Collaborate on Massage Receipt Template for Planning with Ease Using airSlate SignNow

Massage receipt template for Planning

[Music] welcome to the world massage conference hello and welcome to this special pre conference broadcast for the 2011 world massage conference I'm your host Erick Rowan along with my co-host cliff corn I want to welcome everyone on board for this presentation with renowned massage expert Dianna Thompson on insurance billing for massage therapist need to know information for getting paid before we get into our broadcasts we'd like to thank our global sponsor Massage Envy Massage Envy is the leading employer of massage therapists in the United States so discover the benefits of choosing Massage Envy as your career visit their website at wwlp.com and thanks so much to all our daily sponsors that make all this possible associated bodywork and massage professional massage warehouse massage today bond Vittal Biofreeze massage magazine and the up ledger institute here tonight on world massage conference for the start of our fall 2011 conference program we bring you one of the world's top leaders in the massage industry diana thompson in this webinar diana thompson will provide easy to follow guidelines for reducing the risks associated with accepting insurance reimbursement as payment for services and for staying on top of the shifting information of insurance procedures understand the paper trails necessary for providing clean claims and learn strategies for managing reimbursement challenges specific to each of the three primary types of insurance workers compensation personal injury and private health insurance diana will also examine legal and ethical considerations for setting fees and billing for services it's my pleasure to introduce diana thompson she's a licensed massage therapist with more than 25 years of experience enjoying success in her private practice in the beautiful city of seattle washington she's the author of hands heal communication documentation and insurance billing for manual therapist which is now in its third edition she's the immediate past president of the massage therapy foundation a wonderful organization and she's a consultant for massage therapy research with the Center for Health Studies diana it's a pleasure to have you here at the world massage conference it's great to be here Eric thank you so much for having me now we're really excited about this broadcast as I was saying before the broadcast started I believe you hold the world record for the most live attendees on a massage webinar so people are very interested in surance and I'm sure they have lots of questions and I have cliff corn on the line as my co-host tonight and he's going to be taking listener questions so if anyone in the audience has any questions you'll see a blue ask question button on the broadcast screen all you need to do is click that button enter in your question for Dianna and cliff will be going through those and well he'll pose those to you towards the end of this broadcast and we'll get to as many of those questions as possible so if you have insurance questions make sure to ask them take advantage this opportunity there's no one that knows insurance like Diana so I'm gonna hand the mic over to you Diana now and I'm going to leave the audience in your capable hands great well thank you so much and thank you cliff it's great to work with you on this program yeah so what I really think is foremost in people's mind when it comes to insurance billing is getting paid so that's going to be the focus of today I'm going to start out talking about the different types of insurance and how you might know if something is available to you as an option for billing and then we're going to talk about questions that you might want to ask yourself to consider really to see if insurance billing is something that's right for you and then to see if insurance billing is something that's actually an option for you and then we'll get into the nitty-gritty of what you absolutely need to do in order to make sure that you're going to get paid by these insurance companies so if we can go to the first slide after the introduction slide there are three primary types of insurance reimbursement that's possible for massage therapists the most common one is for motor vehicle collisions or it's called personal injury and we often used to see motor vehicle accident so for those of you that are still using MVA I just want you to know that the current buzz term is now motor vehicle collision because they don't want to seem like it was just an accident but nobody's at fault they're actually trying to find some fault here so a motor vehicle collision is the proper term these days the other type that you might see a second most commonly is workers compensation often known as labor and industry claims and then of course the final one is private health and not every state will entertain insurance bills from massage therapists in the private health sector but for those of you that can bill within the private health system I want to give you some hot tips on how to work with them so the next slide gets into the different types of motor vehicle collision or personal injury insurance that you need to know about your primary hope is that people have PIP or personal injury protection it's what make sure that people's medical bills get paid as well as getting paid for services for things they can no longer do for example if people aren't able to clean their house they should be able to hire a housekeeper to come in and clean for them if they can't drive they should get some reimbursement for taxi services those kinds of things so PIP is one of those all-encompassing insurance coverages that you hope people have when they come and see you it means that regardless of fault you're going to get paid all of you should know what your PIP coverage is a great way to kind of introduce yourself to pip insurance is to go to your own policies and see what kind of coverage in some states you have to deny PIP coverage in writing so it's actually mandatory for insurance companies to provide you with PIP insurance and you have to sign a waiver that says no thanks I don't need PIP coverage pip is one of the cheapest forms of insurance and so you want to max out your benefit so rather than going and pain I don't know ten dollars every quarter for ten thousand dollars worth of coverage you want to pay the thirty dollars a quarter and get thirty or fifty thousand dollars worth of coverage because that money gets used up pretty darn quickly med pay is different than PIP in that it just covers format it just covers your medical expenses if there's no PIP no med pay then you're looking at third party payment which means you don't get paid until the case settles that means fault has to be determined you might wait one year in some states you might wait three years in other states before you see a penny of the money so third party claims or something you really have to think about before you decide to take on a patient who only has third party coverage um coverage is underinsured motorist or uninsured motorist so it's an additional policy onto your claim or whoever the driver is that says you know even if I get hit by someone who doesn't have any insurance I want to make sure that my expenses are paid for so that's where your uninsurance or your uninsured motorist insurance comes in it's great when there's a legal team involved if this is a litigation kind of claim so often people think of motor vehicle collisions as a litigation insurance relationship if you have a lawyer or if your patients