In the last issue of JMS, we published an article by our former student Steve Smith, LMT, CMMP, where he shared his experience working with the Veterans Administration. Our readers greatly appreciated this article, which provoked productive discussions in different massage groups. One of the comments by Laura Newton caught our attention because she commented that she also works with the VA and commercial medical insurance. She does all the billing herself, and her clinic gets 100% reimbursement for the bills she submits.
So, we convinced Laura to share her expertise on this vital topic. She was very responsive and caring about her colleagues and agreed to contribute several articles on how her clinic is doing medical billing. Our joint vision is to share with therapists what they can do by billing themselves without hiring a professional. This article is the first introductory piece on this important subject.
Dr. Ross Turchaninov
JMS Editor-in-Chief
MEDICAL BILLING – SIMPLIFYING A COMPLEX ISSUE: Part I
Laura C. Newton, BS, ED, LMT, NMT
Statesboro, GA
My journey to becoming a medical massage therapist was not direct. I graduated from the University of Georgia with a B.S. Ed in Exercise Science in 1995 and a Master of Physical Therapy from the Medical College of Georgia in 1998.
In 2015, I learned that our local Ogeechee Technical College would be starting a Neuromuscular Massage Therapy Program, and I decided to join. After graduation, I was hired by a local chiropractor to see patients, with veterans being the primary focus. While working with the chiropractor, I grew my own massage business to a volume that required the addition of six massage therapists.
Recognizing the growth potential, I began to think about branching out, and in 2022, I started to navigate the world of medical billing on my own. I opened Integrated Massage and Bodywork and became certified with NCBTMB as a Continuing Education provider. In late 2022, I also became an approved Veterans Administration provider for massage therapy.
The general concept of most insurance programs today, including the VA, is to encourage preventative care to curb the risk of large claims that can reach hundreds of thousands of dollars if not more. Thus, massage therapists who want to work within the medical system face two challenges:
- delivering stable, effective clinical results.
- correct, efficient medical billing.
In this article, we will concentrate on medical billing.
One very fortunate aspect of billing for Massage Therapy is that there is only one procedural code that I need to know to file claims. That one CPT Code is 97124: Therapeutic Procedure, one or more areas, each 15 minutes. Massage includes effleurage, petrissage, and/or tapotement (stroking, compression, percussion).
On average, massage therapy clinics may get reimbursement up to $160 per hour. While we have observed questions posed regarding other codes being used, those codes are specific or implied to be reserved for other disciplines beyond the scope of allowable treatment for Medical Massage.
Each patient entering our clinic already has a unique diagnosis code assigned by the referring physician, so we must note it clearly in submitted claims. The initial diagnosis code and our code tell the VA or insurance company what the patient is being treated for and what treatment is being provided.
A second advantage is that the billing process for Massage Therapy is simplified because there is no possibility of having to file a complex claim with multiple codes for a single visit. This makes the filing process for my practice very manageable, especially with the VA, which has a dedicated, simplified billing portal specifically for that reason.
The three most common sources of medical coverage that a therapist may use for efficient billing are:
1. Veterans Administration (VA)
My practice is currently weighted more toward VA patients. The primary procedural difference between VA billing and medical insurance billing is the method of transmitting the claim information and receiving payment. The VA works with third parties that adjudicate claims processes for different sections of the country. For Georgia, it is Optum that has been contracted. We have electronic access to both claims filing and payment portals and a single point of contact for claims administration with Optum. It is a very convenient system that, once learned, is easy to operate.
2. Commercial Medical Insurance
Commercial insurance companies are slowly catching up with the VA and coming on board with covering Medical Massage, especially for pain management, versus the more costly pharmaceutical options. Medical insurance patients are often covered under their employer’s health insurance program or the Health Insurance Marketplace.
In my home state of Georgia, this usually requires the patient to pay either an office visit co-pay for each treatment or the amount billed will go towards meeting the patient’s deductible. Patients with the VA are covered for 100% of the allowable amount of the visit.
Medical insurance billing will be set up with the same attributes, in most cases directly with each insurance company the therapist associates with. While the number of carriers offering medical insurance in Georgia has fluctuated from year to year following the enactment of the Affordable Care Act of 2010, Anthem (BlueCross/BlueShield) and Humana are prominent carriers in our state currently covering Medical Massage. The therapy services need to be at the direction of a physician who has determined them to be a medical necessity as part of the course of treatment to be covered.
3. Independent Medical Coverage by Employer
Many employers in Georgia are large enough to utilize self-funded health and wellness plans to provide medical coverage instead of purchasing coverage from an insurance carrier. These self-funded programs appear to be opening up to coverage for massage therapy as a cost-effective treatment option for the most frequent diagnosis codes we receive, which are pain management, traumatic brain injury, and PTSD.
Medical Massage is also a covered treatment for HSA, HRA and FSA plans with a letter of medical necessity from a physician.
HSA is an account that the patient owns. Both patients and employers deposit money into it for future healthcare expenses. These funds pay for doctor visits, medical supplies, and other out-of-pocket expenses, like vision and dental care, even before medical insurance kicks in.
The employer owns an HRA account and deposits a predetermined amount each year for qualified healthcare expenses, such as co-pays, primary doctor or specialist fees, and medical supplies.
FSA is an account that the patient opens and owns. The family deposits a sum that must be used within the same year for medical expenses only. The patient saves about 30 cents on each dollar for all eligible healthcare bills.
The primary objections to adding medical billing to your practice that I have heard from other therapists concern the turnaround time and reimbursement amounts, on top of having to learn new skills just to be able to participate. I was surprised to find that most insurance plans that cover Medical Massage allow as much or more than my hourly rate for cash pay and have a typical turnaround time of two weeks to receive payment. While the VA’s allowable rate per visit is slightly lower than my hourly rate, the frequency and consistency of VA patients using their benefits more than outweigh the few dollars I lose. The VA also has the quickest turnaround time for payment, averaging around 4 to 5 business days.
My final observation on how medical billing has affected my practice and why I would strongly encourage you to consider adding it to yours comes down to a simple economic side effect. Patients who have benefits that cover all or most of their treatment’s cost will schedule more often and more consistently.
In addition, both VA and insurance patients serve as a hedge against times of the year when my cash-pay business might slow down significantly. My results have been overwhelmingly positive since I began this journey to incorporate medical billing as a service. Over the last year, my practice has more than doubled, and I am now consistently booked two weeks in advance with as many appointments as I can manage. The growth I am experiencing has resulted in opening a second location and adding additional therapists to my team. This was my goal, and I got there much sooner than I had expected!
In Part II of this article, we will discuss simple steps to navigate the process of credentialing and getting established in the clearinghouse protocols that all insurance companies and the VA use to vet providers for being part of the system.
Please visit our main educational website, where you can find comprehensive information about Medical Massage and its clinical application. From textbooks and Video Library to live hands-on training during Medical Massage Seminars SOMI offers ultimate professional information: Medical Massage Courses & Certification | Science of Massage Institute
About The Author
My name is Laura Newton, and I live in Statesboro, GA, with my husband and two teenage children. I graduated from the University of Georgia in 1995 with a B.S.Ed. Degree with a major in Exercise Science. I graduated with my Master’s in Physical Therapy in 1998 from the Medical College of Georgia.
I started my business, Integrated Massage and Bodywork, in 2022 and became certified with NCBTMB as a continuing education provider. Late 2022 I also became an approved Veterans Administration provider for massage therapy.
My business focuses on medical massage and therapeutic outcomes. I offer Medical Massage Therapy, Neural Reset Therapy, Quantum Alignment Technique, Pre-Natal Massage, Baby Bodywork, and Manual Lymphatic Drainage.
Laura’s contact information: 912-687-9101, Email: integratedmassageservices@gmail.com
Category: Medical Massage
Tags: 2024 Issue #1