Insurance Billing Issues
GREED IS THE SEED
Is a major blessing about to be lost forever?
By: Vivian M. Mahoney, LMT,
Policyholder and previously injured auto accident victim.
Greed is the seed of destruction, despair and our potential downfall.
For years I’ve warned massage therapists about the dangers of taking advantage of a blessing we’ve been able to enjoy. That blessing has been being able to accept insurance for payment of our services. We are blessed to be one of the very few “complementary” health care practitioners who have been able to enjoy this privilege. This blessing has been a major door opener for us to treat thousands upon thousands of people who would have otherwise not been able to benefit from our line of work. This blessing has continued to open doors for therapists to work in all sorts of medical settings or to be independent and accept direct referrals from physicians. It has opened doors for us today to be accepted as viable health care practitioners nationwide. Will those doors now close?
Even though all doors were not yet totally opened, we were beginning to see the rays of light, not only for our benefit but for auto accident patients with medical conditions. I warned that we were blessed to be in this system by the skin of our teeth as the saying goes, and could be eliminated with a stroke of a pen.
I warned about gouging insurance companies and patients alike by over-billing, over-coding and under-documenting services. I warned about the greedy attitudes I began to see developing. I could “see” how this could negatively affect our entire profession. We needed to protect the gift we had and treat it as if it were gold, protecting our privilege to bill insurance for patient care.
In the beginning insurance companies learned of our valuable remedial, restorative services, low prices, sufficient documentation and the capacity to help patients recover and/or return to work. They even began referring patients to us. Now it is all about how they can get rid of the high costs of massage therapists. We didn’t even begin to make it to the top before greed of some began to slam us downward towards the bottom. Can we turn it around? This year’s legislative outcome will tell the tale.
The majority of massage therapists are in this business because they LOVE what they do, they LOVE seeing medically related changes right before their eyes (and under their hands) and they LOVE the opportunity they never had before to make a living or to build a career. The majority of massage therapists are ethical, honest, hard working and caring.
However, in most recent years many massage therapists, thinking they are worth a fortune right out of school, billing $200.00 to $500.00 and up a session, taking shortcuts, learning just enough to be dangerous, learning from those who are not truly concerned or who do not know what’s going on within the insurance industry, listening not to their inner senses and training, but to some clinic owners or others for whom they work, knowing internally that something is wrong, accepting bribes to sign claim forms or progress notes when in fact they often did NOT perform the work or in some cases never saw the patient.
Massage therapists must have an idea something is wrong when they sometimes are the only ones working and seeing 50 plus patients in the office a day. When they see patients being run through the mill so to speak, coding and billing 10-12-14 and more procedures and modalities on each client or not at all, and yet they’re asked to sign notes or claims.
Do I blame all therapists in situations like this? Yes and No. Therapists who are being paid up front money to come to work and “do what they were told” has to know something is wrong. Those involved in setting up “Clinics” through the AHCA when they know for a fact they do not have the financial where-with-all to do it and are backed by others and they themselves are not really the “owners” have to know they’re being “used” or that it’s bordering on illegal and/or unethical or they made the choice to do this in the first place. If you’re involved in a situation like this, know that you probably are being watched by investigative agencies so be forewarned, massage therapists in these situations are being arrested. Don’t let it be you!
Due to what is happening as mentioned above a bill has now been introduced in legislation this session by Senator Negron that will, if passed in current form, eliminate massage therapists entirely from Florida No–Fault PIP payments. At this time the FSMTA Executive Committee is in this fight to protect you and auto accident victims who will be the ones to ultimately suffer the most if our services or those of chiropractors are eliminated.
IF we can win against this and remain able to accept and bill auto cases we would need to be even more vigilant to prevent this situation from ever happening again. We need to do what we can to show insurers that we provide one of the most valuable forms of service to their policyholders.
If you are reading this information after the legislative session, I hope you have read that PIP No-Fault is saved and that massage therapists are saved and that FSMTA won yet another battle for members!
If you are reading this information before legislation is over, I hope you will help in the fight to save our rights and abilities to bill for medically necessary prescribed auto accident cases, first for the injured patient’s sake and second for our financial future in more ways than one.
What is not the answer?
Eliminating massage therapists is not going to eliminate most of the fraud in the industry! If they eliminate massage therapists the same procedures, modalities and other related services will still be provided by other health care professionals or worse yet, a non-trained employee. The over-billing, over-coding and under-documentation will still go on and premiums will continue to rise. But we will be out of work! The injured parties will not receive quality services that only we are trained to perform and only we take the time to do it effectively, (the reason physicians began referring their patients to us in the first place).