are your client has a lawyer but they've got contracted with you can get a guarantee of payment so this means that the lawyer has to pay you before they pay the patient it's something that absolutely everyone should do regardless of how much you trust your patient so anytime there's a lawyer involved get a guarantee of payment it will also help you if they try and negotiate for a lower fee sometimes the attorney will call you up and say hey you know the patient's only getting so much money why don't you cut your fees down and you can say I'm sorry you find a guarantee of payment or a letter of guarantee that says you will pay me my fees in full and then you won't have to go through that negotiation process because you can bet they're not negotiating their fees from the patient for their car accident claim so another thing you can do to help ensure that you get paid is to file a lien so liens are filed with the county government so wherever the accident took place that's the county that you want to file the lien within so what you do there is you say I'm putting a lien on whatever this person owns it might be their house something like that that says if they don't pay you then you've got something to negotiate with it's that bargaining tool if you've got any third party claims you'll definitely want to file liens with the county government so that's what I recommend to make sure you get paid if you do choose to work with third party personal injury cases the other thing you really want to be careful of when you're working with motor vehicle collisions are independent medical exams so oftentimes the insurance company will hire a doctor to do an examination of the patient to say oh this person's better they're fine they don't need any more treatment so an attorney can really help negotiate the independent medical exam situation to make sure they're actually doing an exam that when they write up the report they're writing up information that they actually asked the patient those kinds of things because sometimes they'll just spend a couple of minutes with the patient say they did all these tests and really they didn't do a very thorough examination so those are reasons you like to have a legal team involved next slide so with workers compensation claims or labor and industry claims there's typically a contract that you sign with that government agency so it becomes a contractual relationship you get a provider number and when you build that insurance company you use your provider number and that's what gives you access to that type of insurance reimbursement there's a difference between states and federal insurance companies sometimes an organization will choose to go through the state sometimes if they do business in many states they'll go choose they'll choose to go through the federal government so not every L&I claim is the same so you'll want to be familiar with both types of relationships and make sure that you've got a good contractual relationship with both when you saw when you find a contract with them they get to stipulate fee schedules treatment frequency your reporting and what type of billing forms most insurance uses the CMS 1500 form we'll talk about those in a little bit but oftentimes with workers compensation they have their own type of billing forms that they want you to use so make sure you've got those forms on hand and that all your bills go through using the exact forms that they want you to use with treatment frequency a lot of times they'll recommend six massages and then you have to ask for another set of six it's fairly easy to get your second set of six it's nearly impossible to get a third set of six so you're pretty much guaranteed when you're working with L&I that you'll get six sessions with your patients and possibly twelve you will always have to write a progress report before you get that side effects in the next slide we're going to look at private health insurance sometimes those are called HMOs or health maintenance organizations many of the different insurance companies have several insurance plans so you might think well I've got five people on Regent's it's probably the same with each one and that's not necessarily the case though Regents might have six different plans that their insureds or lives as they call them that their lives could prescribe to or subscribe to so make sure that you understand the differences between the different insurance plans I'm going to take you through in a few minutes a step-by-step process so that you know exactly what your patient can get even if they have a different insurance plan than someone else so we want to make sure we know exactly what's required so with a contractual relationship in an HMO or a private health they're going to dictate the fees so whenever you sign up for them you're agreeing to their fee schedule they might have reporting requirements as well and they certainly will ask for access to your charts at no charge so you can't charge them a per page copying fee if they want copies of the charts or anything like that everything's included in your contractual relationship with in-network you should read those contracts very carefully there might be restrictions in them on who you can treat for example you might not be able to treat to anyone that's in your immediate family and that's important to know there are also restrictions for who can bill under a particular provider number so you might go to work for cliff for example cliff says well I have a provider relationship with Regents you can just bill under my number but it might stipulate within cliffs contract that he cannot loan his provider number to anyone even if they're an employee of his if he does that and it's against his contract not only could he lose his contract with regions but you would also be barred from ever becoming a contractual provider for that insurance company so read your contracts very closely some insurance companies have an out-of-network benefit what that means is that even though you're not contracted with that particular insurance company they'll reimburse for your services and the patient pays a coinsurance amount instead of a copay amount so they might pay 30 percent or 40 percent and then the insurance company will pay you the 70% or 60% whereas with a contract situation they'll pay their copay which may be a $10 copay $20 copay that kind of thing and then you'll get the right the remainder so those are the three different types of insurance relationships that you could be in the next slide is really asking yourself these questions do I want to accept insurance reimbursement as payment what am I getting myself into one reason that I always think is very motivating for taking insurance is whether or not you need more clients once you become a contracted entity with an insurance company they are going to send you a ton of clients I have found myself in a situation where I've had to leave some insurance companies because they ask that you have a certain amount of your practice open for their their lives their covered entities so there was just no way I could hold open thirty percent of my practice for this particular insurance plan so I chose to leave this one network for that reason but you that may be a very motivating reason for you it's kind of like going to Home Depot instead of a local hardware store you're getting this huge add access to this huge organization that can just send you a ton of clients and you don't have to do any sort of marketing as a result though they're gonna pay you less so like when you go into Home Depot you don't pay as much for your electric saw or