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General Insurance Billing Procedures

Massage Therapists

Working with clients who are injured or having some health problems can be quite an experience.  There are many benefits and negative aspects to the process.  You will be treating clients regularly which means extra paper work in the form of chart notes, billing and follow up. This may bring many financial rewards along with headaches from the paper work.  It is important to be organized and take accurate notes.  You may want to consider finding a billing service that does this all for you if you find the paperwork to be overwhelming.

General Guidelines

  1. Get as much information from the client on the phone before they make an appointment.  Ask as much about the injury as you can to determine if you think massage will be appropriate and that you would like to treat this individual.  Ask 

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    these questions: What is the nature of the injury/accident?  When did it occur? Did you go to the hospital?  Was anything broken?  What other treatments have you been getting? Have you been improving?  How will I be paid?  What is the claim number and insurance company?  What is the adjusters name and phone number? Do you have a physicians referral?

  2. Call insurance company to verify claim is active and still paying bills. Check to see what the policy limits are.  Most will pay for treatments for a year after the accident (variable).  If it has been reached, an alternate method of payment will have to be arranged.  If client can not pay you directly, it is best not to continue treatment until they have an attorney that will handle the Third Party Claim. (see below) limit (dollar amount and time allowed) is and find out if it has been reached.  Find out if there is a copay that is to be paid by the client at the time of treatment.  See if there is a deductible that must be met first before payments are made to you by the insurance company.
  3. Have client fill out  forms:  Intake, Sign release of 

    treatment, Insurance information, Lien, Release of records, Payment schedule or agreement, as applicable.

  4. Keep good chart notes of each treatment.  You may be asked to write a summary at a later date or even testify at trial, mediation or arbitration.
  5. Send bill with copy of chart notes and copy of physician referral. Allow a reasonable amount of time (2-4 weeks) for payment.  If you do not receive payment start a follow up procedure beginning with a phone call to make sure they received the bill and find out what is the delay.  You can contact your state insurance commissioners office if it becomes delayed for no reason.
  6. Keep the physicians and attorneys informed of the status of the patient through regular reports. You may be asked to send copies of all bills, charts etc to the attorneys office regularly.
  7. Insurance companies want to know things like are you charting accurately, is massage helping to make this person better,  is the person getting better.  They will also check to see if you are providing treatments as per the prescription (number of treatments, times per week, length of treatment).
Personal Injury Protection (PIP) : Most Auto Insurance Policy's cover Personal Injury that occurs in an automobile accident. The client's insurance company pays all bills, regardless of fault. The injured person needs to file a claim with their company.  Most will pay for reasonable treatments.  If the treatment becomes questionable i.e.-client does not show improvement, an independent medical exam may be requested to verify injury and treatment protocol.   A referral from a physician is recommended, but may not always be necessary.
See also common legal terms in personal injury cases.
See also Common Legal Terms

Third Party Payment:  Someone else besides the client is responsible for paying bills such as the other person (whoever hit them) insurance company.  These claims usually imply that payment will not be made until the claim is settled.  There is usually a 3 year waiting period in which the claim must be filed. The time could be even longer if a trial is required.  You will be working through the clients attorney.  The attorneys usually work for a percentage of the settlement so they try to get as much as possible.  Chart notes will be requested by the insurance company and attorney so send copies to both.
Some things to consider in these cases:

  1. Is the client delaying "getting better" just to get a big settlement?
  2. Are you able to continue treatment without receiving payment for awhile, maybe years?
  3. Are you willing to testify at a trial or other proceeding in behalf of the client? (This doesn't always happen, but it is a possibility)
  4. Do you know and trust the attorney's office?  Will they pay you before giving the money to the client?
  5. File a lien for medical services with the attorneys office.  This will ensure that you will be paid by the client no matter what: i.e.-if they don't get enough in the settlement to pay you.  If the attorney refuses to sign the lien, you should file a lien with the county clerks. office.  Fill out the lien, have it notarized, and mail to the county clerk.     ( Be sure to remove this when the bill is paid!)
  6. They may also ask you to waive some of your fees if they don't get enough to pay you.
Labor and Industry/Workmen's Compensation: All states have their own department of labor an industries to handle claims of workers who are injured on the job.  The rules may vary state by state.
Some companies are self insured meaning they are not a part of the state labor and industries but have their own insurance to cover injured workers.  They usually have to abide by the same rules as Labor and Industry.
The following applies to Washington State:
  1. You will need a provider number from the state to process these claims.
  2. The client is usually allowed and initial 6 visits:  Confirm this coverage first before treating.  Additional treatments can be approved with documentation that it is necessary and that the client is improving.
  3. It is necessary to have a prescription from the primary care physician.
  4. Chart notes must be kept and sent to the insurance company on request.
  5. There is usually a limit on the amount of payment allowed per treatment.  Even thought you may bill at a higher rate, you may not receive the total amount.  You can ask the client to pay the additional amount, but check with the legalities of this.
General Medical Insurance:  In Washington State, more and more companies are paying for 

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massage therapy.  You can become a provider with each individual company to receive payment and referrals.  Other states hopefully will catch on soon.
At that time they will inform you of all the rules regarding the billing process. Make sure you call the company before treating a client to verify claim and eligibility.  If you are in a state that does not pay for massage therapy, you may consider sending them copies of chart notes and invoices that your clients have paid to show that they are getting treatment and that they are getting better.

Direct Payment from Client: You may ask the client to pay for your services at the time of treatment and give them a bill that they may submit for reimbursement.  This simplifies the whole process for you, but not necessarily for the client.  This usually does not apply to a Labor and Industry claim or other type of insurance that you are a provider for.



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