A quick guide for billing health insurance companies for massage services
Create a system
To bill effectively you will need to make it a routine and you will need to be organized, this means creating a solid system that works for your particular needs. I use a spreadsheet to keep track of each clients insurance information as well as dates and amounts that are billed and paid. You will also want to have a plan for verifying client benefits prior to allowing them to use their insurance with you. Checkout my Insurance Billing Tool Kit for help with all of this!
As far as actually billing the insurance companies, many people are using Office Ally to bill and store information online. This is a free software that allows you to create client profiles and store information so that you don't have to re-enter it every time you want to send a bill. Office Ally offers free training over the phone and is fairly easy to learn and manage. The alternative is using the CMS 1500 form and sending it directly to the insurance company yourself via their individual online systems, fax, or through old fashioned snail mail. If you choose this route you will need to contact each insurance company to find out their preferred method for billing.
Know your codes
CPT codes-These are numeric codes that are assigned to the type of treatment given to a client. The most commonly used code by Massage Therapists is 97124 which generally covers most massage modalities. Some insurance companies will also pay for 97140-myofacial release but many will not. Sometimes it takes a bit of trial and error to find what works best with each company. If you are denied for 97140 try resubmitting for 97124 and you will likely get payment. CPT codes are billed in 15 minute increments which means you would bill 4 units of 97124 for a one hour massage session.
ICD-10 codes-ICD-10 codes are numeric codes assigned to a diagnosis or are codes that reflect areas of pain and tension. You will need to pick codes that reflect each clients issues when billing their insurance company. Here is a great resource for commonly used ICD-10 codes for Massage Therapy.
Bill and follow up in a timely manner
Best practice is to bill weekly, in fact, I find it easiest to schedule my billing for the same day each week so that it becomes very routine and I never miss it. Record the amount and date you bill for each client as well as their co-pay. Record the date payments come in and the amount you received as well. I make it a practice to review each clients account monthly and if I have payments that are outstanding for more than 60 days I call the insurance company to see if there is an issue with the claim.
Create clear policies regarding insurance practices and payments with clients
I have a packet of digital documents that I have clients fill out prior to using their insurance with me. These include an insurance information form to share their member ID, date of birth, address, and name so that I can verify their insurance information. A HIPAA information sheet and signature page which is required by law for you to have on file. An assignment of benefits which gives you permission to bill the clients insurance company. And finally, a financial agreement which details my terms in the case of a denial of payment from an insurance company. In other words the financial agreement gives me permission to charge the credit card on file after a denial from the insurance company for a client.
Billing insurance companies is not difficult once you know the drill, set up a great system, and make it a regular routine. If you want to learn more please check out the insurance billing class I offer at the Oregon School of Massage. Looking for someone to get you credentialed or bill insurance companies for you? I do that too! Please send me an email at firstname.lastname@example.org to find out if I am the right fit for your practice:)
Thanks for reading and happy billing!
Julie Campbell, MBA,