by Laura C. Newton, BS, ED, LMT, NMT
In the previous article, Simplifying a Complex Issue: Part I (Medical Massage Courses & Certification | Science of Massage Institute » MEDICAL BILLING – SIMPLIFYING A COMPLEX ISSUE – PART I), I discussed the larger picture of adding medical billing to your practice and the boost in your practice’s productivity that it can create. In this second part of the discussion, I will go through the preliminary steps of applying for the necessary credentials to participate in the medical billing process.
The first step you must complete is to apply for your National Provider Information Number (NPI) assignment. The NPI serves as your provider identifier and is assigned to you by the Centers for Medicare & Medicaid Services (CMS). The NPI number will be used by governmental medical programs and private and commercial insurance carriers to identify you and your credentials for becoming an appointed provider. Your NPI number must also be used on electronic claim transactions for health care billing and reimbursement for all governmental and community support programs, like the Veterans Administration.
Applying for an NPI is a free process and can typically be completed in less than an hour. You can apply online or by mail, however the Department of Health Care Services (DHCS) encourages you to use the NPI online application process as it is faster and will allow you to track the application process through completion. According to CMS, online applications are processed approximately 20 days faster than paper applications and may be completed as quickly as ten days if all the initial application information is correct. A link to begin the process is provided below.
How_to_apply_for_an_NPI_online.pdf (hhs.gov)
The second step in the vetting process is to complete an application for your Council for Affordable Quality Healthcare (CAQH) number. CAQH is a non-profit alliance of health plans and related associations working together to streamline the healthcare business. For your purposes, acquiring a CAQH number will add you to the provider directory organizations use for medical benefits and insurance claims. The provider directory serves as a clearing house and single point of access to the necessary credentialing information required for the provider appointment process. A link to begin the process is provided below, along with the link to the CAQH application document.
CAQH ProView – Getting Started
Completing the CAQH application is a straightforward process if you have your NPI number, practice location address, current liability insurance, and a current state massage therapy license. You will also need to have an EIN number if your business is an LLC. The website takes you through each section step-by-step and is very user-friendly. If you have issues with a section, there is a customer service number so you can talk to a customer service representative.
The profile setup is the first section to complete. Putting this in the National Uniform Claim Committee (NUCC) grouping would be best. When completing the NUCC grouping part of the application, select the tab for respiratory, developmental, rehabilitative, and restorative service providers. The rest of the application is straightforward. Once done, you will be asked to upload documents like liability insurance, massage therapy license, etc.
When the CAQH application is completed, you will be assigned a CAQH number. Every 120 days, you will receive an email reminding you to review the CAQH information and attest that everything is still correct.
The CAQH number will be required when completing applications to become insurance company providers. Before completing an application process with any insurance provider, you must have all the requirements to be credentialed. For example, I will use the Veterans Administration to show how the process works.
The VA Community Care Network (CCN) is the VA’s direct link with community providers to ensure veterans receive timely, high-quality care. The USA is divided into five regions that provide care to veterans. Regions 1-3 are served by Optum; regions 4-5 are served by TriWest. Use the process for the region in which you are practicing massage therapy. You must have a practice location to complete the application and your NPI number, CAQH number, and federal tax ID number (either EIN or social security number). Currently, Optum’s application process lists telephone numbers to contact to initiate the process, and TriWest has a link to an application page.
Once the application process is complete, your information will be sent to the VA agencies in the area, and you will be listed as a massage therapy provider. You must reach out to each VA facility and ensure that the employees who make the massage therapy referrals have your information. It can be helpful to get a QR code linked to your website to take it to the doctors who send in the referrals.
It is important to start marketing information about your therapy to veterans in your area. It has been my experience that many veterans do not know that massage therapy is an option for pain management. I listed the website below, which shows which states are in which regions, along with the contact telephone number and links to the TriWest application page.
Community Care Network–Information for Providers – Community Care (va.gov)
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 the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) as a continuing education provider. In 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, integratedmassageservices@gmail.com
Category: Medical Massage
Tags: 2024 Issue #2