You will have to find out if you can bill auto insurance in your state.  From what I understand, in most places you can.  Find out from other massage therapists or if you get a client calling saying they were just in an accident, get their insurance information and call the insurance company.  Tell them you are a MT and you have been just referred a patient.  You will need to tell them the claim number and the persons name.   Tell them you are licensed as a massage therapist and have a prescription for massage (yes you need a prescription) and ask if they will cover massage.  Tell them what CPT code you will be billing and some may need to know the diagnosis code that will come from the doctor.

The things to ask are how much will you be paid per unit of massage.  The CPT codes which indicate the procedure that was done is paid in 15 minute increments so an hour would be 4 units of massage.  The most common codes are 97124  and 97140.  Tell them you will be billing one of those codes and ask what they will pay.  Find out when you will get paid.  Some policies are Personal Injury Protection or MedPay.  Will they pay you before the case is settled.  Most will depending on the available benefits on their plans.  Most will have a certain amount that can be paid up front as the massages are done so you won’t have to wait years to be paid.  After benefits run out, you will have to wait to be paid.  You just have to decide if it is worth it and if you have enough cash flow to wait.

The other most common form of insurance is workers compensation or Labor and Industries as it is known in some states.  This is insurance for those who are hurt at work.  In most states you can bill for work related injuries but there are usually strict rules and limits.  You can usually find fees schedules on the workers comp. board websites.  Most will also have billing manuals or more help to learn how to bill insurance.  You have to find out what you will need to do in order to get paid.  You may have to sign up with them first and get a provider number.  You will need to know how many sessions you will be able to bill for.  There are some stated though that don’t really pay enough to make it worth your while but if you do need clients, even a low rate of pay is better than no income for that hour.

So you will need to decide if billing insurance is right for you.  Figure out your cost per client and if taking insurance will increase your profits.

You will then need to lean how to bill and how to do SOAP Charting. Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists (LWW Massage Therapy and Bodywork Educational Series)  is a comprehensive manual for doing chart notes that will support your massage work.  It is important to show improvement in your sessions and document properly.

Insurance Billing 101 for Massage Therapists will also get you started in learning how to bill.

Related posts:

1. Billing Insurance Companies for Massage Therapists
2. Massage Insurance Billing Manual
3. Can a massage therapist bill insurance companies?

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.

Related posts:

1. Should you get into taking insurance?
2. Can a massage therapist bill insurance companies?
3. Massage Insurance Reimbursement

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?

Related posts:

1. Massage Insurance Billing Manual
2. Can a massage therapist bill insurance companies?
3. Screening Massage Insurance Clients

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

Related posts:

1. Medical Massage vs Relaxation Massage
2. Medical Massage
3. Medical Massage or Not

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.

Related posts:

1. AMTA makes no plans to define Medical Massage
2. National Certification for Massage Therapy
3. Credentialing and Massage

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

Related posts:

1. Insurance Billing Manual
2. The State of Billing Insurance in Washington State.
3. Can a massage therapist bill insurance companies?

In WA State, massage therapists are allowed to become contracted insurance providers.  In Fl, the law states that insurance companies must pay for massage therapy to be covered when referred by a physician.

In other states there may be a few insurance companies that are now paying bills from massage therapists.

In all states, massage therapists are able to bill auto insurance when there is an injury caused by a motor vehicle accident and massage therapists are able to bill Labor and Industries (or workman’s compensation) when there is an injury on the job.

Currently the state of insurance billing is questionable.  Here in WA State, we are paid less than $75.00 per massage.  When we were first able to bill insurance companies, I was paid almost $100 per session.  The allowable fees have steadily decreased and the clients benefits have steadily decreased also.   Auto insurance companies who once paid whatever was billed for are now becoming part of networks which means the allowable fees are being determined by the networks and we are getting paid less.  It is only a matter of time before the rest of the insurance companies start this procedure.

The insurance companies are also in the process of definining what the definition of medical massage is and they are ruling out various modalites of massage and setting criteria to be a provider.

The future of insurance billing looks grim.  While you may think that it is good for the profession to be able to bill insurance companies and that it will help you build your practice, you may be better off focusing on building a cash practice.

I wrote a guest editorial for Massage Magazine in 2005 addressing this issue.

You can also see Deane Juhans article in Massage and Bodywork Jan issue.

Related posts:

1. Being able to Bill Insurance Companies – is it worth it?
2. The State of Billing Insurance in Washington State.
3. Massage Insurance Billing Manual

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

Related posts:

1. Website survey
2. MTCIM – day 1
3. Multiple streams of income

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

Related posts:

1. Massage Insurance Billing Manual
2. Can a massage therapist bill insurance companies?
3. 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.

Related posts:

1. Massage Insurance Billing Manual
2. The State of Billing Insurance in Washington State.
3. Billing Insurance Companies for Massage Therapists

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