Procedural Codes

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Permalink Reply by Bill Curry on September 20, 2009 at 9:33pm

Have the client contact the insurance company directly. Do not get involved. Just get the client to get a prescription for X number of appointments per week, and depending what is wrong, you can get a couple of months from insurance companies. I myself would avoid the insurance company. Give the client a receipt, and let the client get reimbursed. I speak from experience. I am on vacation at the moment, but I do have the codes at home. I will be back next week, but I do not recommend putting it through. Good luck!
Bill

Permalink Reply by Kari Stewart on September 21, 2009 at 8:16am

I agree with Bill. I learned this the hard way and never recieved payment for work I performed in conjuction with a chiropractor. Let the client handle it with their insurance provider. Get your money at time of service and give them a receipt. Good luck:)

Permalink Reply by Bill Curry on October 14, 2009 at 9:56pm

Hi Candice - I am sorry I forgot about this request. I have been back from vacation a couple of weeks now, and I am going to Key Largo, FL next week for another vacation. Now ans far as the codes. If you are going to use codes, 97124 is for massage. Massage is billed in units. Each unit is 15 minutes each. So if a client has a 1 hour massage you bill for 4 units. You can not bill for more than 4 units in one day. Their computer will kick it out. Code number 97140 is for Manual Therapy Techniques. Using this one is tricky though, as you need to prove that you are a expert and have been certified to use those techniques. I would stick with the first code and forget the second. You want to get a prescription first for said services, and be sure it is as vague as possible. The insurance company may require you to show proof of your certification in that area. Not just the massage itself but the particular manipulations that you use to treat that area. As for the treat word, erase it from your vocabulary. We are not allowed to treat under the current law. When the new law goes in to effect, then we will be allowed. Prescription should read something like, "Palpatory, kneading, and massage techniques needed at lower back", or something like that. After getting the prescription, if it looks OK, then call the insurance company and ask them if this client has met any deductible that may be applicable. Ask them if they have any problem accepting your services, the clients prescription, and then ask how many visits the client is allowed before re-evaluation. Also, ask them if they discount the amount they will pay you or do they pay the whole amount billed. Sometimes they may try to say after you submit the bill that they only pay a certain percentage. Usually every 12th visit you will need to check with the insurance company (ask them up front), to find out if the original prescription is still valid, or do they want the client to go to the doctor to be evaluated, and another prescription written. Write the phone number you called and the persons name that you spoke to, the time you called, and what you talked about. These companies record the conversations, and can go back and listen to the conversation that took place if it ever came in to dispute. CYA, Cover Your Assets.
The form you will use you can download off the internet. It is insurance form # "CMS-1500", and is called "Health Insurance Claim Form". You can probably google it. To continue, you need to use soap notes. This is the medical establishment you are dealing with. Do not write anything that could indicate that you are diagnosing a problem. In other words don't say, "Client has swelling and inflammation at ..". Instead reword it to read, "Client appears to have swelling and inflammation. You want to keep it vague but not make it look like you do not know what you are doing.
There is still more! If you are submitting the insurance form under the chiropractors name or someone else you will need to use their provider number. At that point your reimbursement is subject to their involvement with the insurance company. Some are what they call network providers, and accept what ever the insurance company is willing to pay. If you are submitting it yourself, then you need a provider number. You can call "NPI Enumerator" (800) 465-3203 and request one, and they will issue you one. I believe it is free of charge.
Their Web site is:
https://NPPES.cms.hhs.gov/nppes/welcome.do
Still interested in dealing with insurance companies, well, good luck.

Going back to my original statement. If you give the client a receipt; they can turn it in for the reimbursement. If you are not "State Certified", be sure and not use the abbreviation "CMT" or write Certified Massage Therapist" anywhere on the receipt. If you do, and you are not state certified, there is a $5000 fine for first offense. This is non negotiable if it goes to court, and I know of two cases that did over the years, you would loose and the $5000 is the lowest amount you can be fined. This is all do to the Physical Therapy act of 1977, which states in essence, "If you call yourself a Therapist of any kind in the state on New Jersey, you must be licensed by the state as a therapist". The insurance company will probably not say anything. They would probably just turn it over to the "NJ Insurance Fraud Division".

One last thing....Never write on the client intake form, unless the client initials the change or comment. It is against the law to alter it. Make your notes on a page that you attach to the intake form. This could be used against you if the insurance company wanted to push it.

Sorry, I can be a little long winded at times.
I hope others read this, because this is very important. I work in an oncology unit, and I do not even use the insurance option.