Massage Insurance Billing

Massage is being more and more accepted by health insurance and in most states you can bill insurance for massage services for motor vehicle collisions (MVC) (formerly motor vehicle accidents),  work related injuries (Workers Compensation/Labor and Industries).  Across the US there are small organized movements happening to make massage more accepted by medical professionals and become a regular part of health care.

In most states, you can bill insurance for car accidents and for work related injuries.  With the new Affordable Care Act, it is now the law that health insurance companies must cover massage.   Don’t be left behind!

More than ever, learning to bill insurance for massage services can help you to build your massage business.

Since each insurance company/plan and each state has such different plans and rules around billing, learning the basics of how to bill and how to deal with insurance companies will help you to learn how to figure out what YOU need to do in Your State, with whatever plan or company you are billing for your massage services.

Learning the very basic concepts of how insurance companies work and start taking insurance clients in your massage business in this easy to read book.   Once you understand the basic concepts and the process, you will be able to start asking the right questions to the right people and learn what you need to do to bill correctly and get paid by insurance companies!

These basic concepts include:

  • Figuring out if massage will help your business be more profitable.  (2012 and 2015 edition)
  • Figuring out what to charge for your massage services. (2012 and 2015 edition)
  • Understanding HIPAA and why all massage therapists should move toward being HIPAA compliant even though they may not be a ‘covered entitity’.    HIPAA basics, HIPAA NoPP forms, HIPAA Risk assessments,  HIPAA compliant forms, Electronic Health Records/Electronic Medical Records.   ( (2012 short overview and 2015 edition expanded chapter with more details)
  • Learning about what forms you need to collect the correct information in order to bill insurance.  (2012 CMS 1500 form and 2015 edition will include new CMS 1500 02/12 and matching intake forms)
  • Learning how to fill out the basic billing form (2012 CMS 1500 form and 2015 edition will include new CMS 1500 02/12 and matching intake forms)
  • Learning what CPT codes you can use to bill.  (CPT codes are also changing in 2016 and you will get this information in this unique offer – see below.)
  • Learning the process of billing and what to do if you don’t get paid.    (2012 and 2015 edition)
  • Creating a referral network of physicians and lawyers.  (2012 and expanded on in 2015  edition)
  • Glossary of Terms (2012 and expanded on in 2015  edition)

 Working with people who are injured and in pain usually means that clients will come in once or twice a week for a few sessions or for many months depending on the severity of the injury or condition.   That means regular weekly/monthly clients until they are better and usually a regular weekly/monthly client after they are better and the case is settled.

Before you decide if you want to get involved in billing insurance for massage, you really have to analyze your business model and your financial status to see if taking insurance will help your bottom line and help your business become more profitable!  You can do that by figuring out your cost per client and then assessing what your earnings potential will look like if you take a few cases or even decide to have a full medical massage practice/clinic!

If you decide to accept the challenge and open up more income opportunities and help put the ‘care’ back into healthcare, here are some of the things that you will need to know :

  • You will need to know what to ask the client when they call asking if you take insurance and analyze the case so that you can decide if you want to take it or not.
  • You will need to know the lingo and how to work with lawyers, doctors and insurance companies.
  • You will need to know how to do extensive chart notes so that you can show how massage has improved the functions that were impaired due to injury and various conditions.
  • You will need to know how to promote yourself to doctors and other health care professionals.
  • You will need to know what forms you will need and how to fill out the forms correctly so that you get paid.
  • You will need to know what to do if they don’t pay and what to do if they ask for money back!

Learning to bill is very complex to start with and also each state is different, each plan is different making it quite a challenge.  No one person can really tell you how to bill or if you can bill because it is so different in every state and within each insurance company and with thousands of plans out there.  It is also complicated by the type of injury and who is at fault.

