What you need to know about Insurance Billing.

Graph source: Massage Today Magazine, January 2003 Issue
www.massagetoday.com

Are you recovering from an auto injury, work injury or surgery?
Have you had an auto or work injury in the last 12 months.  Ask your doctor for a prescription for massage.  Personal Injury Protection (PIP) covers massage therapy when referred by a primary health care provider such as a Medical Doctor (MD) or a Chiropractor (DC). I can recommend several qualified Chiropractors should you not currently have one. I highly recommend Dr. Michael Ross of Steubenville Chiropractic 740-266-7246 and Dr. Douglas MacPherson of MacPherson Chiropractic and Therapeutic Rehab 304-723-5340.  You have the right to choose your licensed massage therapist.  In addition to communicating with your team of health care providers, I will directly bill your insurance for you.  I have training and experience in massage insurance billing, making sure that you will receive all of the benefits that you deserve.  I want to help you to recover from your stress and injuries and not have to worry about dealing with the insurance people or finances.

 Medical Massage

What is medical massage?
Medical massage is massage performed under the supervision of a medical doctor to aid a person's recovery from accident, injury or chronic pain. The massage focuses on the specific condition for which massage is indicated as a treatment.

Who can prescribe medical massage?
Chiropractors, Naturopaths, and Medical Doctors

Who can receive medical massage?
Anyone who may have been injured recently in an auto accident or work related injury.
Anyone with a prescription from their doctor who has deemed massage "medically necessary".

Who pays for medical massage?
Your insurance may pay for your massage. I'd be glad to check for you, saving you time and added stress.

Group Health plans

Healthcare & insurance providers generally negotiate custom contracts with large organizations. Under some contracts, the employee would simply submit an expense voucher to their employer HR department for reimbursements.

Who would disseminate this information in your organization?

• Advertising by the insurance provider to the employees would not make financial sense for the insurance company.
• The HR personnel generally do not have enough staff simply to handle all day-to-day corporate activity.

Do some research to learn your full benefits in any group plan.

Personal Injury Protection

Most vehicle and real estate insurance contracts contain personal injury protection (PIP). PIP covers a broad range of medical expenses associated with any accident involving the property.

Most often, your insurance provider must by law pay for the massage services: You may need to obtain the following from your doctor:

• Prescription for massage
• Letter of Medical Necessity (LOMN) for massage

Determine which, if any, forms are needed.

Workers Compensation

Like personal injury protection, insurance providers must pay for any massage services related to Workers Compensation. The claims typically require:

• Prescription for massage from your doctor
• Letter of Medical Necessity (LOMN) for massage
• Progress reports from the practitioner

Determine which, if any, forms are needed for Workers Comp.        www.ohiobwc.com

PRESCRIPTION

For insurance billing, I require the following:

• Prescription / treatment plan from your doctor
• Letter of Medical Necessity (LOMN) from your doctor
• Verification of adequate insurance coverage

Massage therapists fall under the jurisdiction of the state of Ohio Medical Board.  We are not permitted by law to diagnose medical conditions or develop treatment plans for medical conditions. The diagnosis codes provided by your doctor specify the medical condition to be treated; while, the procedural codes designate the treatment approaches.

Consequently, I work under the specific direction of your doctor; I treat you as your doctor's patient, following the instructions provided within the prescription and LOMN.

We work together as a team, providing you with more integrated and comprehensive treatment approaches.

VERIFICATION CLICK HERE FOR VERIFICATION FORM

The initial questions to ask would be:

• Does your plan cover massage therapy?
• May YOU submit invoices from the massage practitioner for reimbursement.
• Do the invoices need to be accompanied with a prescription?
• Must the prescription specify diagnosis and treatment codes?
• Must you provide a letter of medical necessity (LOMN), in addition to the prescription for massage services.

If your plan DOES cover massage, but the PRACTITIONER must submit the invoices for payment, then:

• Does your provider require the practitioner to submit any additional forms (e.g., CMS 1500 Claim Form)?
• Does your provider require the practitioner to submit Progress Reports with any claim forms, invoices, or prescriptions.

FORMS

• Verify your insurance coverage
• If necessary, send a letter to your physician regarding medical massage
• Obtain a prescription / treatment plan from your doctor
• Obtain a Letter of Medical Necessity from your doctor
• Submit claims for reimbursement by insurance
• Provide evaluation and progress reports to your insurance company, your doctor, you, and if necessary, your attorney

Start by contacting your healthcare insurance provider and your physician.  I can provide you with forms that may help you..

RATES

A typical medical massage session lasts 45 to 60 minutes.
(rates effective 4/1/04)

They incorporate the necessary client assessments, insurance documentation, progress reporting, and claim follow-up procedures required to work cooperatively with the insurance and medical communities

Insurance and Discount Information

Most people are concerned about the costs of healthcare, whether it is the high price of health insurance, or “out of pocket” expenses, such as the expense of Alternative and Complementary Therapies or seeing “out of participation” health care providers. As we patiently wait for coverage in the State of Ohio for alternative and complementary therapies, here is what can be done to potentially lessen the cost of treatment.

The first step is to contact your insurance company and find out whether they cover the treatment that you are seeking. Currently some insurance companies may cover a percentage of the cost for acupuncture, nutritional counseling, psychotherapeutic services and/or massage. All plans vary; different employers have different policy plans. So, it is difficult to give a general statement about what can be covered and how much of the treatment will be covered. The patient may be required to submit a medical referral form from their physician, recommending the treatment, to the insurance company. The insurance company then will decide whether the patient is eligible and if so, the patient should be directly reimbursed.

Here at Ohio Valley Massage we do participate in many different Alternative and Complementary Medicine Discount programs that are available through most major insurance companies.  To find out further information please call us at 740-544-6644

Making the choice to take health care options that require more “out of pocket” expenses can be a difficult one. However, the alternative of not having treatments that have a beneficial outcome on wellness may end up costing us a lot more.