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Massage Today
March, 2007, Vol. 07, Issue 03

2006: A Year in Review

By Vivian Madison-Mahoney, LMT

I hope everyone is optimistic and off to a very happy, healthy and successful 2007!

Because I am receiving so many calls and e-mails about information I previously have written about, I am going to briefly review last year's important issues.

This article will only mention those issues, but you can go to www.massagetoday.com and look up each of my articles in the archives for complete information. Here are the important issues of 2006 that could have a bearing on your massage practice in 2007:

  • national provider identification (NPI) Numbers
  • senate bill introduced to preserve patient access to medical care
  • nine key points
  • join the coalition to protect Patients, doctors and our rights
  • clarification on S.3963
  • CMS 1500 claim forms; and
  • CPT code changes for 2007

NPI: National Provider Identification

Have you registered yet to obtain your NPI? As a massage therapist, you do not have to obtain this number unless you are considered a "covered entity." How do you know if you are a covered entity? If you submit any patient-identifiable information by electronic means, you are considered a covered entity and must be HIPAA compliant.

However, whether or not you are a "covered entity," having your personal National Provider Identification number puts you ahead of the game, so to speak. Having your own number allows you to use it on the CMS 1500 insurance claim forms when submitting bills to insurance companies. Filling in all of the required blanks on a claim form reduces the chances of insurance adjusters denying or delaying your claim. If you do not bill insurance at this time, you can still obtain your personal NPI number, so you'll have it ready if or when you have occasion to submit a claim in the future.

There currently are four ways to contact the NPI enumerator to obtain your own number. Here is the contact info:

  • Tel: 1-800-465-3203
  • E-mail:
  • Web: http://nppes.cms.hhs.gov
  • Mail: Enumerator
    P.O. Box 6059
    Fargo, ND 58108-6059

If applying online, click on "National Provider Identifier" and then "Apply Online." Most of the registration process is very straightforward. When you get to "Taxonomy Information," look under 22 - "Respiratory, Rehabilitative and Restorative Service Provider." Then scroll down to "Massage Therapist." Don't forget to include your license number and the state in which it was issued.


Note: If you are in an unlicensed state, you might want to call the toll-free number and ask to speak to someone who can advise you regarding whether you should use your National Certification Number, or if you can still apply to receive an NPI number.


Senate Bill 3963 Introduced

Sen. Craig Thomas introduced the Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006 (S.3963) on Sept. 28, 2006. The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services supports access to quality health care and therapy services for Medicare beneficiaries. It also supports allowing physicians to choose the health care professionals who provide those therapy services to Medicare beneficiaries while under a physician's supervision in their office. These are billing situations know as "incident to." The passage of the Act will ensure that Medicare beneficiaries have better access to quality health care provided by licensed or certified health care professionals.

Go to www.coalitiontopreservepatientaccess.com to get all the information you need to know and to join this all-important coalition. Please help ensure the passage of this bill. The coalition's goals are threefold:

  1. Improve patient access to quality health care by ensuring that Medicare patients have access to the medically appropriate health care professionals, and that the physicians' practices will receive payment for covered services delivered under the supervision of a physician.
  2. Allow physicians to decide which state-authorized or certified health care professionals have the requisite education and training to provide quality, cost-effective physical medicine and rehabilitation services to their patients. The physicians are the most knowledgeable and qualified people to decide who is best able to provide services to Medicare patients.
  3. Reduce expenses to the Medicare system by providing services in the most cost-effective manner.

Nine Key Points

For nine key points to use when contacting your legislators regarding this important legislation, please contact me.

The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services

Twenty-four associations, organizations and member groups already are fighting to preserve your rights and the rights of patients. I am happy to say that the Florida State Massage Therapy Association (FSMTA) has joined this coalition. I had proposed that the AMTA join the coalition as well. The proposal was presented by Pat Donohue, president of the Florida chapter of the AMTA, to the 32 House of Delegates members at the AMTA convention in Atlanta. The vote was 28 of 32 in favor of the AMTA joining the coalition.

At this time, we are still awaiting confirmation from the board, as well as the board's position statement to add to the coalition's Web site.

Clarification on S.3963

I asked Bill Finerfrock, lobbyist for the National Athletic Trainers Association (NATA), if he could clarify S.3963 for us in regard to billing Medicare and supervision issues. Here is his reply [edited for clarity/space]:

The bill fixes the "incident to" problem for everyone equally. In the case of providers who meet the definition of lymphedema therapist (LT) or athletic trainer (AT) (as defined in the bill), the supervision requirement would be relaxed to allow the delivery of these services without the physician being "in the building."

Under "incident to," the individual providing the services must be under the "direct" supervision of a physician. This is defined by policy as being "in the building." In addition, the individual providing the incident to service must be an employee of the physician (or practice). For many years this meant an actual W-2 employee; however, a few years ago CMS relaxed this standard and now allows the individual to be a contracted employee.

Medicare policy recognizes three levels of supervision: personal, direct and general. Personal refers to immediate, over-the-shoulder supervision. Direct refers to "in the building." General means available via telephonic communication. In the case of "incident to," it is always direct supervision.

The second part of S. 3963 relaxes the supervision standard only. In this case, the individual AT or LT would still provide services under the supervision of the physician, but state law, rather than Medicare policy, would define the supervision. Therefore, general supervision would be permissible (if permissible under state law), and payment would still go to the employer of the AT or LT.

Under S.3963, ATs and LTs are not able to bill for their services, as billing would still be by the physician/employer, as it is under the "incident to" stipulation. This is very similar to what exists under the current law for physician assistants. This also is a very important distinction in that we do not want to create the impression that we are trying to allow ATs or LTs to independently bill Medicare for their services. Medicare would cover their services, but athletic trainers and lymphadema therapists would not bill Medicare directly for their services.

Contact Cate Brennen Lisak, coalition organizer and external affairs director of NATA, and/or myself for more information on the coalition, or to let us know if you or someone you know is willing to join. There are no costs; only requests to assist with calls, e-mails and letters, when necessary. The only possible future costs might be to send a representative of your group or association to special events.

CMS 1500 Claim Forms

CMS 1500 forms will be changed to reflect the new provider number and to include a space for that number. There will be a few other minor changes as well. These forms will be the only forms available after April 1, 2007, and will be referred to as "1500 Insurance Claim Forms."

CPT Code Changes

There are no CPT code or definition changes for 2007.

Contact me regarding insurance billing or coalition issues at , www.massageinsurancebilling.com, or by phone at (865) 436-3573. Cate Brennen Lisak can be reached at , www.nata.org, or by phone at (800) 879-6282, ext. 148.


Click here for more information about Vivian Madison-Mahoney, LMT.

 

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