whatever and as you would if you went into a local mom-and-pop hardware store because they're getting it for a lot less when they're buying in bulk so they're kind of buying you in bulk so then you need to also consider can I survive if I get paid a lower fee so if I really do take these people on and I don't have as much room for cash clients can I still survive so then you're looking at you know do I charge less money for my cash clients do the insurance company actually pay me more or are they paying me substantially less than I'm getting from my cash clients the other question to ask is can I wait to get paid they'll typically pay on it every two week or every 30-day cycle so once you get into the system the checks come fairly regularly but before you get into that regular system sometimes you feel like you're just waiting a long time to get paid with p.i cases it's a little different if it's an end of settlement case of course you're not going to see any money until the case settles which could be anywhere from one year to three years from your data first service but otherwise if they've got personal injury protection or pip you'll get paid on a regular basis so it kind of often depends on the how soon you get your bills in as well so if you're billing weekly you might get paid on a weekly basis with pip if your billing once a month you're only going to get paid once a month L&I seems to be your workers comp seems to be on an every two week cycle as well so mostly with lni and with your private health you're going to get paid on a two-week cycle the other questions you want to ask yourself am I willing to do the chart notes that are necessary you have to do some medical charting and you have to write reports to the insurance companies and the referring doctors and do I understand the legal and ethical billing requirements because you want to make sure you're not committing billing fraud in these situations well we're going to go through those as well so that you know what you're getting into and then you want to ask do I want to provide the billing services or do I want to hire that service out so I did my own billing service for a long time and then I did it for a large clinic and and actually for the last few years I've been using a billing service so that's been really nice I stay in touch with them and do a lot of consulting with them so I know I'm still on top of what the needs are for insurance billing out there but it's kind of nice to have someone else that does the billing on a weekly basis in the next slide you want to make sure you're eligible for insurance reimbursement if you're in a state where other massage therapists are having success billing insurance then you can pretty well be sure that you're going to have success as well but not every state has access to private health insurance I don't know any states that don't allow motor vehicle collision insurance billing for massage therapists it's one of those situations where legally they're required to have the patient get back to pre-existing condition or pre-existing status and if the physician or whoever is the primary care provider prescribes a particular type of treatment the insurance must comply with that prescription within reason and they will hire those independent medical examinations to make sure that what they're paying for is actually absolutely necessary for that person to get back to pre injury status so check into all of those different types of insurance both the motor vehicle collision or PIL and I and the private health within the state so any of your networking groups that you've got going on would be a great place to check in in some situations you can be under the supervision of another licensed healthcare provider and use their billing information so they might bill for you in some places a chiropractor might hire you they would do the billing they would bill under their number and then pay you as an employee so that often is the case so make sure that that's acceptable I would call the insurance plan itself and make sure that you're allowed to have your services billed under someone else's provider number and ideally you can become the credentialed provider in the next slide there are certain things that you need to ask the insurance company to know if you can bill their insurance so when you call up their insurance number on the back of their insurance card these are the questions you're gonna ask so you'll ask about the clients condition to see if it's covered under their insurance plan not all conditions are covered conditions so make sure if they've got fibromyalgia or cancer or you know whatever it might be that it's something that is covered under their insurance plan the second question you're going to ask is if they have a physical medicine and rehabilitation benefit for that particular type of condition so massage therapy falls under physical medicine and Rehab and you want to make sure that they have that as a covered benefit for that condition thirdly you'll ask who can provide that physical medicine and rehab service can a licensed massage therapist do that the next thing you'll want to know is which CPT codes or current procedural terminology codes are reimbursable and we'll go through some of those codes in just a minute and are there any restrictions on those codes sometimes they'll say well you can only bill for two units under that code or four units under that code so even though you might be accustomed to doing a 30 60 minute massage or a 90 minute massage they may only say you can do a 30 minute massage depending on what the condition is so know what those restrictions are I would also always ask what the reimbursable amount is for those CPT codes so we're going to talk about those CPT codes next so we're on the next slide so I just put a few of them up for you these are the ones that most likely you will bill or most likely they will reimburse there are several other codes available and some people have success using those codes but not always so these are the ones that pretty much most insurance companies will reimburse for the first one is the primary insurance code this is the massage therapy CPT code nine seven one two four so its first Swedish massage effleurage petrissage tapotement that type of treatment nine seven one four au is a manual therapy code this means that you can provide services like myofascial release or a lymphatic drainage or cranial sacral therapy all of those codes go under nine seven one four oh you cannot bill anyone with those two codes together there's something called CCI coating or NCCI coating it's a bundling issue you cannot bundle those codes because they're too similar so they're gonna say you know really pick one so which one are you doing more of out of a fifteen-minute unit so most of these are 15-minute unit codes is is more of the time spent with Swedish massage or is more of the time spent with mild fashion for example and then you pick that code 9 7 1 1 2 is more of a postural re-education code so it's really pretty much an active movement technique that you're going to be doing muscle energy technique would go under this or those passive positional release strain counter strain type moves Feldenkrais Alexander Trager all of those are built under 9 7 1 1 2 I've also found that the kinesio taping or the postural taping or functional taping people are using these days often gets billed under nine seven one one two nine seven oh one o is for hot cold therapy this is not done in units of time the first three are done in 15-minute units but nine seven oh one o is just a one-time thing so you can't