Tag Archive for Massage Insurance Billing

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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Can a massage therapist bill insurance companies?

February 5, 2007 Julie Onofrio Massage Insurance Billing

Currently only Florida and Washington state make it mandatory for insurance companies to bill your health insurance for massage therapy services.

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.

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SOAP Charting

November 19, 2006 Julie Onofrio Massage Insurance Billing, News, Start Your Massage Business

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

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Get Your National Provider Number

October 29, 2006 Julie Onofrio Massage Insurance Billing

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

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Insurance Billing Manual

October 28, 2006 Julie Onofrio Massage Insurance Billing

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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