Billing Insurance?

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Billing Insurance?

Postby IsHisBiz on Mon Dec 27, 2004 9:29 pm

I've a new insurance client soon and haven't done insurance billing in years.<br>Can anyone tell me the Actual, current 2004/2005, most common Diagnostic codes? Most common Treatment codes for massage?<br>CPT? code numbers and titles?, etcetera for billing insurance companies? <br>What do I put on my homemade form to them?<br>What else do I need to know?<br>I asked him to get them from his doctor but, would rather have a second opinion as to what I should be communicating with insurance companies exactly?<br><br>Any tips in billing insurance so it is paid at best amount?<br>I may be dealing with workers comp.  Any hints on dealing with them too?<br><br>Thanks.<br>
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Re: Billing Insurance?

Postby IsHisBiz on Tue Dec 28, 2004 8:48 am

Thanks Pete for the information you shared.

I will look it up as soon as possible.

Thanks again.

You might want to check out http://www.sohnen-moe.com/forms.php for HCFA forms so you won't have to send in a "homemade" one.  You can print them out and send them in handwritten if you need to; they will still get processed and it will be easier to get paid.

As for cpt codes, Massage and Bodywork magazine usually prints them in the first issue each year.  If you have them for 2004, you might want to take a look through them, but I did find a listing here http://www.thebodyworker.com/insbillcodes.html by doing a search on yahoo.  BTW, as an MT, we are not allowed to diagnose, so make sure you get the diagnosis from the client's physician. (But, I'm sure you already knew that...)

Hope that helps you...
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Re: Billing Insurance?

Postby julieonofrio on Sun Jan 02, 2005 3:28 pm

I have the most common CPT codes listed on my website at

http://www.thebodyworker.com/insbillcodes.html

along with other information on billing insurance companies at

http://www.thebodyworker.com/businessinfo.html

You should also use a HCFA 1500 to bill.  You can get them at office supply stores or at places like
http://www.massagecpt.com

You have to charge insurance companies the same rates as you would if a client were paying cash for the same service.  Say you are billing 97124 - therapeutic massage  which is a 15 min. increment.  If your hourly rate is $100 for your cash clients that would break down to $20 per unit.  It is illegal to bill more for the same code than you charge your cash clients...

Good luck

Julie Onofrio
http://www.thebodyworker.com
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Re: Billing Insurance?

Postby IsHisBiz on Sun Jan 02, 2005 5:32 pm

Dear julieonofrio,

Thanks for your reply.

I didn't know it was illegal (in all states?) to charge a different rate for insurance rates as compared to cash paying clients.
(Where does having a sliding scale rate come into play?)

I've never charged a different rate for insurance billing but, I was going to do it for this year at a rate of $2.50 more per unit or, per 15 minutes, because it takes so much extra time in paperwork.

Thank Goodness that the bill is still waiting to be mailed out.

I will buy and have filled out by client the "HICF 1500" (HEALTH CARE INSURANCE FORM)  form available at my local "Office Depot" store, at a cost of about $14. (for - I didn't look for how many forms but, it looked like 20 or so in the package?). In triplicate? Double?

Guess it's worth it if it makes processing of insurance claims easier.
You have a signed release by client to pay me, etcetera.
No more homemade forms although, the insurance adjuster did ask to look at my SOAP notes too.
Guess I need a signed release from client for that too, huh? Legally?

There is far too much paperwork in the world and I do try to minimize it as much as possible.

It's better than having to shred all that paper you may do eventually and of course, less use of trees for all that paper and ink.

Hopefully someone will come up with a way to make it easier to file HEALTH INSURANCE CLAIM FORMS electronically over the computer and email, etceteras easier some day?
Any ideas on making this happen?

I was about to send in just a homemade form made up, typed on computer, from info from HEALTH INSURANCE CLAIM FORM 1500.

Are you sure it's illegal to bill at a different rate, literally? I do more work. I should be compensated accordingly.

What do you think?
Some therapists charge more for deep tissue than swedish massage?
Could'nt charging insurance for extra work be like this too?
What exactly, literally, does the "law" say about billing of insurance as opposed to cash paying clients? Where do you find this exact information?