To make things even more challenging:

On March 23, 2010 President Obama signed HR 3590, the Patient Protection and Affordable Care Act into law. As it stands now, here is the excerpt from the health care reform bill passed:

The provider non-discrimination provision (Section 2706) to be enacted into law reads in part:

‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.'”  (read more on the new law and massage)

That basically means that health insurance companies will have to pay for massage if massage therapists are licensed as health care providers in your state but it isn’t quite so simple.  You will need to find out what is going on in your state and get  involved in the process of making it happen.   Each state will need to have massage therapists involved to make it happen.

When billing insurance, it means that you will be faced with many challenges like being asked to reduce your fees and having laws created locally that will try to stop you from billing for massage (as currently is happening in FL with MT losing the ability to bill for car accidents).  Insurance companies dictate what they will pay and the number of sessions they will allow in their plans.  The one thing that they do not understand is that massage can save them money in other areas such as eliminating the need for surgery and drugs for many conditions.  If massage therapists want to be more accepted in the medical profession and respected, we will also need a strong, cohesive group to help lobby politicians and to make stands against insurance companies low pay rates.  The more people who understand the process of billing, the more people we will have to be able to do just that.  Even if you choose not to bill, it is important to know what is going on in the world of insurance billing.

That is why I have written this book.   I want to share what I know about billing and help teach you the basic concepts of insurance and billing so that you can learn what to ask the various companies, doctors and lawyers and get paid!

 

The edition that is available now is the 2012 edition.  The 2015 edition is on it’s way soon.   Anyone who purchases the current 2012 edition before the new 2015 edition comes out will also receive the new 2015 edition when it comes out and You will also be invited to join my private Facebook Group where you can ask any questions and get the latest updates emailed to you regularly!

Insurance Billing 101 for Massage Therapists

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 Buy the PDF download Now and
receive the updated
edition and updated information
when it comes out and get access to the
Private Facebook Group and be added to
my mailing list for free updates.

The new edition expected at the end of Jan 2015/Feb 2015
will include these features but will be at a much higher price ($47 + most likely)

 

In the private Facebook Group you can download forms, keep up with the latest changes, and ask questions!

We will be also talking about Health Care Integration and working on the way to implement 2706 in the Affordable Care Act or help figure out what is best for your state.

(Page and expected date of new edition updated 01/17/2015!  It’s on it’ way!  Really!)

 

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Comments

  1. says

    If every state has different regulations of therapists, and what is/is not covered by insurance, how can we know if we are approved providers within our own state?

    • says

      Hi Lisa – no it has been delayed – probably by the end of the year. Not much different really – the basics are the same. I will just be adding info on HIPAA and also on the ACA and expanding on the basics in this book.

      thanks
      Julie

  2. Michael Redline says

    What’s states can medical insurance cover massage and how much can we charge the insurance. Cause I know it can take weeks months or even years to get paid from the insurance company

    • says

      Only WA and FL have laws that allow MT’s to bill health insurance. In each state, some insurance companies are starting to ‘willingly pay’. Actually they pay quite fast depending on the company but as a provider, I usually get paid within 2 weeks – direct deposit into my checking account. It takes years when it is a auto collision and they don’t have PIP or have used up their PIP and then you have to wait until the case is settled which could take years. You charge the insurance the same as your cash rate for your massage service otherwise it is insurance fraud (but you can add on a fee that you would have to pay an insurance billing person to do the billing – like if you hire a billing person and they charge you $15 per bill and you charge $65 for your massage you can charge $80. You have to charge the same rates for the same services. It is explained more in the Book!

  3. Chelsea says

    I’m an LMT in Oregon. How are the insurance billing laws here? If I do bill insurance can I still create a nice soothing ambiance in my massage room (candles, music, etc)? If I buy the book I will get the updated version for no additional charge when it becomes available?

    • says

      You have to find out what the laws are in your state and the rules for billing. You have to find out on your own if you can bill specific insurance companies. You can do whatever you want with your room. Billing depends on how you work with people and if you work with them in a way that improves their condition (diagnosis). Yes If you get the PDF version of the ebook (it is only for the PDF version which you download to your computer NOT the paperback or kindle), you will get the next edition.

      Julie

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