bill twice for nine seven oh one Oh in a session it's just the application of hot packs or cold packs or both and it's just a one-time code the last two codes I have found more success with recently I've really been on the lookout for an exam code because you often spend more time with people the first time you see someone or on those reevaluation sessions it would be nice to get paid for that extra time that it takes to go through your range of motion testing your postural assessment those kinds of things and I think I have finally found the codes that work the best for massage therapy there have been some physical therapy codes that I've recommended in the past but some people have not had very good success with those even though I have up here in Washington State but these codes consistently have been working so if you want to try them go right ahead they're also not units so they would be in addition to so if you did a 60-minute manual therapy session so it would be four codes or four units of 971 400 you would just add nine nine to zero one as a new patient exam on top of that so it would just be additional fee it's not an additional amount of time so it's kind of handy that way in the next slide we've got something called icd-9 codes so when we were talking earlier about the questions you would ask the insurance company oftentimes they'll ask for an icd-9 code instead of the canaima the condition so if it's fibromyalgia then they would ask for the icd-9 code that's associated with that diagnosis so most of us when we're billing insurance company we're working off of a physician prescription or a physician referral in some situations you can self-refer to massage therapy it's very rare but there are a few plans up here in Washington States I know where you can sell for self refer to Massage Therapy if there isn't a diagnosis from a physician so we can't call things by a diagnostic term because we don't have that scope of practice but we certainly can call things by the symptoms that were seen so I thought I'd throw in some symptom codes in here so if someone's asking for a diagnosis code but you know they're coming in with neck pain absolutely that's something that we can say people have without thinking that we're crossing over our scope of practice so I put in neck pain diagnosis code or icd-9 code at 7 to 3.1 in there so there's several in there for pain stiffness and swelling all within our scope of practice all diagnosis codes you can feel comfortable using if you're in that situation always the best thing to do is get a prescription from a healthcare provider so that you don't have to create those codes on your own in the next next slide it's also good to ask the insurance representative when you're on the phone with them what else they might want so you're going to send the CMS 1500 form unless it's an L and I claim in which case they've got their own billing forms but find out if they want copies of your soap charts copies of the prescription if they need any copies of the reports that you've been sending the doctor on a periodic basis anything that will help you get paid faster you can get that information upfront then you won't have to risk that delay time as they ask for more information on the backend I also want to know what the turnaround time is for reimbursement and if there's anything that could affect that time frame so I want to make sure I'm covering all of my bases and getting paid as fast as I possibly can in the next slide there are some things I'm going to have the client find out because I think it's really important to get them involved in the insurance process they need to take some responsibility these are really good questions for them to find out and ask so have them call the number on their back on the back of their insurance card and ask what their deductible is and how much has been satisfied to date if it hasn't been satisfied then you're not going to build the insurance company until it is so you'll want to get paid up front and then submit those bills and the money that they paid you will count towards their deductible you also want to know what the copay or coinsurance is so remember copay they'll pay if you're a contracted provider coinsurance they'll pay if you're an out-of-network provider and they're gonna pay a percentage of your fee there is no copay and no coinsurance with motor vehicle collision insurance coverage so they're gonna pay the total amount the insurance company they don't dictate the fees you're gonna get paid what you charge and we'll talk more about that later too because there are some sticky points with that also with L&I they won't let you take any money from the patient as well so if L&I is going to pay their full fee and you can't get any additional fees from the patient you'll want the patient to ask what their limits of their coverages do they only get twelve massages a year do they get 60 massages a year what's the annual amount but also what's the per incident amount because it could be different ask them if they need pre-authorization for massage and if they can verify the coverage for the massage while they're on the phone with their insurance provider right then so those are the types of questions you want to get the patient involved in asking make sure that you have your patients so we're looking at the next slide now and responsibilities of payment make sure you have your patients sign something that says they understand that they are fully responsible for your fees if the insurance company does not come through you don't want to be left holding the bag if the insurance company denies the claim or their deductible hasn't been met so they're not paying you anything anything like that you just want to make sure that the client understands that if the insurance company doesn't pay that they're responsible for everything you also want them to sign on there'll be a little line that in your billing form and I've got some samples of billing forms in my book that I can share with you that they are authorizing the insurance company to pay you directly you never want the insurance company to send the payments to the patient because then you know they've got the money in hand it makes it harder for them to turn those checks over to you so assign the benefits directly to you you also want the client to sign a release with you so that you can send medical records to the insurance company should they ask for them that's confidential information and you need their permission to be able to send the insurance company that type of health care information that they hit the requirement so get the patients to sign a release of medical records all right yes come on I know you this is a little bit of a longer session so maybe I can just give you a few minutes to catch your breath I've done a couple long webinars myself okay has a little pile it's not want to grab a little drink of water I know we're going to talk about are going to talk more about charting requirements and making a clean claim so that you make sure you get paid and you're going to talk about the ethics of charting as well so I would just want to take just a few minutes just to remind people that if you do have any questions that aren't being answered here on the broadcast tonight then just click the ask question button you'll see just below the broadcast screen and send any questions you have in today Anna very knowledgeable as you know already and she'll get to any questions that she doesn't answer specifically through this formal presentation and our my co-host cliff corn will join us and he'll field those questions hey Erik