************************

I have the most common CPT codes listed on my website at

http://www.thebodyworker.com/insbillcodes.html

along with other information on billing insurance companies at

http://www.thebodyworker.com/businessinfo.html

You should also use a HCFA 1500 to bill.  You can get them at office supply stores or at places like www.massagecpt.com

You have to charge insurance companies the same rates as you would if a client were paying cash for the same service.  Say you are billing 97124 - therapeutic massage  which is a 15 min. increment.  If your hourly rate is $100 for your cash clients that would break down to $20 per unit.  It is illegal to bill more for the same code than you charge your cash clients...

Good luck

Julie Onofrio
www.thebodyworker.com
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Re: Billing Insurance?

Postby BigDog on Sun Jan 02, 2005 5:57 pm

According to the Inspector General's Office of the United States, it is NOT ILLEGAL to charge a different amount for cash v. insurance.  The delivered a decision that stated that it was two different products being sold.  With a cash client your reposibility ends when the client leave your office.  (They come in receive massage, pay, and leave)  When a patient comes in you have to verify insurance coverage, do the massage, do all your paperwork, bill, await payment (and even face the fact you might not get paid) and possible court appearance).  <br><br>Please research this for yourself.  For some reason this has been passed around from therapist to therapist and it keeps a lot of therapist from doing insurance work.  I know there are people reading this and thinking 'this is wrong, I was told ....."    <br><br>I felt the same way as IsHisBiz,  Why shouldn't I be compensated for the extra time I put in with this patient.  When I asked a lot of therapist told me it was illegal and/or unethical to charge more just because they had insurance.  That wasn't the reason I wanted to charge more, it was because of the extra time I put into that session and the chance that I would not be paid (which is a risk with insurance work)  So I had my attorney do some research and he showed my the decision.  Check it out for yourself.
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Re: Billing Insurance?

Postby IsHisBiz on Sun Jan 02, 2005 6:24 pm

BigDog,

Where Exactly Do I Check it Out?
What your attorney found?
Internet or Library Site?
Where? What exactly does it say if you could point me in the right direction, BigDog? Or, Other?
Thanks for your feedback.

I think I ought to be able to bill my time I invest into a client and adjust my rates accodingly. That's fair.

I'm so glad to hear you say that you found out that it was Not Illegal.

Guess, I won't have to redo the claim for now.
Maybe they can learn to handle the minimal paperwork?

According to the Inspector General's Office of the United States, it is NOT ILLEGAL to charge a different amount for cash v. insurance.  The delivered a decision that stated that it was two different products being sold.  With a cash client your reposibility ends when the client leave your office.  (They come in receive massage, pay, and leave)  When a patient comes in you have to verify insurance coverage, do the massage, do all your paperwork, bill, await payment (and even face the fact you might not get paid) and possible court appearance).

Please research this for yourself.  For some reason this has been passed around from therapist to therapist and it keeps a lot of therapist from doing insurance work.  I know there are people reading this and thinking 'this is wrong, I was told ....."    

I felt the same way as IsHisBiz,  Why shouldn't I be compensated for the extra time I put in with this patient.  When I asked a lot of therapist told me it was illegal and/or unethical to charge more just because they had insurance.  That wasn't the reason I wanted to charge more, it was because of the extra time I put into that session and the chance that I would not be paid (which is a risk with insurance work)  So I had my attorney do some research and he showed my the decision.  Check it out for yourself.
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Re: Billing Insurance?

Postby IsHisBiz on Sun Jan 02, 2005 6:36 pm

There is a link to a december 21st topic regarding this too.

Here's a link to it.

http://64.233.161.104/search?q=cache:Af ... n&ie=UTF-8
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Re: Billing Insurance?

Postby BigDog on Mon Jan 03, 2005 8:58 am

It was the OIG 98-8.  It pertained to Dr.'s in the body of the decision but when questioned about it the OIG responded with the statement that it should pertain to all Healthcare providers.   It is true that you should have one rate for all insurance claims and bill the same to each.  Even if you have a contract you should bill them the same.  As I always state you should get professional help with legal questions.
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Re: Billing Insurance?

Postby IsHisBiz on Tue Jan 04, 2005 5:15 pm

Big Dog,

I googled the code you mentioned, "OIG 98-8", but it seemed unclear in found on http://www.Google.com

What exactly are you talking about and where is it found?

