Insurance billing for massage therapists – an expert tells all!

vivian-mahoneyInsurance billing is one of those hot-button topics for many massage therapists. We wanted to tackle the subject, but we knew enough to know that we didn’t know much. That’s why we rang up Vivian Mahoney – massage therapist, business owner, consultant, author and teacher, with nearly 25 years experience in the field. She was kind enough to agree to an interview about insurance billing for massage therapists, and boy did she deliver! Read the Q&A below to get some stellar advice and guidance for diving into the world of insurance billing. Her success story and words of wisdom will inspire you!

Massamio: How did you get to be an expert in the field of massage therapy insurance billing? What’s your story?

Vivian: I was actually the first in the massage industry to ever accept and be successfully paid on insurance cases, auto, workers’ compensation, slip and fall (personal injury) and some health insurance.

The FSMTA (Florida State Massage Therapy Association) president and legislative chair asked if I would serve as insurance committee chair (1990) because they heard of my successes.

The success grew even more as I attended every health or insurance related convention, workers’ compensation educational conference, (in 25 years I had not missed a year, then missed last year, attending again this year), AMA CPT Coding symposiums and other such events to stay on top of every issue related to insurance as it may possibly pertain to massage therapists.

I eventually was blessed to have over 175 physicians of many specialties referring patients to my office, as well as even insurance adjusters, city and county officials. We treated on the average of 28-32 patients/clients a day, often 6  days a week, sometimes on Sundays or up to close to 500 a month, and after 1986 most were insurance cases. In my first year on an outcall basis I performed 1821 massages from Feb 21 to near the end of the year (full hour+ per session). During my first 3 months of being licensed I had 4 insurance clients at 2-3 times a week.

My first insurance case within a week of receiving my license and being paid on that was the thrill of my massage career! It was the beginning, setting me on the road to success and helping others to do the same over the years. That first case was from 9 to 11 at night for $45.00 but when I got my first check for that case from State Farm I was never so elated. I had ALWAYS wanted a business I could receive money in the mail!

My staff consisted of up to as many as 14 LMTS and 2-3 employees including my daughter Lori who did all of my insurance billing for over 14 years. We grew it to right at $500,000 a year (this was with fees as low as $35 to high of $65 for a full 60+ minute session).

I sold this practice in late 1998.

From then until now I continue to write, present seminars and consult with massage therapists and many others in the insurance and medically-related industry. I have been doing some consulting, claim reviews and other such work for attorneys, defense and plaintiffs, insurance investigators, National Insurance Crime Bureau (NICB), and some FBI and undercover agents have also asked me to present to groups and explain what and how massage therapists are and are not allowed to do when it comes to insurance billing. They are trying to get a handle on the ever increasing fraud and abuse of insurance as well as how massage therapists can stop being “used” by criminals /organized crime so prevalent in Florida and growing elsewhere.

Massamio: That’s quite a success story! As a teacher and author in the field, I’m sure you hear a lot of common worries from MT’s about insurance. What do you think is the biggest hurdle for most people getting started with insurance billing?

Vivian: The biggest hurdle as I see it is getting the most accurate information to massage therapists. I am actually weary of always having to “straighten them out” after they receive inaccurate info from their friends, colleagues and even those teaching the subject of insurance acceptance and billing. They accept cases that will not reimburse a massage therapist under any condition, then shout it to the world around them that “insurance sucks” and they will never try it again.

Over the years I had a pretty good handle on it, people came to me for the truth, facts and assistance through counseling, purchases of my materials and taking seminars. But in the most recent world of social media I hear it all–the negative, the problems–and feel helpless to get the correct info in the hands of massage therapists.

Now with the Affordable Care Act coming into play with the non-discrimination of provider clause 2706 of the law, I forsee even more nightmares in that they might think they have the right to bill and be paid, will be furious over the low rates they may get, not understanding even with low rates, building a business the right way could reap them profits beyond belief. I fear they will bill incorrectly, unethically, and unfairly until the insurance companies will find ways to write the services we provide right out of their plans.

This scares me and I don’t know how or what to do to shout from the mountain tops that if we are fair, ethical, accurate in our acceptance of and billing of insurance cases, we can help EVERYONE win!

Massamio: What are the different types of insurance that MT’s can bill?