What might be the answer?
• Getting us on track with the insurance companies and legislators and letting them know we are here to police ourselves and to inform them that massage therapy has major benefits when performed correctly and that massage therapists are the only ones who provide this effective time involved and hands-on service because it’s what we’re trained to do.
• Turning in those we suspect of being involved in any sort of fraudulent activity, be it by physicians, massage therapists, clinic owners and operators or patients themselves. Remember the honest, hard working physicians are just like us, they too are getting a bad rap for the few crooked ones in their industry.
• Get schools to begin to train their students about the prospects of fraud and to train them on what to be on the lookout for and what to avoid.
• Get investigators in the schools to show students the end results of what a massage therapist in handcuffs looks like. (They are willing and ready to do this and have asked me to help open those doors for them)!
• Get LMTs to understand that it is a privilege and not a right to be able to bill insurance for our services and to protect that privilege by not being greedy, by doing no harm to the public and by not taking advantage of policyholder’s finances.
• For us to continue to be the caring, health-minded, results-oriented therapists we are and have always been.
• Be mindful of the fact that in today’s time, not all attending school to become licensed massage therapists are of like mind and desires. Watch out for suspect activities of other massage therapists and be willing to report them for the sake of all.
• Learn to correctly bill for insurance cases and know it is not all about what code or form to use and to learn how to correctly document your work so that you are protecting yourself and the patients you serve.
I am open to listening to all suggestions, ideas and comments! Please send them to vivianmadison [at] gmail [dot] com but also know I may not be able to respond to all.
Any questions, contact me at: 865-436-3573
Vivian M. Mahoney, LMT
FSMTA Insurance Consultant / Insurance Consultant (19 years)
January 15, 2010
Email: vivianmadison [at] aol [dot] com
Website:
Downloadable pdf archives:
Massage Insurance Billing Update February 3, 2012
Massage Insurance Billing Update January 10, 2010
Massage Insurance Billing Update June 5, 2008
If you can’t find the answers to your questions here, please feel free to contact Vivian directly. She is the expert when it comes to billing insurance for massage therapy!
About cold laser and low level laser therapy.
I would highly suggest, if you plan to use this service, be absolutely sure it is in your scope of practice, and that you have liability insurance that covers this service. FSMTA’s insurance provider, the American Massage Council, has coverage that is rated and charged on that rating system, higher risk, more training and higher premium. Check this insurance coverage out here.
Be aware that we as LMT’s have NEVER used HCPCS Codes but have always used CPT Codes.
Read article below I obtained from my research on this issue on Google.com when searching HCSPC Codes.
HCPCS Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices, and represent items and supplies and non-physician services not covered by CPT-4 codes (Level I).
I suggest using a CPT Code for a questionable service and in this case 97799 and I would personally call the insurance adjuster first and make pre arrangements to use this code for Cold Laser Therapy or Low Level Laser Therapy.
Most importantly, be absolutely sure that you have had proper training for patient safety protection, be sure you have liability insurance that specifically covers you in case of injury or complaints of injury. And last but not least, check your scope of practice and see if this service is within your scope of practice. Is this service using a mechanical or electrical device? Does it fit in with the definition of manipulation of the soft tissue?
Vivian M. Mahoney
Laser Therapy and Billing Codes
One of the major challenges practitioners face when using laser therapy in their practice is getting reimbursed for the work they have done. The following are common codes used by practitioners of laser therapy. We are not recommending any particular codes and cannot advise you on billing issues. However, here are some current codes and practices.
While there is no CPT code that defines laser therapy, there is a HCPCS Level II code – S8948 that does reference this service. The S8948 code, which includes a time component, is defined as follows: S8948 – Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes.
It is true that many worker’s compensation and personal injury providers do not recognize HCPCS Level II codes and in such instances CPT 97039 is used.
97039 is an unlisted attended modality code. Reimbursement is good because it is understood to take more time than an unattended code. Being an unlisted code however, it is often rejected or hand audited.
Since codes ending in a ‘9’ are considered unlisted, they require an explanatory summary letter to be submitted in with the claim. The outline of the letter should include your name, patient’s name, date of treatment and a description of modality used.
If anyone is interested in a summary letter, please contact John Mai and he should send you a template to use.
John Mai Email: John [at] irradia [dot] us
Irradia USA
P.O. Box 18947
Irvine, CA 92623
Office: (800) 300-LLLT (5558)
Fax: (310) 775-9749
Web:
Education:
