introduction

At some time or another during your career as a massage therapist, you will most likely have
a regular client who gets in a car accident or injured at work, and will ask if you can bill their
insurance to pay for their ongoing massage sessions. Will you be able to say yes, or risk losing
their business if you say no?
Navigating your way through the maze of insurance billing is no easy task and is not for the
faint of heart! It is for massage therapists who want to reach more people and fill the small
gaps in their schedule. It is for massage therapists who love working with injuries and more
complicated conditions such as whiplash and other injuries that are found in workers and in
car accidents. It is also for the forward-thinking massage therapist who sees a future of increased insurance coverage for massage services.
Im here to help you figure out if insurance billing is something you want to pursue to
grow your massage therapy practice and to give a basic overview of benefits, challenges,
and how to get started.
Are you with me? Lets begin!

To Bill or Not to Bill

First you will need to decide if taking insurance will help your business be more profitable.
You can usually get an idea of what insurance companies will pay in your area but it takes a
little research.
Ask Start with asking other massage therapists in your area and also check the labor and
industries (or workers compensation) website for your state. They should have fee schedules available so that you can see what they will pay per session. In general, when billing for
car accidents, you should be paid your full fee.
Analyze You will have to analyze your potential income if you take a few insurance cases or
if you even decide you want to have a full-time business working only with insurance cases.
This may come with higher risk because of the constant changes that are always happening
and the many challenges of billing insurance.
Accept Challenge accepted. After you research and analyze the data, you may find that taking a few (or more) insurance clients will improve your bottom line and fill out your schedule. Do you have the patience to learn the process and follow through? Once youve made
the decision, theres a lot to learn. You can eventually know which cases to accept and which
to avoid, making it less of a challenge as you go.

Benefits //////////////////////////////
Billing insurance is a great way to get a few more clients on the table and build your
business. It is also a great way to start showing the medical community and insurance
companies just what massage can do. In general, insurance companies do not really
understand that massage can save them money. They think that they will have to pay the
surgeon $25,000 and then pay the massage therapist $2,000 on top of that, but they do not
realize that the surgery might be avoided and save them money! Billing insurance and
charting what you do can help make them more aware of just what massage can do.

A few of the benefits to accepting insurance:

Help fill your schedule with regular clients who come in once to twice a week (or more,
depending on the injury) for the duration of the healing process (2 weeks to years
depending on the benefits and injury)

Help show insurance companies that massage is a respectable and necessary part of
healthcare and healing, contributing to the growth of the profession

Demonstrate to doctors the importance of massage in the healing process

Foster more research and case studies on massage, which also supports the profession

Reduce the risk of clients leaving if you are unable to bill insurance when requested by a
regular client

Challenges //////////////////////////////
The challenge in accepting insurance cases is that it will take more time and energy to learn
the ropes, process the claims and work with these clients. Working with insurance companies can also be a challenge as they are about making money as well as caring for people.
The more people who get involved in billing insurance for massage, the larger our resources
and the louder our voices become. There is power in numbers when dealing with such large
companies and bureaucracy.

Affordable Care Act //////////////////////////////

How will the Affordable Care Act (ACA) affect the massage therapy profession? That is the
top question on everyones mind these days and the short answer is: were still trying to
figure it out. The good news is that the ACA does include provisions that appear to make it
mandatory for massage to be covered by health insurance plans in every state.

Each state is in charge of setting up what is called an Insurance Exchange System. States can
choose whether or not they want to do it themselves or use the system the Federal Government is setting up. Insurance companies in each state apply to be a part of the exchange
system.
Thankfully, the Integrative Healthcare Policy Consortium (http://www.ihpc.info/) is working
on it for us. They have hired Deborah Senn, the former insurance commissioner in Washington state who brought Health Care Reform to Washington in the mid 90s. Now in that state
we have something called the Every Category Law which mandates that insurance companies provide benefits that cover massage.
Massage therapists in every state need to be working closely with the Office of the Insurance Commissioner in their state to ensure that massage will be covered in that state under
the ACA. It will be a very long road to creating a place for massage in the exchange systems
and implementing the plans, as well as teaching massage therapists how to bill and understand HIPAA and privacy concerns when billing healthcare plans.
While there is still some uncertainty about how ACA will affect the massage industry, it is
more imperative than ever that massage therapists prepare themselves by learning how to
bill and work with insurance companies and doctors.

The three basic types of insurance are /////////////////////////

Personal Injury car accidents, slip and fall accidents and the like. (Car accidents are now
more commonly called car collisions.)

Workers Compensation or Labor and Industries- work related injuries including car
accidents or slip and fall injuries that occur at work

Health Insurance HMOs, PPOs, Managed Care

In most states, you can bill for car accidents or work related injuries, but there are a few
states that do not allow it or there may also be special rules you have to follow, like working for a chiropractor for instance. Florida and Washington allow massage therapists to bill
health insurance and there are more states and plans paying for massage services.
Figuring out if you can bill in your state is not really an easy answer since there isnt any one
resource on that. This is where connecting with your local community can help. You will
have to start asking other Massage Therapists, your teachers at massage school, your local
AMTA chapter and others if you can bill insurance in your state. You will have to find out on
your own what type of insurance you can bill (workers comp, car accidents, health insurance).

learn the basics of billing

What all is involved in learning the basics of billing? I cant possibly cover all that you need to
know in this beginners guide, but I can touch on what to expect when you first learn the ins
and outs of billing.

Once you decide to accept insurance, you will first be learning the basics of how
to bill--

what forms you will need

how to fill out the forms
how to submit them to the insurance companies
what you will need to do to follow up
making sure you are paid

Getting paid /////////////////////////

You will need to learn what to do when you arent paid and how to deal with the many challenges that come up in the process of billing.
You will have to have a basic understanding of how claims work and understand the various terms that insurance companies use in their communications. What will you charge and
what codes should you use to bill insurance?

Partnerships /////////////////////////
Along with learning new policies and processes, youll begin to work with healthcare partners, such as insurance companies, doctors, chiropractors, and more. Its important to know
how to communicate with these medical professionals. The bulk of this communication is
through your chart notes and progress reports. Your chart notes will need to show improvement in their health/condition and be able to demonstrate that massage was medically
necessary in each case.

Working more closely with doctors and chiropractors and other healthcare providers means
that more research is needed to show how and why massage works. It will also mean that
massage therapists will need to up their game and learn to work within these
communities while preserving the art of massage. That I believe can be done through the
process of supervision, as in clinical supervision, and working together to support each
other through these challenging processes.

getting started checklist

Calculate your cost per client and decide if taking insurance would help your business.
Figure out if you can bill for work related injuries by asking others or doing research
on the Workers Compensation Board or Labor and Industries Board in your state to
see if you can bill for work related injuries. Find out what the requirements are in
your state. L&I/Workers Compensation usually has classes on billing you can take to
learn how to bill.
Figure out if you can bill for car accidents in your area and what will be required for
you to do so.
Find out if there are any health insurance companies that will pay for massage
services. Occasionally companies will have special plans that cover massage or
special benefits.
Decide if you want to learn about billing just in case one of your good clients requests
it so you can keep that client.
Decide how much billing you want to do. Do you want a full time practice
(not recommended due to the extra risk) or do you just want to bill a few cases a
week or as they arise.
Learn everything you can about billing and the process of billing.
Keep up to date on billing codes, procedures, rules, regulations.
Get involved in your community with other massage therapists and share information
on billing and help each other keep up to date on changes.
Get involved with your States Office of the Insurance commissioners to help
implement getting massage covered by health insurance.

resources
This is just the beginning and you might find that you have even more questions now than
when you started this book. Thats okjust take it one step at a time. There are experts, myself included, who offer books, seminars, and classes to help make this process easier and
more productive. If youre serious about becoming successful at insurance billing, please
contact me or one of the resources Ive listed below. We are here to help!
Julie Onofrio massagepracticebuilder.com/massage-insurance-billing
Insurance Billing 101 for Massage Therapists, an introductory book on billing insurance.

Vivian Madison Mahoney www.massageinsurancebilling.com

The true expert on the subject! Insurance Billing Manual and more.

Diana Thompson - www.handsheal.com

Book on SOAP charting, essential to getting paid and some basic info on billing

Massage Insurance Billing Forum - massagepracticebuilder.com/forum/

Share what you know about billing in your area and find others to network with.

Richard Adler (Personal Injury Attorney) From Injury to Action

Understand the process of personal injury from a clients perspective

Workers Compensation Boards by State - http://massagepracticebuilder.com/massage-insurance-billing/massage-insurance-billing-work-related-injuries/

About the author

Julie Onofrio, LMP is a massage therapist in
Seattle, WA, and author of the book Insurance
Billing 101 for Massage Therapists, an
introductory book on the subject. She is also
the creator of many websites for the
profession:
www.massagepracticebuilder.com
www.massageschoolnotes.com
www.massagecareerguides.com

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