Insurance Billing & Credentialing for Massage Therapists
Adding insurance billing services to your massage practice can be a great way to gain new clientele who visit regularly for pain management and injury prevention. My goal is to help you decide if insurance billing is right for your practice and to help you learn how to set yourself up for success through systems, paperwork, and helpful tips for getting payments in a timely manner. I offer a virtual course through Udemy to help you learn how to get in network with health insurance companies and how to bill health insurance, MVA claims, and Workers Compensation claims for massage therapy!
Is Insurance Billing Right For You?
Types of insurance that we can accept
Health Insurance -
Motor Vehicle Accident (MVA/PIP) and Workers Compensation -
Getting Credentialed (in network/on insurance panels) with Health Insurance Companies
A quick guide to billing Insurance Companies for Massage Therapy:
Want to learn more? Book a 1:1 session, or email me with questions. I am looking forward to meeting you!
- Do you have space for new clients?
- Do you have the cash flow to cover expenses while you are waiting for insurance payments to arrive?
- Check out my insurance billing cost analysis to get help deciding if accepting insurance is right for you!
- Will you be able to stay organized and on top of billing?
Types of insurance that we can accept
Health Insurance -
- In Oregon and Washington we can accept most health insurance for Massage Therapy
- You do need to be credentialed (in network/on the insurance panel) in order to bill most health insurance companies
Motor Vehicle Accident (MVA/PIP) and Workers Compensation -
- As soon as you are licensed you can accept MVA and Workers Compensation claims
- There is no special credentialing process needed to begin accepting MVA or Work Comp claims
Getting Credentialed (in network/on insurance panels) with Health Insurance Companies
- You will fill out the Oregon Practitioner Credentialing Application
- find the blank form here and a sample form here
- You will need to get a National Provider Identification number to complete the application
- The taxonomy number for Massage Therapy is: 225700000X
- You will send the completed application, a copy of your massage license and liability insurance, as well as a completed W-9 to each individual insurance company that you would like to get in network with to initiate the credentialing process.
- The entire process takes between 60-120 days
A quick guide to billing Insurance Companies for Massage Therapy:
- Client Paperwork - You will want to protect yourself and your clients by ensuring that they fill out the appropriate paperwork. I have included the items that I recommend below and these are available for download in my online store.
- HIPAA Agreement - You must keep a signed HIPAA agreement on file for every client that you will bill insurance for
- Financial Agreement - An agreement outlining the financial responsibility in the case that insurance doesn't pay is a good idea. I also recommend getting a credit card on file when possible.
- Assignment of Benefits - This is how the client gives you permission to bill their insurance company for your services.
- Intake Form to Verify Benefits - This form helps you gather all the necessary information from the client in order to verify benefits and bill their insurance company.
- Benefit Verification for health insurance clients
- Call the insurance company using the provider line listed on the company website or the back of the patients card prior to the clients visit and ask the following questions:
- Is the patient covered for massage therapy by a licensed massage therapist?
- Are you in network with their plan?
- Does the patient have a deductible and has it been met?
- What is the patient's co-pay and/or co-insurance?
- How many visits does the patient have per year and are they shared with other types of practitioners?
- How many visits does the patient have remaining to use for the year?
- Does the patient need a prescription to use their massage therapy benefits?
- Does the patient's plan require a pre-authorization and if so, how do you pre-authorize?
- Always get the name of the person you spoke with and a reference number for the call
- Call the insurance company using the provider line listed on the company website or the back of the patients card prior to the clients visit and ask the following questions:
- Benefit Verification for Motor Vehicle Accidents and Workers Compensation Claims
- Call the adjuster of the claim and ask the following questions:
- Is the claim active and are there funds available?
- Is the patient covered for massage therapy by a licensed massage therapist?
- Does the patient need a prescription for massage therapy?
- Where should you send the bills?
- Call the adjuster of the claim and ask the following questions:
- Billing Insurance companies using Office Ally - PracticeMate
- Sign up for both Office Ally and PracticeMate Accounts
- See my guide for navigating PracticeMate for insurance billing
- Tip: Bill weekly or at least monthly to ensure that you are getting payments regularly
- Download the Sample CMS 1500 (HCFA) form here
- Diagnosis Codes: You can use pain codes if you don't have diagnosis codes provided by a doctor
- Common Pain Codes-
- Shoulder — M25.511 (R), M25.512 (L)
- Upper Arm — M79.621 (R), M79.622 (L)
- Elbow — M25.521 (R), M25.522 (L)
- Forearm — M79.631 (R), M79.632 (L)
- Wrist — M25.531 (R), M25.532 (L)
- Hand — M79.641 (R), M79.642 (L) (excludes fingers)
- Hip — M25.551 (R), M25.552 (L)
- Thigh — M79.651 (R), M79.652 (L)
- Knee — M25.561 (R), M25.562 (L)
- Lower Leg — M79.661 (R), M79.662 (L)
- Ankle — M25.571 (R), M25.572 (L) (excludes foot/toes)
- Foot — M79.671 (R), M79.672 (L) (excludes toes)
- Thoracic Spine — M54.6
- Low Back Pain — M54.5
- Neck -- M54.2
- Track Your Billing and Payments
- Use my handy spreadsheet to keep track of your important insurance information as well as each clients insurance information, the bills you send and payments you receive.
- Even if you don't want to use my spreadsheet, please create something to help keep yourself organized! This is one of the most important pieces of successful insurance billing.
- Tip - Make a note of the clients deductible, co-pay/co-insurance amount, and number of visits per year in the notes of their profile in your online scheduling system (or somewhere visible at each of their visits). It will make your life easier, I promise!
- Tip - Follow up with insurance companies if you have not received any communication from them regarding a claim you submitted after 45-60 days.
Want to learn more? Book a 1:1 session, or email me with questions. I am looking forward to meeting you!