Bill PIP for Massage Therapy

One of the most challenging yet lucrative massage therapy clients are those who have been in motor vehicle collisions and are injured. Their personal injury protection insurance on their car insurance should cover massage therapy services if they sustained soft tissue injuries such as whiplash, strains and/or sprains or other injuries from the impact.

People who are injured in car collisions often need mutiple sessions a week in the beginning of their care and taper off as they get better. Massage therapy needs to be medically necessary and be prescribed by a doctor and their case managed by a doctor.

Billing PIP for massage therapy services is a great way to maintain your practice during a recession or to help grow your business. Taking just a few cases at a time is usually enough to do that.

Simple steps to billing car insurance for motor vehicle collisions.

Steps to Billing PIP/MedPay

1. Confirm the client has a prescription for massage and has opened a claim with the insurance company. The client will be assigned a case manager.
2. Get the claim information and call the claim manager to verify benefits. Tell the manager you have a prescription and tell them the diagnosis code and number of sessions prescribed. Ask if it’s covered.
3. Ask how much money remains in the PIP fund. Most policies have a dollar-amount limit. If benefits have been maxed out, the case will become a third-party claim, meaning you will get paid when it is settled.
4. Ask if you need to send any paperwork in addition to the bill. Often the prescription and chart notes are required.
5. Ask where to send the bills and if they should be sent to anyone’s attention.
6. Find out when the accident occurred and how severe the injury is. This information often helps you determine if you want to take the case. Severely injured clients often use up all their PIP benefits. You then may have to wait until the time of settlement to get paid.
7. If the case is a third-party claim, set up a contract with the client and, if applicable, their attorney. Another option is to create a lien with the county court house.
8. Perform prescribed massage therapy.
9. Chart all sessions and show the areas you worked on, the results, the plan of care, and progress of care (SOAP notes).
10. Fill out a CMS-1500 form and send the bill and any other required paperwork.
11. Call to make sure the insurance company received the bill and ask if there are any questions or problems.
12. Continue care. Track prescription due dates and progress of client. Renew prescriptions when needed.
13. Work with physicians to bring client back to pre-injury status.
14. If you haven’t received payment approximately one month after sending the first bill, call to find out what is holding up payment.
15. If an attorney is involved, find out what information they want and when they want it. Often, they only want the copies of the bills and SOAP charts when the client has finished treatment and is ready to settle the case.
16. Use the attorney’s office to help you get paid, if necessary.
17. Get the client involved too, if you are not getting paid promptly.
18. You may be asked to take a reduced payment with end-of-settlement cases. You can and should say NO and make arrangements to be paid. That’s the purpose of the contract and lien: to ensure payment no matter what happens in the case. (If you are a provider with any affinity plans, you may be required to take a discount for your services if the plans are also contracting with vehicle insurance companies. You can opt out by contacting the affinity plan and requesting removal from that part of the network. Otherwise, you will be required to take the discount.)

Learn to Bill Insurance for Massage Therapy Services

While this is a simple step-by-step list of things to do, each step requires that you know how to do each thing. Filling out the forms and knowing the codes to use is just part of it all. Charting and reports are required. You need to understand how it all works. As you learn, you can also start to know what cases you want to take and which cases will be more challenging. You can purchase my book Massage Insurance Billing and join my Facebook group to ask questions.

You will need the skills to assess clients condition and work with the various conditions. Medical Massage is the word that is usually used to describe what you need to know but it is not a specific technique or method. Any type of massage can be applied to various conditions if you understand the condition, anatomy, physiology, pathology and behind the injury.