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January, 2011, Vol. 11, Issue 01 >> Billing / Insurance / Records

Insurance Billing Issues: 10-Year Review

By Vivian Madison-Mahoney, LMT

I cannot believe it has been 10 years since I wrote my very first article for this newspaper's very first edition in January 2001 - and I am still here, having fun sharing with massage therapists across the country.

So much has happened in the field of massage therapy in the past 10 years. If you are reading this for the first time, please take a few minutes (or hours) and review the archived articles that I and others have written.

As far as insurance issues are concerned, I will bring you up-to-date by providing the major highlights, since the first issue of this newspaper.

Insurance in Review: Changes & Updates

  • We have had the opportunity to be included in obtaining a National Provider Identification (NPI) number. The capability to obtain an NPI number has been expected to and seems to be working to help simplify things in the medical reimbursement field. With the ability to obtain a personal identifier now each medical provider does not have to use a different number for each insurance payer. It was a new door opener, however small, for massage therapists to be included. Read "Get Your National Provider Identifier" (MT, November 2006).

  • We had to begin using new 1500 claim forms that became available a few years ago. Read "2006: A Year in Review" (MT, March 2007).

  • CPT coding has not changed enough to comment on since the first issue.

  • Massage therapists across the country have begun to open new doors for themselves and for patients needing massage services prescribed by their physicians. This trend has considerably increased since our first issue, especially since the economy took a nosedive and therapists began to see (and feel) a need to increase their clientele and income.

  • The Health Care Reform Act, signed into law March 23, 2010 by President Obama, has a non-discriminatory clause included. If not repealed or changed by January 2014, insurers will no longer be allowed to discriminate against state licensed or certified health care provider types. The provider non-discrimination provision, applicable to all health benefit plans (both insured and self-insured), enacted into law reads in part:

    (Section 2706) "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."

    Many thanks to the American Chiropractic Association and some other state chiropractic associations such as Florida Chiropractic Association and New Jersey Chiropractic Association, as well as state massage therapy boards such as the Florida State Massage Therapy Association and other state and medically related associations that fought long and hard to ensure that if there was to be reform - there would be no discrimination. Much of this will hinge on the insurance companies ability to finagle (as they are so used to doing), so we will be watching this like a hawk. Read "Health Care Reform and You" (MT, May 2010).

  • Fraud, mainly with other providers using massage therapists, has been on the incline. Make no mistake, insurance fraud investigators are on top of this. I have been more than happy to assist with some of this after being asked by attorney's, fraud investigators and adjusters to perform bill reviews. I have also had the pleasure to help insurance company fraud departments, adjusters and others understand the massage therapy profession and what we should and should not be doing to protect it. I will continue to assist in any way I can to help those outside the profession understand the profession, as well as educate massage therapists on the correct procedures when accepting and billing for insurance cases. I know that all of this effort will ultimately open new doors for the massage therapy profession, especially patients who need our services. Read "Insurance Fraud and Massage Therapists" (MT, November 2010).

  • Another note about insurance fraud in the massage therapy profession. To combat this assault on massage therapists, we have started a task force and are creating guidelines, industry standards and rules to bill by in order to help all those affected. Stay tuned. I will be keeping you posted on the outcome of this.

I look forward to another 10 years with this great informative and "non-denominational" newspaper. And readers, I hope to bring you another decade of insurance issues and information. Thank you for reading!

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


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