Insurance Billing for Massage Therapists

Insurance Billing for Massage Therapists: Resources for Credentialing and Billing In WA & OR

Getting in network with insurance companies and billing insurance can feel overwhelming. I hope these resources will help simplify the process for you a bit! I do offer one on one training sessions and small group classes as well if you decide that you need more help. Please feel free to email me with questions anytime at massagebusinesscoach@gmail.com.

Credentialing Information
*This information is the latest that I have on where/what to send to insurance companies to get in network with them.

Step 1: Create your credentialing packet
You will need to create a credentialing packet to send to insurance companies.
*Hand sign and date each document right before you send them

Here is what you will include:

• Oregon Practitioner Credentialing Application
• Therapists license
• Liability insurance cover sheet
• 147C letter verifying the tax ID from the IRS
• W-9

Where to send your Packet

Regence -
Email credentialing packet to:  regence_credentialing@regence.com

American Specialty Health Network -
*Health Net, Providence, Cigna

1. Fill out the online application: CAQH

2. Fill out the online interest form: Here

MODA Health -
1. Fill out online pre-application:  Here

2. Email credentialing packet to:  credentialing@modahealth.com

Reliant Behavioral Health -
Email credentialing packet to:  providerrelations@reliantbh.com

Of course there are other insurance companies that you could get in network with that are not listed above. I have included the list of those that are most commonly accepted by Massage Therapists.

The credentialing process typically takes around 90 days from start to finish.

-------------------------------------------------------------------------------------------------------
Insurance Billing Resources
The following are a list of resources for your information.

Personal Injury Protection in Oregon
This site gives you a breakdown of the law
http://www.oregoninsurancelaw.com/oregon_pip_law.htm

Storing patient records in Oregon
http://www.oregon.gov/omb/Topics-of-Interest/Pages/Patient-Records.aspx

HIPAA Resources

Information
http://www.hhs.gov/hipaa

HIPAA Training
http://www.medscape.org

Insurance Billing Learning Resources

Massage Practice Builder website
http://www.massagepracticebuilder.com/massage-insurance-billing/

Workers Compensation Fee Schedule
http://www4.cbs.state.or.us/ex/wcd/maxpaycalc/

Billing Workers Compensation in Oregon
http://www.saif.com/medical/billing.html

Here are 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 Pain - M54.2

ICD-9 to ICD-10 translator
https://www.aapc.com/icd-10/codes/

Financials for Insurance Billing
Insurance billing cost analysis spreadsheet
Please make a copy of this document for yourself after opening by choosing “file”-”make a copy” or download into excel or other software.
https://docs.google.com/spreadsheets/d/1TYdRoBxxzL_Sto9AwjrIlFRpEiJdZiY9doD5ldlF1ek/edit?usp=sharing

-------------------------------------------------------------------------------------------------------
Insurance Verification Checklist
Use this guide when verifying client benefits

Step by step checklist for verification:

1. Send the client an insurance intake form to get the required information, along with the HIPAA agreement and financial agreements to sign. Get a credit card on file on or before their first visit.
2. Get the client’s member ID or claim number, full name, birth date, address, phone number, name of adjuster or insurance company, contact information for adjuster or insurance company, main complaint and date of accident (if applicable).

 Verification Questions to ask the insurance company/adjuster:

• Is the client covered for massage therapy by a licensed massage therapist?
• If so do they need a prescription?
• Do they need pre-authorization?
• Do they have a deductible and has it been met (for health insurance)?
• What is the patient financial responsibility ie. copay/coinsurance?
• How many visits do they get per year and is it shared with other providers? How many have they used? (for health insurance)
• What CPT/Diagnosis codes can you bill for, is there a limit on the number of units per visit?  What is the rate of reimbursement for the CPT code(s)
• What is the preferred way to bill the insurance company.  *always get a name/ref number of the person you spoke to

*Record this information so that you know what the client is covered for, what their co-pay is etc… also let the client know.

*Record detailed SOAP notes with progress reports and a clear treatment plan after each client visit.

Step by step checklist:  Billing with Office Ally
Office Ally is an online insurance billing platform that makes billing on behalf of your clients quick and easy!

Billing through PracticeMate:

1. Create an Office Ally and Practice Mate account (this is a process that will likely take more than one day)
2. Login to Office Ally and click on the link to go to Practice Mate
3. Click on the “claims/billing” tab
4. Click on the “Add a new claim” link then choose the “cms 1500 2/12 new” link
5. Use the grey box with ellipses to search for and auto fill client and insurance company info.
6. Complete the CMS 1500, refer to the sample guide I sent you via email if you need help
7. Choose “update” at the bottom the page when you are finished
8. You will see the claim at the top of your list of claims. Click the arrow under “submit” to submit electronically, or “print” if you plan to fax to mail the claim yourself.

Add a new patient in Practice Mate

1. Choose “manage patients” tab
2. Choose “add new patient”
3. Fill in client name, DOB, address, phone in the “patient data” tab
4. Click “insurance” tab and fill in insurance information
5. Choose “add patient” at the bottom of the page

Add a new insurance company in Practice Mate

1. You will do this from the claims section on the cms 1500 in the box where the payer goes:
2. Click on ellipses
3. A new box will open, in that box, click “add new”
4. Another new box will open, choose “browse”
5. Search for and add the insurance company there

Insurance Billing Tips

• Bill insurance companies at least one time per week, Record billing date and amount billed
• Follow up with insurance companies around 60 days after billing if you have not been paid, record every interaction with a name and reference number for the call
• Record payments as you get them.
• Don’t forget to check Office Ally weekly for repairable claims, and ASHlink and Availity for EOB’s.

Insurance Billing Companies
If you decide that you do want to bill insurance companies yourself, here is a list of reputable companies that might be able to take it off your plate:)

LD Billing, LLC

• https://ldmedbilling.com/

Medical Billing Specialists

• www.medicalbillingspecialists.net

Efficient Medical Billing Service

• http://www.efficientmbs.com/

Integrity Billing and Consulting

• https://www.integritybillingconsulting.com/