just a quick question since we started a few minutes late do I still need to end at quarter Taylor can I go till 10 till well oh no you can you can keep going we have we have an hour and a half scheduled oh yeah nice all right so so you have time you don't have to rush with the rest of it I know I'm talking really fast aren't I no but so is it it's perfect yeah there's lots of information there and and make sure you stick around after the cute Q&A session or the question-and-answer session because Diana you're going to go into the chat room and and talk with the participants there as well and answer any other questions they have now if some people in the chat room have been asking is a recording going to be available this is a pre conference broadcast so we're going to keep a replay available for about 24 hours to let people access it and it's going to be archived for the paid registrants of the conference and that will be available in the replay room so if you haven't signed up yet for the 2011 conference program I want to encourage you to do so do it tonight you can get or you'll have access to really over 40 of the world's leading massage experts between the recorded spring Russians and the live sessions that are happening November 14th to the 16th and the 2011 program it's really like the Academy Awards night of massage these are all the superstars who you've always wanted to meet and you can interact with most of them one-on-one through asking them questions on the brow path like we're doing tonight or through chat after their presentations superstars like Diana Thompson so a few other featured presenters we have our Erik Dalton you might have heard of him Thomas Meyers Aaron mattes who does a active active active isolated stretching Roberts like was going to be talking to us about fashio Tracey Walton massage and cancer Robert grant you're a great therapist from Australia is going to be talking to us about sports massage Laura Allen who everyone knows diana thompson who we have here tonight and and many many more and you can registers can take c equals and print off certificates for each of these presentations as well and i think they are all NC BTM be specific credits so there's a one small time see $40 for i believe over 50 hours of continuing education certificates now we know that not everyone signs up specifically for the credits but it's a fantastic opportunity and these days most organizations recognize at least some online continuing education credits if not all so once again I want to encourage you to sign up for the world massage conference 2011 and and get access so how are you doing there Diane are you ready to move on I'm good thank you for UK fantastic that was awesome okay so I am it's a mic back over to you again and we can talk about charting now thank you so we're on the charting requirements line this is really it of course would not be me on the telephone if I didn't talk about charting so you'll have to forgive me for just a moment as I go off on to my favorite topic in the world charting what's absolutely necessary when you're billing an insurance company is to chart in a way that proves medical necessity what that means is that you've got a chart that this person has a medical condition and then you have to chart that that medical condition was affected by your relationship with that patient so your intake form is going to demonstrate that they've got these symptoms your subjective information gathering will document how they're feeling what functional limitations they might have difficulties with our activities of daily living you'll probably use a pain scale something that will measure the level of pain that they're having especially with specific activities so you've got to prove that they have a medical condition one that massage therapy can affect the next thing you're going to do is prove progress as a result of the care which means that you haven't have to have enough measurable information that you can show a change over time so for example if you're charting on a pain scale of 0 to 10 they come in and they've got pain that is a 7 out of 10 by the end of the series of sessions that pain should change on that scale of 0 to 10 significantly so that has to be by 2 points or more so down to a 5 out of 10 hopefully even further down the scale most insurance companies now are looking for functional outcomes that means that you have to document what activities are limited by their condition and how those activities have improved as a result of your relationship for example if people are having difficulty sitting at their computer for a length of time it might be that they're having numbness and tingling down the arms so how long can they sit at their computer before the numbness increases or the numbness starts and then how long can they sit at their computer at the end of the series of massages are halfway through the series of massages before the numbness begins or the numbness gets worse so always try and relate their symptoms back to an activity of daily living and that's the best way that you can prove progress for physical conditions rehab type services you always want to treat within the diagnosis so you're sure your chart should not reflect working in an unrelated part of the body if you're working with carpal tunnel syndrome for example since we're using that concept you don't want to be working on the Cache muscle for example the lower leg might not have anything to do with our carpal tunnel condition if you do work in that area your reports and your charts should reflect the reasons why you chose to work there so the more fashion work that we do these days we're really looking at the full-body connection of the fashio crossing joints those kinds of things so you just better be able to justify your treatments if you're working outside of the area of diagnosis your treatments must reflect the dates of services billed so every one of your treatment notes have to be dated and those dates must I know this seems like a silly thing for me to say but I can't tell you how many times I've looked at charts and the date is not the same date on the chart as it is on the billing form so make sure that the dates are correct and that the services are correct so if you are billing for a hot cold pack the hot cold pack better be written on the soap chart if you're billing for a lymphatic drainage and not Swedish massage lymphatic drainage had better be listed on your soap chart so you want to make sure the dates are accurate from soap chart to bill and that the services provided are accurate from soap chart to the bill every date of service should reflect the duration of the session as well so if you're doing a 30-minute treatment or a 60-minute treatment make sure that that is also written on the soap chart so these are the absolute requirements for soap charting on the next slide I'm going to tell you what the recommendations are for soap charting so you want to have a comprehensive health history you really want to know not only about this particular condition but if there's any pre-existing conditions or any family history of other conditions it might be that you're working with a particular thing but some complication arises and if you have a good sound health history background you can figure out why what happened what is happening is actually happening so it will give you some really good information and allow you to trouble troubleshoot some difficult situations you absolutely want a medical record for every single section that session that you do there's a difference between charting for a medical condition and charting