This is not just about billing…
Be a part of the next wave of getting massage therapy covered by health insurance across the US.
Almost everyday I see a news article or report from various associations, legislators and others calling for the inclusion of massage therapy into healthcare to help with the Opioid epidemic.
The Comprehensive Addiction and Recovery Act of 2016 (CARA) required the Pain Management Best Practices Inter-Agency Task Force to develop the Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations – (PDF)*, which identified gaps or inconsistencies, and proposed updates to best practices and recommendations for pain management, including chronic and acute pain.
Key takeaways from the report:
Pain is an enormous public health problem with profound individual and societal consequences.
Successful management of pain requires individualization of care in the selection of therapies tried, in the consideration of risks and benefits of therapies, in the duration of treatment, in the optimal dosing of medication and so on.
Best practice in pain management is achieved through a multi-modal, multidisciplinary, integrated model of care including a full range of pharmacological and non-pharmacological treatments.
That’s Massage Therapy
Stigma is a major barrier to treatment, so it is critical to provide education and awareness of the underlying disease process of pain and to provide empathy and a nonjudgmental approach to treatment.
Public, patient, and provider education is critical to the delivery of effective, patient-centered pain management and is necessary for optimizing patient outcomes.
The risk-benefit balance for opioid management must be considered on an individual basis as there is wide variation in factors that affect the optimal dose of opioids.
270 Medicare Advantage plans just made massage therapy a part of their benefits.
American Specialty Health ( https://www.ashcompanies.com/ ) just announced that their affinity network was adding massage in the following states:
Acupuncture and Therapeutic Massage coverage has been added in the following states: Alabama, Arkansas, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Missouri, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin. This coverage is offered under the Essential/Everyday Extra benefit under Alternative Medicine which provides up to a combined total of twenty-four (24) medically necessary acupuncture and/or therapeutic massage visits each calendar year. Services must be health related and not primarily for comfort or relaxation as determined by your health care provider.
Massage therapy 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 get massage more accepted by medical professionals and become a regular part of health care. I have been collecting information on the various states and what types of insurances can be billed by massage therapists.
The Opioid Epidemic is leading to a Call for more alternatives to Pain Pills. The American College of Physicians recommends massage therapy for back pain. In Sept 2017, The National Association of insurance commissioners have asked for it to be used to battle the drugs. (See the letter PDF)
“When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care.”
Massage therapy could be a big part of the solution. The one drawback is that massage therapy is not yet covered by health insurance in every states. But it is in WA State and has been since about 1996.
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 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 entity’. 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 to use and how to use them.
- ICD 10 codes and how to interpret them and use them.
- Learning the process of billing and what to do if you don’t get paid.
- Creating a referral network of physicians, health care providers and lawyers to get more clients.
As a result of learning the basics of billing and actually billing cases, you will be able to start telling which cases will require more time, energy and have more risk of not getting paid so you can focus on taking cases that will take less time and energy to bill AND get paid.
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.
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.
When billing insurance, it means that you will be faced with many challenges. 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. We need more massage therapists billing insurance and getting to the table with the insurance carriers right from the start so that we can have a say in what happens.
The ability to bill and get paid by health insurance is coming no matter if you want it to happen or not.
I have been billing insurance of all kinds since about 1990, when I started my massage business in WA State. I have taken every class I could and read every book and article on billing insurance that I could find.
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!
This book is not just about Billing… It is a Call to Action for YOU and the massage profession. I have added a Chapter on How to Get Massage therapy covered by health insurance and a Call to Action with 42 Action Steps that We need to start taking as a whole. I want to create a grassroots movement to bring awareness to massage and create the attention that it deserves to take it’s rightful place in healthcare.
I updated the cover of this edition if you bought one in 2019 with a black and white cover – this is the same edition!
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.
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