Issue link: https://www.massageandbodyworkdigital.com/i/1128556
Ta k e 5 a n d t r y t h e A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 79 T he initial thought to collect payment through insurance billing might come from a client, asking if you can bill their car insurance for their whiplash treatment. A physician might also ask if you can submit claims to major medical insurance companies for the therapy you provide to their referred patients. Or, you might have heard that practitioners can make a lot of money charging insurance companies for therapy services, so billing is a prospect you want to investigate. And, it is possible that your clients might have their bills covered through their insurance rather than treatment being an out-of-pocket expense. So, "To bill or not to bill?" is a legitimate question worth investigating. LAWS AND LICENSING In the US, state laws and licensing requirements dictate whether a therapist will be reimbursed at all for all forms of health insurance. Many years ago, my San Francisco wellness center was billing insurance for about 70 percent of our services. We billed motor vehicle insurance and workers' compensation and were getting paid well—and on time. This is because I spent many nights pulling my hair out and screaming at the computer in frustration, and through trial and error I finally learned the secret of getting paid by insurance companies. However, over the years, the insurance laws changed dramatically, and there are many more restrictions placed on providers. These new requirements were aimed at reducing insurance fraud, but they limited the services we could provide—and the amount we were reimbursed. For example, we used to regularly bill code number 97010 for a hot/ cold modality (for most treatment sessions) and, although we continued to provide the application and included the code and fee on our claims, workers' compensation insurance completely stopped reimbursing us for it at all. 1 Vivian M. Mahoney, author of The Insurance Billing and Practice Building Manual, says, "I would estimate only about 5 percent of the solo or small therapy clinics in the US are currently billing insurance for the services they provide. I think the biggest reason there are so few therapy providers actively billing is that they simply are afraid to take the time to learn how to do it ethically and effectively." 2 Over the last five years, my wellness center has slowly transitioned from predominantly charging insurance companies to being a cash-based practice, where we collect payment directly from our clients and patients for all services rendered. When requested by a client, we do provide a statement of all services, called a super bill. A super bill includes all charges, payments (for all dates of service), and all the other required information on the provider, the insured, and the services. We provide the super bill so the client can submit the claim to their insurance company for reimbursement themselves. Many of our clients understand the importance of receiving brilliant therapy, and the possibility of getting reimbursed is secondary to them. As a Precise Private Practice (a business model I developed that focuses on effective ways to serve both clients and therapists), we prefer not to bill insurance. This gives our providers much more freedom of clinical choice, as well as dramatically cutting down on office administration time needed for processing claims. Basic Billing Terminology Claim—This is the bill submitted to the insurance company. The claim includes the date of service, charges, payments received (if any), provider information, client information, and appropriate billing codes. Provider—This is YOU! You are the service provider submitting the claim for treatments provided. As a provider, you will submit the service claim to the insurance company. Fee Schedule—These are the rates (or prices) you establish as fees for specific services. You determine your fee schedule, and you bill the insurance company for services you provide to your client.