Vivian: Right now the most prominent ones are automobile insurance, workers’ compensation for injured workers, slip and fall (personal injury cases) and now and then a health plan. This is nationwide (except in New York they cannot be paid for work comp cases. Florida is in the throws of a lawsuit).

The Affordable Care Act may open more doors after Jan 2014 but we won’t know until things move forward. I have been asked to help and was assigned the title of Massage Therapy Advocacy Coordinator by Alyssa Wostrel who is the Executive Director now of IHPC

Alyssa, Debora Senn, JD (Former Insurance Commissioner of Washington State) and Janet Kahn, the first Executive Director of IHPC appointed by President Obama, are all working on the implementation of the Affordable Care Act for the 2706 non discrimination section of the law. So this is a hopeful opportunity ahead for us.

Massamio: You mention the Affordable Care Act, or Obamacare, which we know is causing some questions for many in the health care industry. What are some other concerns in the massage industry about these changes coming with the Affordable Care Act? What can MT’s do to education themselves on those changes?

Vivian: As mentioned above, we are still trying to find the right way, the ability, the “in” to the AHC and how or what we will need to do. They are working on the exchanges or market place insurance requirements or basic coverages, etc., still too early to know for sure but one thing they can do is see that I have their email address on file to keep them up to the minute on all insurance related seminar schedules, information, and code changes. MT’s can continue to keep posted on latest by going to Integrative Healthcare Policy Consortium (IHPC) website.

Massamio: What are some of the positives and negatives for independent massage therapists who want to incorporate medical referrals and accept insurance for payment

Vivian:  The Negatives: Understanding that to build a business they must invest a little time, dollars and willingness to learn to do it the right way just as they did to become a massage therapist in the first place. The rewards are phenomenal if it is done right and from the start. To try to pick up the pieces mid-stream is discouraging, daunting and very demeaning. They should look at this as taking a trip. They need a road map to get them from point A to point B with as little curves, bumps, stop signs and detours as possible.

That is the main negative I see. The next is having to overcome the fact that there is paperwork, time delays with phone calls, not being paid or being paid a portion of the claim they submit. All of this can be overcome as I teach in my seminars by getting someone to help. Remain the LMT that you are and hire others to do many things for you including the insurance “dirty work”. They can do many things for the same price, such as some laundry, cleaning, phone work, promotion, mailing, etc. This can be accomplished in the beginning with some trading for massage services with the right person. As I tell them in class, the more they follow the guidelines I lay out for them the less delays, denials, reductions, cancellations, collections and problems they will have.

The Positives: They can be proud to own a business of their own, to build a future for themselves and family, have more quality time with family and friends when they do have time to get together. They can have luxuries and do things they may have not been able to do, travel, open new doors, all the things you can do with more money! If they do it RIGHT!

They can make more money because I teach them the difference in the cost of doing business and the importance of a different type of service which allows for a more productive fee for medically necessary, prescribed cases versus the time of service (TOS) fees that most massage therapist deal with. I teach them that Insurance Acceptance is a Game, like any game, you have to know the rules, play by the rules, know the players, be willing to accept a challenge, know when to run and when to play, know you will win some and lose some, but it is all in the game.

Once they realize this they can go at it leaving the emotions behind and keep moving foward to open their new and exciting doors as they build their businesses while others are wondering where the next dollar is coming from. There are hard times, this is part of the game, be prepared and save for those times when insurance companies are slow or an attorney asks you to take a small percentage of the claims you submitted. Medically prescribed cases come 2-3 times a week, but others come as they will, now and then, here and there. So steady clients equal steady income and the more you get, the better you get, the more your business begins to grow and grow. Hiring others to help is not a bad thing as many think.

Massamio: Do independent massage therapists need to have a special certification to submit claims to insurance?

Vivian: No, no special certification is necessary. Though some may have you to believe it. What insurance companies most require to reimburse a massage therapist (or anyone) is that the patients condition require medically necessary care and treatment and the only way we can prove that is with a treating physician’s diagnosis and accompanying written prescription.

Not even the “certified medical massage therapist” that some are thinking is necessary (due to a company that increases their attendance and income stating how important this is).

Now if they are planning to, or ever do, bill for any procedure or modality such as therapeutic exercise, therapeutic activity, ultrasound, electrical stimulation, etc., that is questionable or out of their scope of practice then the insurance company may, will, should ask for a certificate proof in that procedure or modality and it should not be an introductory class or such, but should be by an approved provider by that therapists state or by NCBTMB.

