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We present these ideas to help ease the process of insurance reimbursement, clarify protocols, and keep you informed of new requirements. While these tips are mainly written for somatic practitioners who are not primary care providers, most of these suggestions can benefit all practitioners. Each week you will find a new tip, so please visit us often!

If you have strategies that have been successful or are aware of upcoming or new regulation changes, we are happy to include them. Please send them to us via e-mail, FAX (+1 520-743-3656) or the Postal Service!

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From Ed Denning, author of the Medical Code Manual

All the information you place on a HCFA 1500 must be present in your client records.

From Ed Denning, author of the Medical Code Manual, and Massage Therapy Associates a web site specifically created for insurance billing information.

Submit HCFA forms in large envelopes which do not require the form to be folded. Character reading machines don't like folded forms.
Photocopies of the red HCFA form are not allowed. Every submission must be an original.
Always keep a photocopy of the HCFA 1500 form that you are submitting.
To make sure your document trail for your clients is complete, select one day in the month and search for a particular client's date they called your office, a calendared appointment, a dated treatment record, and copy of a dated receipt for payment.
All CPT codes that can be used by massage therapists are in 15 minute increments called units. On the HCFA 1500 use 4 units for an hour of work.
1. Pay for the services of massage therapists who have a very busy, successful practice. Emulate and adopt what they do right and you find comfortable.
2. Seek out those whose businesses are not flourishing, pay for their services, observe what they do wrong and avoid it.
Advisors to include for your business are: an attorney, accountant, business consultant, coding expert, other successful massage therapists. You may barter for services.
Using correct codes is the therapist's responsibility.
Oftentimes the people who process codes for insurance companies are not well versed about the codes' proper use, nor do they necessarily know what a massage therapist does. Being paid for a code does not necessarily mean it was used correctly.
Words like "physician" are defined according to a medical dictionary. The idea of a "physician" as a "healer" is common usage and not an acceptable definition.
Massage therapy could have CPT codes which are designed specifically to aid in reporting your work. This only occurs through the support and guidance of professional associations, so be an active participant.
Begin taking insurance cases on a small scale until you become familiar with the process. Do not allow insurance cases to dominate your practice: waiting for payment can cause serious cash flow problems.
Ethical professional behavior is the basis for your business practices and your personal integrity.
Ethical Issue: Treat insurance companies like a valued client. Billing insurances more because you can get away with it may be legal; it is also a very questionable ethical practice.
Ethical Issue: Treat all clients the same and charge the same fee to everyone. Favor those special interest groups you wish to with posted discounts. Have your fee schedule posted in your office or printed on readily available forms.
A recent study by a national massage organization found evidence that those who do insurance billing have a higher income than those who do not.
There are very few CPT codes which massage therapists can safely use. Most codes in the Physical Medicine section of the CPT Manual describe procedures used by other specialists who use "hands-on" techniques, including massage.
Avoid using more than two CPT codes and two ICD codes on each HCFA 1500.
In 1966 the American Medical Association (AMA) published the first of their yearly editions of the Current Procedural Terminology Manual (CPT).
Current Procedural Terminology (CPT) codes may be added or deleted on a yearly basis. Identify a realiable resource for codes to update your coding information as changes occur.
Insurances accept some CPT codes when used by non-physicians.
CPT codes are written for physicians.
Current Procedural Terminology Codes are CPT codes.
Join a professional association for their many resources including insurance and business information.
Time Saver: Set up your Professional Receipt like a physician's superbill, charge cash and let the client staple your superbill to their insurance form and accept direct reimbursement.
Time Saver: Have the CPT codes listed on your Professional Receipt to simply check them off. (See "The Professional Receipt," Massage Therapy Journal, Summer 1999.)
Time Saver: Find someone who has experience filling out HCFA 1500's and pay them to do it for you. Concentrate your energies and attention on those parts of your business where you are skilled and can create income.
Time Saver: The client must sign the HCFA 1500. Or, have them sign a release exactly as on the HCFA 1500. Then type "Signature on File" on the signature line of the HCFA 1500. This is acceptable to all insurances. That way the client need not be present to process their claim.
NOTE: Be sure you actually have a signature on file dated before the first HCFA is submitted. See HCFA 1500 Frequently Asked Questions for more information.
The HCFA 1500 insurance form must, by law, be accepted by any insurance company. Learn this one form for all submissions.
The "universal insurance form" is called the HCFA 1500. HCFA is an acronym for Health Care Financing Association. They created the form.
Ed. Note: The Health Care Financing Association was renamed the Centers for Medicare and Medicaid Services (CMS) on June 14, 2001.
Any well run business has a carefully organized system of documentation. It is not difficult, and very important, to set up such a system for the use of medical codes.
When the U.S. changes to ICD-10, you'll need someone who understands the new system. You still get your codes as previously described.
The medical profession in the United States is currently using ICD-9. Canada is using ICD-10.
ICD codes may be found on a doctor's prescription, superbill or by calling their office and asking. No other sources are acceptable.
Diagnostic codes are called ICD codes. (See the World Health Organization's Classification page for more information.) ICD-9-CM is an acronym for International Classification of Disease, 9th Revision, Clinical Modification. They may not be used by massage therapists.
To be found guilty of fraudulent behavior it requires a purposeful pattern of actions designed to obtain money you did not earn.
In the AMA CPT manual every word, punctuation and indentation have specific meaning. Unless you have learned those, meanings errors occur.
Worker's Compensation in most, if not all, states accept code 97124 (massage) only. (If that isn't true in your state, Ed Denning would like to know.)
Medicare does not cover massage done by anyone.
In Ohio all auto insurance companies cover massage therapy. Do they in your state? (Ed Denning would like to know if they do.)
A recent study by a national massage organization found evidence that those who do insurance billing have a higher income than those who do not.
If you become a provider for an insurance company, find out who your provider representative is and establish a good rapport. Treat them with appreciation and courtesy as they can save you a great deal of work should a problem arise.
New CPT manuals are available about Nov. 1 each year. Most insurance companies have updated their CPT records by June of the same year.
Laws regarding responding to insurance submissions are tightening. If you have not received the HCFA 1500 form back or payment within 30 days, call and complain.
Make your decisions about whether to get involved with coding on the basis of understanding what is involved and the philosophy of business and not out of fear. Knowledge is power.
Read "Insurance Reimbursement: Pros and Cons" in Massage Therapy Journal (AMTA publication), Summer 2001 for an understanding of both sides of this controversial issue.
Some insurance companies will continue to accept a CPT code which was deleted from the AMA manual for many months after it has been deleted.