for wellness so you do not necessarily have to use a soap chart when you're charting for someone who's just looking for prevention or wellness services but if you're charting for a medical condition soap charting is a very common form to use there's other types of formats that you can use as well but it should be a medical chart and not a wellness chart you want to make sure that you measure the information that you're cut your writing down if it's worth writing down it's worth measuring you never just want to say that they have a headache you never just want to say that they have an elevated shoulder you want to assign some sort of measurement to it so that you can show progress without an initial evaluation with a measurement you cannot know change unless it's gone and oftentimes people come in and they don't go from pain to no pain there's some variation in there so you've got to measure it so you can show incremental progress you also want to set goals with your patients when you're charting functional goals are most appropriate for massage therapy and physical medicine and Rehab services and make sure that that those goals reflect some measurable progress the example that I gave earlier was how much time people considered their computer it could be how much weight they could lift it could be how many stairs they can climb it could be how many minutes they could walk those kinds of things but make sure that you've got some way to measure progress and then lastly you just want to make sure people can read your charts there are so many great electronic software programs now that that's not as much of an issue but if you're still handwriting your charts they don't have to pay you if they can't read them so make sure they're legible reporting something else that comes hand-in-hand with doing insurance billing you want to write progress reports every six to eight sessions so I'm now in the next slide reporting requirements you cannot charge for progress reports you have a responsibility to communicate with referring caregivers I don't know if you know this but they're financially responsible for everything you do for that reason alone you owe them some updates I've had doctors say to me you know I used to refer to massages I never heard back from them how can I stick my neck out for you people if you're not going to send me reports so it's not a lot of time to write a report really you could do one in about five to ten minutes it could be two or three paragraphs long you just give them an update on the progress since your last report and say you would like another prescription for more massage and what you hope to accomplish in that next series of massages so report on the progress ask for more massage and tell them what your goal is for accomplishing and your plan for accomplishing those goals the initial report will be a little bit longer maybe four or five paragraphs because you'll want to lay the foundation for why you're seeing them and what you found in the first section but progress reports are very brief you send them to the referring healthcare provider and if the insurance companies want copies of those they are likely to ask for that and you're obligated to send them if you get asked for a narrative report that's the type of report that you can charge a fee for so I always send them a bill first and then they'll go oh no never mind we'll just take copies of your progress reports and then you can get out of writing those two or three page narrative reports really it's only the attorneys that are going to request those and really want them and a good narrative report will keep you out of court and it's no fun testifying for a patient so a good narrative report is a great thing and good soap charts are even better because if your soap charts are fabulous they won't even ask for a narrative report on the next slide we're gonna talk about clean claims so how do you make sure that you're sending in something that is so squeaky clean they're gonna pay you without question first rule of thumb make sure your name address and phone number is on every single page in the patient's chart if you've got a little stamp you want to stamp the top of every single page I can't tell you how many faxes I've gotten from insurance companies they send over these copies of soap charts and at the very bottom there's copyright Dianna L Thompson at the bottom of the soap chart so they think it's my chart but whoever the massage therapist was there's nothing on there that identifies them and so I know you're just getting thrown into a file that says do not pay because they don't know how to find you so make sure your name address and phone numbers on every page client identifying information should also be on every page of the chart that's the patient's name their date of birth and their insurance ID number every single page make sure that your prescription covers every date of treatment if the prescription needs to be backdated you should send it back to the referring caregiver and say you know there's a date missing on this maybe you could back date it a little bit make sure all these dates are covered because anything that the prescription doesn't cover they don't to pay for then make sure that your icd-9 codes justify the treatment that you've been given that you've been giving so you want to make sure that the treatment you're providing the services you're providing those patients match the type of services that really meet their needs for that particular diagnosis and only submit reimbursable CPT codes that's why you call and ask those questions in the beginning you want to make sure you know exactly what codes they'll pay for and that you're not doing for other codes this is actually it can seem like a little squirrely thing to do but often times they'll bundle services so they'll only let you for example bill under nine seven one two for the Swedish massage code but they'll say it's a bundled code and you can actually do everything that's within your scope but that's the only bill that's the only code they're going to reimburse for so that's how that works on the next slide a few more tips on submitting clean claims make sure the dates match the dates on the charts make sure that the treatment that you provide is within the period authorized this is very particular to lni or workers compensation claims they're gonna give you an authorization date and they're gonna give you an end date so often times they'll say all services must be provided within six weeks so make sure that all the dates that your all the services that you're providing match that authorized time period my best recommendation for you is that you submit bills weekly and that you don't cross month so if you see someone at the end of May and the beginning of June submit to different billing forms one for the May dates one for the June dates once you start crossing months it gets a little tougher to get paid sometimes it goes into a different pile if it gets to be too much money sometimes it needs a second signature so just bill every single week and within the same month if they deny your claim and you want to appeal make sure that you submit an appeal within the time frame that's specified for example I had a client who was injured in a car accident she had a pre-existing condition but the condition was not a problem for her until the accident it was like all these symptoms came right back up even though it'd been resolved before it was exemplified by her car accident so the insurance company denied the claim saying it was a pre-existing condition so I was able to submit an appeal that said she