Issue link: https://www.massageandbodyworkdigital.com/i/1128556
Does your business have enough cash flow to withstand not being paid for 30–90 days? It takes time to receive payments from insurance companies—if you get paid at all. Depending on the type of insurance, most have between 30–60 days from receipt of your claim to reply to you. Their reply may be a request for more information, they may make a partial or full payment, or they may deny the claim altogether. Your business must have enough cash flow to withstand the time lag and be able to absorb the loss if they don't pay, or pay only a small portion of the total bill. Do you understand the overall concept of insurance billing and how it works? There is a lot to know about insurance billing, and each scenario is different. You must be able to observe each situation and make decisions on how to collect from the insurance company. You must also know how to directly bill the client for any remaining unpaid balance. (Note: It is not legal for you to request payment for services from a client on a workers' compensation claim. Workers' compensation payments are considered paid in full.) Do you have the infrastructure and time to generate, oversee, and follow up on insurance claims? Discussing billing with a client (or their health-care provider) takes time. Confirming the client has coverage and creating the paper trail (or PDFs), and then mailing, faxing, or submitting them online takes even more time. Finally, you'll need to follow up to be sure you get paid in a timely manner. All of this takes skill and infrastructure—skill that not everyone wants to learn and infrastructure that not everyone wants to obtain. Do you know the purpose and use of ICD diagnostic codes? The diagnostic code is determined by a medical provider who is licensed to diagnose your client's condition. ICD stands for the International Classification of Diseases, and each condition, injury, disorder, disease, symptom, and infection—and its specific characteristics—has its own unique code. The coding is complex, and a therapist should never assign an ICD code to their client unless they are legally allowed to diagnose. These codes are used to categorize and manage our country's health-care system, and the diagnostic code(s) indicate why you are treating your client (and justifies the treatment and billing for services). Do you know the purpose and use of current procedural codes? Current Procedural Terminology (CPT), overseen by the American Medical Association, is coding used to report each procedure or modality that is provided to bodywork clients, such as manual and movement therapy and ice/heat. Health insurance companies determine if they will reimburse for each specific CPT code based on the license of the provider, the diagnostic code it is applied to, and other variables (such as other treatments performed on the same day—by the same or outside provider—and/or whether the condition being treated is stable or improving). Do you have a business address you can list on the claims? Do you see clients at your home? If so, you may not want your address to become public information. Place of service (in this case, your home address) is required on the insurance claim. IS IT WORTH MY TIME? It takes a particular type of person (and business) to do well at billing insurance companies. It is absolutely the right thing for some therapists and, alternatively, a complete nightmare for others. Getting a certificate or degree in medical billing can take from six months to four years. But even if you don't go to school to learn the ins and outs of billing, make sure you have the basics and nuances down before submitting even a few claims (to see how it works out). Remember, as with any industry, the laws, codes, and requirements change, so you must keep up to date. Since most therapists and clinic owners do not want to switch careers and actually become medical billers, the alternative is to gain as much information as possible through trial and error or continuing education opportunities. You can learn what you need to be able to handle your medical billing, or you can choose to hire an outside person (or service) to submit claims for you. If you want to bill insurance, but don't want to handle all the paperwork yourself, outside billing companies typically charge 5–15 percent of collections—or they may charge a flat fee per date of service billed (regardless of the collection amount). Michael Grise, of Hopkinsville, Kentucky, has been billing insurance for 10 years and says he typically collects around $180 per hour for a medical massage session when billing for either massage or manual therapy. He agrees that once you take the time to figure out how to bill ethically for your services, insurance can be an advantage for your practice. Still not sure whether to bill or not to bill? Ask yourself the following questions to decide whether billing is right for your practice: