Insurance Billing Manual for Massage Therapists
1. Introduction:
Insurance companies are beginning
to recognize that massage therapy is a vital part of rehabilitation from
injuries and other health problems. All 50 states allow massage therapists to
bill insurance companies for massage sessions on clients who are injured on the
job (worker’s compensation/labor and industries) or when someone is injured in a
motor vehicle accident. WA and Fl are the only two states at this time who
widely accept massage therapists as contracted providers in the health care
system. We are able to become providers with companies such as Blue Shield and
Blue Cross. With this recognition, also come the issues and problems in dealing
with insurance companies.
The process of billing insurance
companies for your massage therapy services will be time consuming and often
challenging. Each state and each insurance company in each state will require
different paperwork and will allow different codes and will pay you different
amounts for the same CPT code. Within each company, you will often find the
procedures will vary greatly from policy to policy. I can guarantee that no
matter how many manuals you read or classes that you take on billing that you
will still have problems collecting the money that is owed to you. With this
wide range of acceptance, it is impossible for any one person or class to
provide all the information necessary for you to process insurance claims
without any problems. In order to reduce the headaches that you have, you need
to know the right questions to ask the insurance company, the client, the
attorney and anyone else involved so that you can get paid. In order to know
what questions you need to ask, you need to learn everything you can about the
insurance industry and how to communicate effectively about what it is you are
doing with each client. Working with insurance companies will be a constant
learning experience. It will be a process that will challenge you to learn
more and ask for more for yourself. You will find yourself need patience,
strong boundaries and the willingness to make a stand against the insurance
industry.
With this in mind, I am writing
this manual with the intention of providing you with the basic information that
you will need to know to start working with decide if it will be worth it. You will need
to know what codes you can bill for, how to fill out a HCFA billing form and
some ideas on what you can do if you are not getting paid. The key to working
with insurance companies is learning what to ask each party involved.
Some of the challenges you will
be faced with include:
·
Being asked to reduce your fees for your services
·
Waiting 1 month to 3 years for payments
·
Having to call each month to see where the check is
·
Having to call each month to see why payment has been denied
·
Resubmitting bills because they were lost or incorrect and waiting
another month or so for payment
·
Waiting on hold to talk to a customer service representative
·
Being told the check is in the mail
·
Learning what you need to do with each company in order to get
paid
So if you are ready for the
challenge, the first step is to decide if you want to take insurance as
payment.
Is it worth it?
Will your business profit?
Will your profit increase?
Will you enjoy the
challenge of dealing with insurance companies and attorneys?
Would you rather spend your time writing out bills,
calling insurance companies and waiting for payments than actively building your
cash practice?
One of the first things you will
need to do is to figure out your cost per
client. That will help you determine if taking insurance as payment
will increase your profit and income. If it does - Great. If it
doesn't then just spend all of the time that you would have spent in dealing
with insurance companies in building your practice.
If you decide that you do want to
continue, learn everything you can about it. That way you can learn to set
boundaries and choose what clients you want to work with. You will be able to
tell those cases that will be most difficult to settle or prove medical
necessity. You can choose not to work with any that you find are questionable.
This is one of the most overlooked keys to building a successful practice.
Sacrificing your values and accepting money just to make money when it goes
against your values will create stress and increase your risk of burnout. You
don’t have to accept every client who calls. You can focus on working on
clients who value your work and are compatible with your beliefs.
While you can have a successful
massage business without billing insurance companies, knowing how to bill will
come in handy when your favorite client gets in a MVA and wants you to bill the
insurance company for them. You also can build a practice totally dependent on
insurance cases and work with integrity when you know all the rules, regulations
and issues.
The purpose of this manual is to
share what I have learned in 17 years of doing massage and billing insurance
companies so that you can begin to learn how to do it in your own practice. I
also feel that the more massage therapists who learn how to bill insurance
companies will begin to see the effects it will have on our profession and allow
us to find ways to participate that support the profession by paying us what we
need to be making and allowing massage to become a part of preventative
medicine.
Chapter One is an expanded
Introduction to the issues involved in billing insurance companies.
Chapters 2-5 will teach you the
basics about the different types of insurance coverage. Motor vehicle
accidents, Provider Networks and worker’s compensation.
Chapter 6 deals with the billing
form that is used by most carriers the HCFA 1500 and how to fill it out
correctly to get paid faster.
Chapter 7 covers the codes that
you will need to know to be able to fill out the form correctly.
Learning to chart a client’s
progress is covered in Chapter 8.
Chapter 9 is some of the tricks
you need to be aware of to get paid.
Chapter 10 teaches you how to
build a network of referrals.
Chapter 11 is a list of the
questions you will need to ask the insurance company, the client and the
attorney to help eliminate problems in getting paid.
There is a complete glossary
of terms to help you learn what the insurance companies are talking about.
The appendix has a chart
for figuring out your cost per client, intake forms, insurance verification
forms, progress reports, billing tracking form, ICD-9 codes and a list of
resources for more information on billing insurance companies.
And Remember… You can also opt
not to take insurance even though you may be feeling the pressure from clients
and the profession to jump on the bandwagon. I wrote a guest editorial for
Massage Magazine in the Nov/Dec. issue that you can read
online. In it, I challenge the profession to look closely at what is going
on in the insurance world and look seriously at how or even if we want to get
involved with insurance companies. In general, we are getting paid less each
year by each insurance company and they are constantly delaying payments,
lowering allowable benefits and doing anything they can to not pay us. From
what I have seen going on here in WA State, the future of billing insurance
companies for our services is not to bright. It is not only the massage
profession, but also every profession.
To read more about what is going
on here in WA
http://www.thebodyworker.com/challenge_to_the_massage_profession.htm
The way out of being a slave to
insurance companies is to build a practice focusing on an ideal client who
values your work and understands the benefits of massage. This can and will be
achieved when more massage therapists refuse to participate in the insurance
industry and work to educate clients to build a cash practice. This will
require that massage therapists have enough self-confidence and belief in their
own value. One of the ways that this can be done is with the process of
Supervision. It is the process of looking at ourselves first to discover our
own wholeness and learn to stay aware of it as we work with others who are
looking for wholeness themselves. It is the process of becoming aware and
staying alive while others are in their story of pain. Our stories are where we
have come from and what builds our defenses and limits us. It is finding out
what our stories are so that we can know when our story is having us rather than
knowing that we are in our story. Building a community of peer supervision
groups and seeking out individual supervisors where we can share our stories and
come to know our stories better, are the key to getting away from managed care
and building a profession that is accepted by the public. It is the key to
creating successful practices – a practice that is financially rewarding,
emotionally connected and spiritually alive! You can build a successful
practice without billing insurance companies if you are willing to look do the
work to build your ideal practice.
Let me know if you have any questions about what is in the
manual.
You can contact
me
The Massage Insurance Billing Manual
Written by Julie Onofrio, LMP
Author/editor of
www.thebodyworker.com