was asymptomatic before the accident here's the documentation to prove that so she went to various doctors who said yes she was not complaining of these type of symptoms for several months or I think in her case it was a couple of years prior to the injury so appeal can be very successful so I was and I was paid a hundred percent for her case as a result of the appeal that I submitted so you definitely want to go through the trouble a variety in an appeal if you get denied but make sure it's within the time frame that's specified so monitor expiration dates if you're going to submit liens on those end of settlement cases you're going to want to make sure that the dates haven't expired oftentimes with motor vehicle collisions there are medical releases that are signed so make sure that that medical release is current so you're not sending out information that no longer is appropriate that you no longer have permission to send and then finally know the statute of limitations for filing a lawsuit in some states it's one year in some states it's three years so be aware of those dates and make sure that all of your bills or sirs are submitted within the time frame that's specified in the next slide we've got a few more reimbursement tips I cannot emphasize this enough but if you sound like you have a smile on your face when you're talking with insurance adjusters I can promise you they will have a smile on their face when they respond to you so you always get a little bit more grace I think with sugar than with bitterness so make sure that you're not calling upset because you didn't get your money but really say you know I might have done something wrong here what do you need to know in order for me to get paid it's just a much better attitude to have the next thing is very important and can be a little sticky so you might get a cheque that pays for five sessions rather than going back to your billing ledger and just crossing off the first five sessions that you've built for make sure that the dates actually correspond sometimes they'll skip a date maybe it mists in their system something else went wrong who knows but if you go back and try and get payment for a session that they actually say that they did pay you for you're going to be unsuccessful so make sure that you're going back and asking for payment for the date that actually they missed paying you for so line up those dates make sure you're giving credit where credit is due and checking off those payments date by date by date if you can file electronically I promise you it will go so much faster than handwritten claims they're easier to read they get through the systems faster it's much more convenient on both ends so file electronically whenever possible and if you're having trouble getting paid sometimes it's worth it to ask your clients to make a phone call whether it's calling the insurance company or calling their attorney and asking for some intervention on the next slide hmm appeals and denial so I talked a little bit about this often times there's a peer review looking at different chart notes so it might be that a nurse is hired for an insurance company and she looks at all the physical medicine and Rehab claims that could put in whether it's massage therapy physical therapy acupuncture nursing whatever so she's gonna look at those things or he is gonna look at those things and say yes the treatment was appropriate for condition yes the treatment was effective and usually they're looking for quality of life things that's what the qol stands for so they want functional outcomes and then was the cost of the care reasonable if any of those things are a know they might deny the claim and then you're stuck writing an appeal I'm gonna skip through a couple of those denials are not going to happen that often well let's go to the second one so common denials bills for treatment outside the scope will just buzz through these really quickly so oftentimes if someone thinks that you're doing something that's outside your scope of practice I just got a phone call on one and a massage therapist used a laser cold laser or low-level light therapy and they kicked it out of the system because they thought it was outside the scope in the state that he was in there was actually no information either way but the insurance company will also take the might take the prerogative of just saying you know even though it's legally not so outside the scope it's outside the scope for us to pay for it so always make sure that the treatment that you're providing is within your scope of practice and when you call the insurance company in the beginning I gave you those five questions you want to ask make sure that those treatments are covered for this or for the condition that the patient has also make sure that the services are authorized by that diagnosis so exactly what I just said that they're covered for the condition that the patient has this is a really tricky one oftentimes your billing on the same day or they're getting massage therapy on the same day that they're getting physical therapy or chiropractic so make sure that you're not billing for the same modalities on the same day whoever gets the bill in first will get paid so you never want to be stuck in that situation so educate your patient so that they know to schedule things on different days if they're receiving similar types of therapies for the same condition and then bills for services beyond the standard of care we don't have best practices or standards of care written for the massage therapy profession but they might assume that we do there are actually some that are written and stored in the standards warehouse standards Clearing House that were not even written by massage therapists so it might be good for you to go to the standards Clearinghouse and see if there are any standards for care that you need to be aware of but just make sure that your services are reasonable and necessary that's the most important thing now I'm going to talk about ethics for a few minutes here and that's kind of the most important thing that I can tell you about when is it okay not to chart there's a good question to ask yourself that would be never so you always want to make sure that you're writing notes for the dates of service that you're providing we are a health care modality so it's absolutely imperative that we chart all of our health care sessions when is it okay not to write reports never so if you're getting a prescription or a referral from a primary care provider you want to make sure you're corresponding with them they are financially responsible for you and you need to report back to them on the progress of your patients that you share and can I charge more if I'm waiting to get pain you can charge interest on your money so I think most states have a 12% per year limit so a 1% per month and it can't be compound interest so it's simple interest so whatever the amount of the service you can't charge interest on top of interest for example but that's one way that you actually can get charged more for waiting to get paid but you can't actually beef up your fees just because you're waiting to get paid that's a relationship that you have on the next slide we'll talk about a few other things what you can actually do is provide a payment at time of service discount so if you have a fee that reflects the cost of providing the billing service that's okay and then you pass on the savings to the people who pay at the time of service so it's actually called a payment at time of service discount it's not an add-on if someone if you're providing an insurance billing