Issue link: https://www.massageandbodyworkdigital.com/i/494122
50 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 ELIGIBILITY TO BILL INSURANCE How do you know if you're able to bill insurance for your services? There are several factors, including state laws, contractual agreements, and the client's own policy specifications. You'll need to investigate all of these areas prior to working with the client. Clients often ask if you accept their insurance. A more appropriate question would be whether the client's insurance company accepts you. Each insurance company has its own application process for those hoping to be recognized as an approved health-care provider, sometimes including a fee to apply and/or maintain that status. Visit an insurance company's website to learn about its billing policies and procedures. Good information to understand includes acceptable procedure codes, billing formats, reimbursement rates, billing address, and phone numbers. The type of massage you provide is not the deciding factor in whether you can bill insurance. As long as the client's physician has written a prescription for it and considers it medically necessary, massage therapy may be eligible for reimbursement. The key is that there is a physical problem, the client is going to receive massage therapy or bodywork for that problem, and the problem will improve or resolve as a result of the session. This leads to the next thing you need to know: how to document your results. WHAT INSURANCE COMPANIES WANT Insurance companies are looking for (1) a specific condition or diagnosis to be treated; (2) parameters for treatment; and (3) changes in function as a result of treatment. They want documented evidence of continuous improvement as a result of your work, usually shown by the client's ability to perform activities of daily living and/or the client's ability to do his or her job. • You must bill using procedural and modality billing codes. • The client must have a doctor's prescription for your care. • Your care must follow the prescription. • It usually does not pay in full, so your claim amount will be reduced. • It will be based on whether or not you are an "In Network" or "Out of Network" provider. Workers' Compensation This type of insurance covers care for workers' injuries on the job. It is the second most difficult billing category to manage: there are different procedures for government jobs, city and state jobs, and workers at private companies. You must bill using procedural and modality billing codes, which will differ based on the type of case—federal, state, or private. • The client must have a doctor's prescription for your care. • Your care must follow the prescription. • It usually does not pay in full. • It requires a tremendous amount of ongoing authorization and follow-up. Motor Vehicle Accident (MVA) Billing MVA insurance companies (such as A A A, Allstate, or Geico) is somewhat easier than the other categories described here. If you choose to begin billing, I suggest starting with this type. • You must bill using procedural and modality billing codes. • The client may or may not need a doctor's prescription for your care. • It usually pays in full. Medicare/Medicaid This government-provided insurance covers care for people living in poverty, children in foster care, adults over the age of 65, those on social security disability insurance, or those who have been diagnosed with certain diseases. As a massage therapist, you are not able to bill Medicare or Medicaid; federal payers do not deem massage therapy as medically necessary and will not reimburse for it.