It's not extremely important to find, because I've decided to bill insurance $2.50 more per unit or, 15 minutes (and, starting to think I should double what I charge to $100. an hour. Paperwork takes a lot of time and money to get automated, etcetera.  ::))

Other news.

I am searching for Blank S.O.A.P. charts to create my own.

Link to new topic I started below about it.

Thanks for any help.

http://www.bodyworkonline.com/forum/vie ... hp?p=26682
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Re: Billing Insurance?

Postby BigDog on Tue Jan 04, 2005 9:40 pm

Go to the Office of Inspector General and look for decision 98-8.  Unfortunatly, I do not have it book marked, or I would give it to you directly.  If I talk to my atty this week I will ask him to fax it over to me.  <br><br>Another area you may want to check with is David Luther's group...  I believe it is American Medical Massage Therapy Association.  He has written a book on Insurance billing and has dealt with Insurance Co.'s for years.  Just a thought for another avenue to approach.
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Re: billing insurance?

Postby julieonofrio on Fri Jan 07, 2005 9:59 pm

I took a class a few years ago from Diana Thompson, author of "Hands Heal" and she said specifically that it is illegal to charge the different fees for the same cpt code - if you have a cash client who you are doing massage on (97124) you have to charge them what you charge for 97124...  You can add an additional and resonable fee to cover whatever charges you would pay to an insurance billing company to do the billing (which at the high end would be approx. $7.00) The chiropractors here in WA have already legally been forced to stop charging different rates.

You can charge different rates for different services. 97124, 97140 etc.

Vivian Madison Mahoney also writes about it in her manual and in her column in massage today.  This is one article

http://www.massagetoday.com/archives/2002/10/10.html

There was also another one there that I can't recall right now...

I would love to see proof of this otherwise.  I have been researching this for the past few years and I have yet to find any...And everyone says something different just to defend charging more....which is again one of my pet peeves.

See also issues and ethics in billing insurance companies..

http://www.thebodyworker.com/ethics_billingissues.htm

If you are going to accept insurance and the realities of billing (more paperwork etc.) you need to figure it into setting your fees.  accordingly.  I think one of the problems is that we don't charge enough for what we do to begin with so everyone jumps on the insurance bandwagon to get paid more...

I just think this is one area that needs more research and discussion.
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Re: Billing Insurance?

Postby BigDog on Sat Jan 08, 2005 9:56 am

For everyone you find that says it is illegal to charge more for insurance billing you can find someone to say it is not.  
I took a class a few years ago from Diana Thompson, author of "Hands Heal" and she said specifically that it is illegal to charge the different fees for the same cpt code - if you have a cash client who you are doing massage on (97124) you have to charge them what you charge for 97124...  You can add an additional and resonable fee to cover whatever charges you would pay to an insurance billing company to do the billing (which at the high end would be approx. $7.00)


Isn't that a contradiction?  It is illegal to do, but if you charge only a little difference its OK.  

David Luther "The father of insurance billing" says that it is legal to do.  Due to the differences in responsibilities one assumes doing medical massage.  

He is the former Insurance Chair for the Florida State Massage Therapy Association.  He should know something.

Margery M. Callahan, developer of CompMed Billing's Complete Kit, also says that it is legal.

I believe it is up to each of us to research this and decide for ourselves as to the ETHICAL side of this.  

It amazes me that so many people jump on the Diana Thompson comment that it is illegal to do, when she herself says its OK as long as you only charge a little more.  BTW-- Why did most of you take Diana's course, was it so that you could bill certain insurance co.'s?  Where do you think she makes most of her money from?  Would you ruin your revenue source if you were in with the insurance company?  I wouldn't either.
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Re: Billing Insurance?