From Vivian Madison Mahoney, author of The Comprehensive Guide to Insurance Billing. Visit Massage In$urance Billing

Make sure you can provide services other than what you are willing to discount to subscribers at your regular rate.
Ask the insurance company or plan provider if preset discounted fees for subscribers can be increased.
When considering discounted fees for services to insurance company subscribers, make sure you still receive full payment under the policy or plan's insurance coverage for medically necessary prescribed treatment.
With settlement cases make sure to have the client's attorney review any forms that need to be filled out before completing and submitting them to insurance companies or other parties involved.
You may be asked by attorneys to accept a reduced payment on settlement cases.
If a modality is prescribed that you are not qualified to provide, do not provide or bill for the service.
It is wise to keep all patient, accounting and insurance records for at least 7 years.
Be aware that there are business costs when dealing with insurance billing and adjust your expectations about how much money you will make.
Get your client's written permission before submitting documentation to insurance companies, attorneys, physicians or other health care professionals.
When giving a deposition in a legal case, remain dispassionate and professional, stick to the facts, and answer only the question that is asked.
Learn insurance terminology to speak intelligently with adjusters and case managers, and to thoroughly understand what information they are conveying to you.
Learn insurance terminology to speak intelligently with adjusters and case managers and to thoroughly understand what information they are conveying to you.
Understand that you may be called upon to testify and provide documentation in a court of law.
Be clear with your client about what portion of your services they are expected to pay and what portion the insurance company has authorized.
Be efficient and save time by maintaining an adequate supply of documentation and insurance billing forms.
Spend time learning about the insurance process - become an insurance guru.
Although you may be frustrated or angry about an insurance billing situation, remain courteous with the provider and sincerely ask for their assistance.
Send thank-you cards to establish and maintain a good rapport with referring primary health providers, attorneys and others involved in the insurance process.
Inaccurate documentation causes delays and loss of revenue through additional time spent giving explanations and redoing paperwork.
When bills are reduced or denied, work with someone else in the company and request an explanation in writing.
Be aware that there are always exceptions to the rules, some red tape, and sometimes hassles.
It is easy to get overwhelmed by paperwork. Learn the procedures thoroughly, streamline your billing process and perhaps hire someone to do the insurance billing.
Never be afraid to ask why you are being told something or ask for denials to be given in writing.
Professionalism (e.g., dress, mannerism, proper tools of the trade) is essential when dealing with medical referrals and/or insurance related cases.
Authorization by the adjuster, and in some cases the employer, is a must to treat an injured worker in a Workers' Compensation case.
To avoid delays, reduced payment or denial of a claim, the prescription, your documentation, and the medical bills must all match.
It takes the clients, the referring physician and the insurance adjuster working together to successfully bill insurance companies. Remember to show appreciation to each of them.
Overbilling insurance companies only serves to thwart your efforts to be recognized and accepted as a legitimate service. Bill accurately and prudently.
To submit bills to insurance companies, massage treatment must be medically necessary as diagnosed by a licensed practitioner.
For a Workers' Compensation case you must ask for authorization to treat the patient according to the physicians' prescription orders.
Ask to see the patient's policy if there is doubt about coverage for massage therapy services. Check the policy for inclusions, exclusions. and limitations.
Submit bills to the insurance company immediately after first visit to get an early indication of their reimbursement policy per the explanation of benefits (EOB).
If a policy does not specifically exclude massage therapy scope of practice services or massage therapists, it may be your opportunity to accept the client as an insurance case.
Always call the insurance adjuster or case manager for verification of coverage on all insurance cases. Document the entire conversation including name, date and time.
To reduce delays and problems with the insurance company, pretend your documentation and billing will be brought before a judge and jury. You automatically adjust your actions accordingly.
Do not, under any circumstances, practice outside of your scope of practice. Do not diagnose or give a prognosis in a case.
Workers' Compensation rules and regulations vary from state-to-state. What is acceptable in one state may not apply in another.

From Lawrence E. Warnock, LMT, NCTMB

Start by attending the services in your faith. You need divine intervention when dealing with insurance companies.