Explorations in the Theory and Practice
What should SOAP charts say?
While researching information for my insurance billing manual, my attention came to the dilemma we have in massage therapy about charting what we do in order to get paid by insurance companies. I often hear comments from massage therapists such as "No one reads our notes anyway" and "I don't write what I do in a session on a chart because the insurance company won't pay for it. I keep separate notes for myself".
Charting what we do is one of the only ways we have to provide insurance companies, physicians and the medical community with information about what we do in a session with a client. It is a necessary part of developing our profession.
Insurance companies want us to tell them how has a client improved. Have they gotten better as a result of the session with us? This is the only thing they can use to determine if a treatment is "medically necessary". This really does not tell what exactly happens as a result of a massage session. There is so much more to what actually goes on in a session beyond the technique we do and is the client getting better. What does better mean? What do we want to be telling insurance companies about what we do and see in a session?
Here in Washington State, we are being required (as a contracted provider of one health insurance company) to take a SOAP charting class offered by Diana Thompson, author of "Hands Heal: Communication, Documentation, and insurance billing for Manual Therapists". I have read the book and have taken the class. The book talks about how we need to communicate what we do in a session and that a session is more than just trying to "fix" a client -which is the heart of my writing and websites. She talks about "mirroring" and active listening and how that is such a part of the therapeutic relationship. Then the charting system she proposes goes on to focus on functional outcomes- what the insurance companies want to hear about.
I also recently read an article on "CARE" charting in Massage and Bodywork magazine. CARE charting tells the condition of the client (C), before and after the session, the action taken (A), the response of the client (R), and an evaluation (E) or plan for the next session. I think there is a great potential for "CARE" charting but I am not sure it will be accepted by insurance companies as they seem to be stuck on SOAP charting. If insurance companies want us to set functional goals, we can add that to the evaluation section as a recommendation.
My challenge to the profession is this:
The reason I am doing this is that it seems that, Diana Thompson's method of charting functional outcomes will soon be the standard. The insurance companies seem to love this method. One insurance company in WA state has already bought into it and made it a requirement to learn (but I don't have to actually change what I do, just take the class to fill the requirement). If we don't take a stand and look at this issue, it will soon be too late or will take longer to change. While this method of charting has been instrumental in getting our work accepted by the insurance companies, it comes at a high cost to the profession. Insurance companies and medical professions are missing out on the core of healing. They are still in the dark about what we really do.
To enhance our profession we need a way of charting that fulfills the insurance companies needs and ours too!
With this in mind, please send me your blank SOAP charts and a description of what information you put in each section. (or a write a example of what you would write but not with a real client- I don't want any HIPAA problems!) What works best for you? What are the insurance companies that you work with looking for? Do insurance companies actually read your notes? Do you leave anything out because you feel that it is not accepted by the insurance companies? Send me your comments, questions, observations, chart notes!
Send SOAP charts to email@example.com
or Julie Onofrio, LMP 1402 Third Ave, Suite 1428 Seattle, WA 98101
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