Postby julieonofrio on Sat Jan 08, 2005 11:17 am

I was forced to take the Diana Thomson class.  It is required if I wanted to be a provider with Premera Blue cross here in WA.  It will soon be required by all insurance companies if she gets her way....which she is working on.<br><br>I think what she is saying is that you can charge more to cover your expenses of billing.   <br><br>There is also the ethical side to this...<br>I can understand charging for your time...it only takes me less than 5 minutes per client to write notes etc.  It takes me about an hour a month to do the billing, make phone calls etc. My practice is about 30% insurance cases.  People who charge double their rates are what are hurting the profession.<br>If it is taking longer than that then there is something wrong...<br><br>I had a client who was in a MVA who was getting treated by another massage therapist who was billing $132 per hour.  (I bill $85). It was for whiplash. The  other massage therapist never even touched their neck.<br><br>I haven't taken a Luther class but was talking to an AMTA WA member who had spoken with him.  He has alot of inaccuracies in his information as far as what is going on in WA.  I also don't like the way he has created a whole medical massage class to increase his business.  The whole medical massage myth is another of my peeves.   Who has the right to determine what type of therapy can be used medically?   Will people who do structural integration (like I do) be unable to do injury work?  or others who do Reiki, polarity, bowen therapy or others???<br><br><br>Vivian Madison Mahoney "the mother of insurance billing" has been doing ins. billing for just as long if not longer than Luther.  <br><br>We could probably go on forever about this...but what is really best for our profession as a whole?   Do we want to become a part of the medical world where they have done this for years to make health care costs skyrocket and become unavailable to some who need it most?  Do we want to have to work harder, longer hours for less pay (which is what is happening here in WA where we are able to be contracted providers - I can tell you stories about how each year we are paid less per unit and are having our clients health put in the hand of the insurance companies who are only out for making money.  They are getting less and less treatment benefits and insurance companies are limiting the number of treatment sessions allowed.)<br><br>I wish AMTA would do some research on the whole thing...<br>or some group..
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Re: Billing Insurance?

Postby migueldc on Sun Jan 09, 2005 4:52 pm

I think we might be getting to somewhat of an impasse here because we are confusing what might be illegal with what might be unethical.<br><br>My notes from Diana Thompson's class say:<br>
  • It is unethical to charge insurance companies more for the same service than the patient.
  • It is appropriate to offer a modest cash discount to patients who do not require the additional expense of a billing service.
  • It is ethical to charge different rates for different services, for example treatment massage and relaxation massage, but they must be distinctly different in technique, modality, application and intent.
  • It is problematic to charge a different fee for relaxation massage and treatment massage when the CPT code is the same.
In the Ethics chapter of her book (Hands Heal, 2nd ed., p. 206) Diana Thompson says: "However, it is unethical and in some cases illegal to charge insurance companies higher rates than patients who do not have insurance coverage for your services."  <br><br>My interpretation of what Vivian Madison Mahoney says in her book (Comprehensive Guide to Insurance Billing", Revised 4/15/04, p.136-137), is that it is ok to charge more for medically necessary massages than for non-medically necessary massages, but  that you should charge the same amount for insured prescribed massage and non-insured prescribed massage. She goes on to say that "this is not to take the place of legal advice."<br><br>I personally am grateful that various authors are willing to share their insurance billing experience.  I wish this was an easy topic with clear-cut answers. Unfortunately, it is not. Therefore we can expect them to have different opinions at times. It is inconvenient, but it is healthy.<br>
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Re: Billing Insurance?

Postby BigDog on Mon Jan 10, 2005 10:39 am

I have to agree with Migueldc.  I believe it is an Ethical question, not one of legality.  In order for something to be illegal, there must be a law.  Since none of us can find a law stating that it is illegal, I believe that it becomes a subject of your own ethics.  Can YOU ethically charge more for insurance work over cash?  <br><br>BTW- Julie, the state of Washington states that an hour of your time is worth $104.12.  That's what the state says you should charge for any L&I claim.  
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Re: Billing Insurance?

Postby nurturing_hands on Tue Jan 25, 2005 10:51 am

Hey everyone:<br>Judy here!  I didn't read every post.  So I don't know if this is something already said.  Check out www.tmmo.biz  <br><br>David Luther and his group are very helpful.  You can take classes on insurance billing and become a certified medical massage therapist.<br><br>David stands behind what he teaches and will answer any questions you may have.<br><br>Their toll free number is 800-322-5520.<br>Yours in Health,<br>Judy
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Postby superspagirl on Thu Sep 22, 2005 11:35 am

at the above site it states the only insurance massage therapists should take is auto accident or workers comp. When you provide medical massage due to injury you are doing something entirely different from
relaxation techniques. There are codes they pay out and they set the reasonable and customary fees. That is how you get paid at a higher rate than say for an hour of relaxation massage.
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