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 and 2706, 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.
- Figuring out what to charge for your massage services.
- 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.
- Learning about what forms you need to collect the correct information in order to bill insurance.
- Learning how to fill out the basic billing form
- Learning what CPT codes you can use to bill. CPT codes are changing in 2016.
- ICD-9 codes are changing to ICD- codes and require more charting.
- Learning the process of billing and what to do if you don’t get paid.
- Creating a referral network of physicians and lawyers.
- Glossary of Terms
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 2015 edition is Here!
(Includes Free Updates and Private/Closed Facebook Group for 1 Year – PDF version only currently)
(Through Clickbank.com and Ejunkie.com secure downloads!)
For Immediate Download to your Computer!
Printable PDF file
Download to Directly to Your Computer and Print.
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.
NOTICE: You will still have to figure out if you can take insurance in your state and figure out how to bill in your state. Each state is different. Each Plan is Different.
I will help you to figure that out in the Private/Closed Facebook Group!
I am also collecting information on what is being done in each state!
- Chapter One. Should You Start Taking Insurance?
Cost per Client
Cost Per Client Analysis
- Chapter Two. Health Insurance Portability and Accountability Act. HIPAA.
Protected Health Information
The Privacy Rule
The Notice of Privacy Practices Form
Patient Right to Access Records.
The Security Rule
The HITECH Act
HIPAA Final Omnibus Rule
Putting It All Together.
National Provider Number
- Chapter Three. What to Charge for Your Massage Services.
RVU, UCR, CPT Codes
- Chapter Four. Types of Insurance (Overview)
Personal Injury Protection (PIP) or Med-Pay (MP).
Private health insurance
- Chapter Five. Personal Injury : Motor Vehicle Collisions and Other Accidents
Working with lawyers.
Independent Medical Exams (IME’S).
Steps to billing PIP/Med-pay
- Chapter Six. Private Health Insurance: HMO’s, PPO’s, Affinity Plans
Steps to Billing Health Insurance
- Chapter Seven. Worker’s Compensation or Labor and Industries
Steps to Billing Worker’s Compensation/Labor and Industries
- Chapter Eight. CMS – 1500. The Billing Form Explained.
- Chapter Nine. CPT® Codes and ICD-9 Codes.
The ICD-9 (International Classification of Disease)
- Chapter Ten. Documentation. SOAP Notes, Progress Reports, Narrative Reports.
Evidence Based Massage
- Chapter Eleven. Getting Referrals From Health Care Professionals and Lawyers.
Sample Networking Letter
- Chapter Twelve. Putting It All Together.
Screening Clients when they call
Calling the insurance company to Verify Benefits and Billing Procedures
Getting Paid and What to do if You Don’t Get Paid.
Appealing Denied Claims.
- Chapter Thirteen. The Challenges of Billing.
- Chapter Fourteen. Healthcare Integration: Getting More Health Insurance to Pay.
Section 2706 of the Affordable Care Act
How WA State was able to bill health insurance – a little history.
- Chapter Fifteen. Glossary.
Cost per client formula:
Insurance Benefits Verification Form
Track communications with the insurance company
Confidential Health Intake Form
Medical History and Information
Confidential Client Intake Form CMS 1500-02/12
Physicians Referral/Prescription for Massage Therapy Services
ICD 9 Codes
Notice: This book is designed to provide information on the general principles of insurance billing only. This information is provided and sold with the knowledge that the publisher and author do not offer any legal or other professional advice. In the case of a need for any such expertise consult with the appropriate professional. This book does not contain all information available on the subject. This book has not been created to be specific to any individual’s or organizations’ situation or needs. Every effort has been made to make this book as accurate as possible. However, there may be typographical and or content errors. Therefore, this book should serve only as a general guide and not as the ultimate source of subject information. This book contains information that might be dated and is intended only to educate. The author and publisher shall have no liability or responsibility to any person or entity regarding any loss or damage incurred, or alleged to have incurred, directly or indirectly, by the information contained in this book. You hereby agree to be bound by this disclaimer.
Billing insurance is done at your own risk. Results will vary. It is your responsibility to use this information and to do your own homework in finding out who you can bill, how to bill and how to get paid. You are responsible for knowing the laws and regulations in your state. You may need to obtain further legal counsel or accounting opinions in order to bill and get paid.