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Massage Today
July, 2008, Vol. 08, Issue 07

Accepting Insurance: From A to Z

By Vivian Madison-Mahoney, LMT

I really appreciate all the phone calls and e-mails from therapists about insurance billing issues. It is through your questions and problems that I learn and can direct my research and better help others.

I often hear people say, "I would love to accept insurance, but so many therapists tell me it's dreadful, not worth it, time consuming, costly, and on and on." I find nearly 100 percent of the time, when checking deeper into the situation, that the disappointed or exasperated therapist did or didn't do one of the following:

  • did not really know how to bill insurance in the first place;
  • used incorrect codes;
  • accepted cases that don't reimburse under any condition;
  • did an improper interview and initial evaluation with the patient;
  • did not properly document treatment;
  • did not have a properly written prescription, if they had one at all;
  • did not use codes within their scope of practice;
  • insisted on taking certain types of cases, even when I've warned against it;
  • did not obtain authorization to treat an injured worker;
  • did not fully confirm benefits prior to billing insurance;
  • filed incomplete or incorrect claims, or used an improper claim form; or
  • did not check to see if the insurance policy covered massage therapy or manual therapy techniques when provided and billed by a massage therapist.

Accepting Insurance: From A to Z

Adjuster, the claims handler at the insurance company. Authorization must be obtained from the adjuster to treat a workers' comp case.

Believe in yourself; believe you can help others.

Claim the bill you submit to the insurance company on insurance claim forms. CPT codes designate procedures and modalities used to provide medical services.

Documentation is legal evidence and is the key to being paid. Treatment must be documented properly or it didn't happen. Diagnostic codes are to be provided by referring physicians. Diagnosing is not in our scope of practice.

(ERISA): Employee Retirement Insurance Security Act. Self-insured employer plans usually don't directly reimburse a massage therapist (except in Washington).

First: Why not be the first and get a head start in your region?

Game: Pretend insurance is a game to play, know the rules and players, and know you will win some and lose some. Make it fun and enjoy the rewards.

Hire others to help with the insurance work, trade massages with a friend or retiree to begin with.

Insurance companies. Not all reimburse massage therapists.

Justice is not always played out when dealing with insurance companies and attorneys.

KISS: Keep it simple, Stupid.

Losses are inevitable when dealing with insurance. To significantly prevent or reduce losses, learn to do it accurately from the start.

Money surely will increase when you correctly accept and bill insurance cases. This means no Medicare cases.

Nothing ventured, noting gained.

Office; You will love the feeling and pride of ownership when you finally open your very own massage establishment or facility.

Physicians refer patients such as personal-injury cases by written prescriptions.

Questions relating to insurance situations and problems (not codes) may be asked by calling me at (865) 436-3573.

Reimbursement is the payment by insurers for properly submitted claims under certain conditions.

Software for documentation, billing and record-keeping is now available specifically for massage therapists.

Tools of the trade in any business are the keys to a great beginning and ultimate success.

Understand correct coding and billing procedures.

Vivian's Web site:

Workers' compensation covers injured workers who sustained on-the-job injuries.

Xanthochroia: yellowness of the skin. If you are going to work in the medical, insurance and attorney-related field, it pays to learn the related terminology.

You can control your own future.

It can feel like a zoo because business will quickly begin to grow as you accept some insurance cases.

Don't forget to take time away from your office for yourself and your family so you can return refreshed and excited.

Click here for previous articles by Vivian Madison-Mahoney, LMT.


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