaning we get paid less per session and clients are allowed fewer sessions.  A few companies have increased their allowable fees through the years but some companies haven’t.  With free electronic billing nowadays with companies like officeally.com, the time between billing and getting the payments have been reduced to a few weeks compared to 4-6 weeks.

If you are thinking that you want to explore the aspects of billing insurance companies for massage therapy services you need to be able to set clear boundaries around your sessions.  People who are coming in on insurance tend to be the first one’s to not show up or cancel at the last minute because they think that they won’t have to pay for it.  I inform my clients on their first session that they will be responsible for a full fee if canceling in less than 24 hours.  Clients who use insurance for massage also tend to want to get massage long after their pain is gone or they may try to use it in preventative ways.  They also try to use it just for everyday aches and pains caused by sitting at the desk too long or working in the yard or climbing a mountain.  If the pain is debilitating and causes a loss in function, massage will cover the session.  With car accidents and injured workers you also may see  more people who are coming in to make their cases seem worse than they really are thinking that they will get a larger settlement from the insurance company.  While I am making these statements more as a generalization and all clients of course are not like that, it is something that you should be aware of when working with clients and insurance.   Creating clear boundaries around your sessions can help you create a more successful massage insurance billing business.

There are also more insurance companies who are allowing massage therapists to bill for their services without being contracted providers.  You will have to find out what each company allows and what each policy allows so it makes billing more challenging.

Some other things you need to know about are included on my website in the Massage Insurance Billing Manual at www.thebodyworker.com

Some other things to be aware of:

  • Setting your fees higher for insurance companies than your cash clients no matter how you want to rationalize could be illegal.  You can only charge the amount that you would pay a person to bill insurance.  You can’t charge more because it takes longer to get paid or it takes more time to do chart notes.  Those are considered part of doing business so your prices should reflect that -ie if you take insurance you may want to raise your cash rates too to compensate for the additional time it takes to bill, write notes and managing the cases and doing all the work it takes to actually get paid.
  • Set guidelines for creating treatment plans that have a clear beginning and end.  What improvements in the clients condition will let you know when the client is done with their sessions?
  • Learn how to write chart notes that include functional outcomes
  • Have clients monitor their claims and payments for you and ask them to call when you are not getting paid

What state do you live in and are you able to bill for mva’s, PPO’s, HMO’s, Workman’s compensation?

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Relaxation vs Medical Massage

March 30, 2007 Julie Onofrio Licensing and Legislation, Massage Insurance Billing, Massage Research

What is relaxation massage? What is Medical Massage? How is relaxation massage different from medical massage?

These questions are need to be answered by the massage profession now, because if we don’t start stepping up and defining ourselves – the insurance companies and individual state licensing acts will and are.

One of the reasons why this needs to be defined is that massage therapists are actually billing insurance companies and charging them more than their cash rates rationalizing by saying that what they are doing is medical massage. Since there is no definition of medical massage that reasoning will not mean anything in a court of law.

The thing about relaxation massage – is any massage ever really only a ‘relaxation’ massage? If you are doing a relaxation massage what do you do when you find a tight muscle or a triggerpoint? What do you do if the person says they have stiff neck from sitting at the computer all day? In 18 years of doing massage, I don’t think I ever did just a ‘relaxation’ massage. Do people at spas or resorts just do relaxation massage?

One of the things that the so called ‘medical massage’ group is trying to do is to separate what they do from someone who they are judging to be less qualified. Education and more hours of training does not necessarily make one more qualified although most of our society gets caught up in thinking so.

So called ‘relaxation’ massage does have it’s place in medical massage since most medical conditions can in one way or another be linked to stress. Eliminating relaxation massage from the medical equation would be a great disadvantage to the profession. We need more research to prove that there is a difference -if any- between relaxation massage and medical massage.

Relaxation massage as far as I understand is also basic Swedish massage. When you learn the benefits of Swedish massage the main things talk about the medical benefits – reduces blood pressure, increases circulation. increases range of motion,
What therapies would be included as being medical massage? What therapies would be excluded? Is medical massage just the ability to work with a physician and an insurance company?

In order to be paid by an insurance company one needs to be able to show improvement in a condition and be able to write medical chart notes that prove medical necessity. The sessions must show that they have outcomes in mind when doing the session. Anyone can learn to write chart notes that way. Hands Heal is a great book that will teach you all you need to know and more.
Other reading : www.thebodyworker.com

Medcial Massage - Marriage or Monster – by Deane Juhan Massage and Bodywork

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Medical Massage is being defined by insurance companies

March 20, 2007 Julie Onofrio Licensing and Legislation, Massage Insurance Billing

Medical massage is already being defined by insurance companies. If we don’t step up and define it someone else will do it for us. It is evident in the laws too regarding massage therapy as I see from the research I have been doing for my site www.massagetherapycareers.com.
This is from an application form from American Whole Health Network credentialing application for therapists in WA State.
“Clinical Massage Practitioner Application”

Application Checklist for
Clinical Massage Practitioner

Applicants may qualify as a Clinical Massage Practitioner, with the
following documentation:
X Valid State or local license as Massage Therapist/Practitioner
X Entry level certification by the National Certification Board for
Therapeutic Massage and Bodywork, or
equivalent State Exam *
X Attestation to at least 60 hours of documented continuing education
course work in massage in past 4 years
X Copy of certificate of completion of at least one advanced massage
training program of 25 contact hours or
more
X Documentation of at least two calendar years in active clinical
practice
X 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
X Certification by a recognized national advanced clinical massage
certification exam
OR
X 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):
X 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.
X Completed AWHN credentialing or recredentialing application for
clinical massage, this includes your online profile
listing for the AWHN web directories***
X Applicable credentialing fee
X Copy of your Published Fee Schedule
X 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)
X Copy of your current unrestricted state license and/or NCBTMB
certificate
X Copy of the AWHN Attestation for Specialty Training and Experience
form with supporting documents
X 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
* States with equivalent exams:
AL,AK,CT,DE,DC,FL,IL,IA,KY,LA,ME,MD,MS,MO,NE,NH,NJ,NM,NC,OR,RI,SC,TN,
UT,VA,WV,WA,WI
** Supervised clinical experience means a) session hours treating
persons presenting with clinical problems in a setting
involving some combination of assessment, treatment planning,
documentation of status and progress notes, and b) the
availability of mentoring and clinical supervision by one or more
experienced massage, physical therapy, medical, or
chiropractic practitioners. Can include practice sessions during
advanced training or preceptorship/apprentice programs.
Documentation includes affidavit by practitioner and/or statement of
completion by employer/supervisor/referring
practitioner.
***If you are listing other professional health services outside of
the scope of massage practice, you must have an AWHN
contract covering the licensed profession involved and meet AWHN
credentialing standards.
Please call the AWHN Network Development office if you have other
questions or need assistance in the
application process.

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Massage Insurance Billing Manual

February 19, 2007 Julie Onofrio Massage Insurance Billing, News

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

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