situation so that's how you need to phrase that if you actually pay if you actually charge different rates for insurance clients versus your cash clients you want to make sure that you're charging the same amount for the same service for example if you're providing myofascial release work and someone's paying cash in someone's billing their insurance company as long as you're providing the same service you have to charge the same rate you can't charge different rates for the same service what you can do again is provide a payment and tylo service discount so that's the only way to get around that you can't up code for example if you know you'll get paid more for the manual therapy code versus the Swedish massage code but you're really providing Swedish massage you can't charge for the manual therapy code just because they'll pay more so that's called up coding and it's actually considered insurance fraud so that's illegal you also can't rebate what that means is if you get referrals from a chiropractor for example you can't kick them back a $20 $25 bonus because they're sending you referrals that's called rebaiting and that's illegal in every single state so there are restrictions on how you can build and how you can charge for your services so just make sure that you always charge the same rate for the same service but if you want to give people a payment at time of service discount you absolutely may but make sure that the amount of discount that they're getting so the amount that area let me say it a different way the amount that the person whose services you're billing for that that increase in fee actually reflects the services that you're providing for billing for example it probably doesn't cost you $50 an hour to bill so it wouldn't be fair to charge a hundred and fifty dollars for your billing service and then give people a $50 payment at time of service discount most insurance billing services are about a 10% fee sometimes it's 6% sometimes it's 12% so really you can only get away with about a 10% discount for payment at time of service so make sure it's reasonable and that you can justify it should you get called out on it or audited for it so that's everything that I have to tell you about insurance billing and making sure that you get paid all the information that I provided for you today in the book that I wrote actually the fourth edition just came out a few weeks ago so when I sent the bio in to Eric earlier it was still the third edition but the fourth edition is now available and it's published by Lippincott Williams & Wilkins and is available online or hopefully in your local bookstores so the final slide is my website address if you have any questions you can email me or go to my website and just really thank you so much for your time today and attending this web conference okay thank you very much Diana and congratulations on the fourth edition so it's fantastic if anybody wants to get information on the book they can go to WWE and he'll calm so that's hands he'll calm and you can find out more information about the book there now don't go anywhere we're going to go into our Q&A session we're going to take questions from the audience and I just took a quick peek in the interface I see there's tons of questions there so cliff corn my fantastic co-host has been going through those questions and picking out the best ones and so are you ready to answer a few questions I am I am thank you okay so are you there cliff I sure AM all right so I'm going to hand it over to you wonderful thanks a lot Eric I'd say Anna I can't get over it every time I I hear you like I learned new stuff and I think I've heard this presentation at least once before but I've always more stuff and it's apparently a whole lot of folks here you piqued their interest because we have a whole pile of questions they're going to try to go to most of them and take a lot of the duplicates here and a lot of them have to do with CPT codes okay and here's one person asked how about a the code nine oh two one oh I've heard about one on TV [Music] okay now let's get to I think that was a joke oh I'm getting it as I write it down oh my god yeah I believe that but here's actually here's a serious one what is the color narrative report or is there a code for a narrative support there is not a code for a narrative report there are no codes for reporting for massage therapy that are available to us what I typically do with a narrative report is I just send an invoice to the attorney so the attorney will pay it out of their retainer usually or pass the bill on to the doctor and take it honor to pass the bill on to the clients and take it off of the top when they finally get paid so not something that you need a CPT code for okay and actually I think a lot of times lawyers when they request reports will include what they're willing to pay for them yeah okay I see a question from Orlando Marybeth would like to know how you actually go about filing something electronically how do you set up for that how do you you know where do you go what do you do if you I want to make that happen that's a good question so every insurance company will have their own systems for filing electronically and sometimes an insurance company will actually go through a network so if you get credentialed through and network then they'll have their own format for doing it but there is an electronic version of the CMS 1500 form so that's the form that you want to use and you'll fill that out on your computer and then attach it to whatever email you're sending off to the insurance company so you want the electronic version of this TMF 1,500 form okay I've combined a whole lot of questions here that all involve how one finds out the actual rates that they can be charged for various CPT codes is there one place you can get that or there are a hundred places you have to go to get you know that's not something that you're actually going to find you don't want to do something called price-fixing there's a lot of legal issues about that so we can't dictate a fee schedule and recommend that people use that for their billing what you really have to do is set your own fees and you can do that by asking people in your area what they're charging so we could kind of do a little informal poll here and see what people charge but you definitely don't want to mandate a fee schedule and then charge that because you're going to get in trouble with price-fixing I think avoiding getting in trouble ISM a lofty goal let's see oh here's a good one we ask Allah for in position if we can use his or her NPI to be in network even if the work is done outside of their office ah that's an interesting question more likely than not they will say no because there has to be some supervision and takes place it's already pretty sketchy and that you're getting supervision and they're never in the room with you so to not even be in the same building with you I'd say would be way outside their comfort zone or their ability to to offer that so I'd say no okay [Music] could you again review what types of claims require a referral from the clients position anything that your billing an insurance company for I would say you want a prescription from a referring caregiver some sort of primary care provider so it depends on what the requirements are in your state in Washington our natural paths can be primary care our chiropractors can be primary care and sometimes physical therapists can be primary care and write those prescriptions so it really just depends on what the laws are in your state there are very very very few insurance companies that will pay fo