Massamio: I realize this is a huge area of knowledge and that a blog post can’t even begin to cover it all. If someone is thinking about getting started with insurance billing, what next steps would you recommend? And what would you recommend for those who are already billing and want to keep current with best practices?

Vivian: You are right, this is a huge subject and it is so difficult to squeeze so much into so little space and time. It is harder for me as I am so long winded my husband says I have to tell about every tree, leaf on the tree, dog and fire hydrant along the way, to say what I bought at the grocery store. Ha!

As for your question, (see what I mean?) what can I say, if massage therapists want to start out on the right foot, to avoid any and all pitfalls, if they want someone to hold their hand and counsel with them for free after their purchase or seminar attendance, then I am the one to turn to and my courses, manual, DVD’s, software I highly recommend and sell is the way to go. It is this or strive to learn it all one step at a time and hopefully not give up as so many do in discouragement. (I so wish I was another person behind the scenes because I HATE self promoting!)

For the second part of your question, what can those already billing do? They can contact me if they are having problems, situations they cannot solve and if they are having great success, pat themselves on the back and accept my congratulations and excitement as this makes me happy.

Massamio: Vivian, thank you so much for taking the time to answer our questions. It’s been a real pleasure! 

Vivian: This has been my pleasure more than you know. But now I need a right arm and shoulder massage big time! Ha!

Comments from original Massamio post:

Insurance billing should always be considered because we dont know what would life brings to us. It is better to get ready and find the appropriate insurance billing not only for a massage therapists and professionals but also for every individual that loves their self and their family. — Posted @ Saturday, August 10, 2013 12:18 PM by Pilates Classes Nedlands

I was honored to have been interviewed and share what I can regarding massage therapists billing for insurance cases. I have now had 29 years hands on experience in billing, coding, legal documentation, and on going consulting with massage therapists, DCs, investigative agencies and others on the practice of billing for massage services. I am here to help you too! — Posted @ Sunday, November 10, 2013 5:28 AM by Vivian M. Mahoney

Thank you for all the great information. Best Regards, Donna — Posted @ Friday, November 15, 2013 4:49 PM by Donna Greenman

Hi my name is Julie Torres. I Read this article and it made me even motivated to take this next step of billing insurance. I would like to know when Vivian Mahoney going to give her next seminar very intrested. — Posted @ Friday, June 06, 2014 8:32 AM by julie torres

Am interested in insurance billing for my LMT business as well. Any seminars coming up, i would like to know.  Thanks for all the info. — Posted @ Monday, June 23, 2014 6:06 PM by Joan Braswell

I also am very interested in seminar dates and related information. I am trying to start a Massage Therapy business that specializes in Medical related Therapy, and I’d love to learn from such a knowledgable person. — Posted @ Sunday, July 13, 2014 12:57 PM by Jeff Reynolds

Relocating practice from Washington state, where I was credentialed with each of the major health insurance providers. Wondering how to apply for similar status in Florida state. Seminar schedule would be appreciated. — Posted @ Monday, July 14, 2014 10:26 AM by Janet Bradshaw

Thank you so much, this article was helpful. — Posted @ Sunday, September 14, 2014 9:47 PM by Danielle Rupert

I see a few comments here and they are so appreciated. I also see some are interested in a seminar. I would LOVE to do some but must continue to heal from a horrific auto accident where a horse, loose from a tourist ranch, ran head on into our car. Car totaled, I am recovering from major eye damage and my husband unfortunately did not make it past 9 days in ER Trauma Unit at UT in Knoxville TN.  I am scheduled to do one for AMTA Maine Chapter on October 25th and 26th. I am hoping and praying and planning to get there and do my best. My husband was always my fill in, right hand man, managing all the paperwork, tech work and filling in when I needed to catch my breath or if I was missing some important information. Including his introduction of me. I may do one in Nov 17rh in Daytona FL. It is in my plans at this moment. Please stay tuned to my seminar schedule as it happens on my website click Seminar Schedule. Thanks so much for your patience and desire to learn to bill correctly. Viv — Posted @ Sunday, September 14, 2014 10:21 PM by Vivian Mahoney