Most car insurance plans will have Personal Injury Protection (PIP) coverage on their plans. A person can opt out of having to have this type of insurance if they prove that they have health insurance coverage and have a signed statement with the car insurance company that they do have the coverage.
- Get your National Provider Identification (NPI) Number, no matter what type of insurance you plan to bill.
If you are billing insurance companies, you need an NPI number. It is free through the National Plan and Provider Enumeration System (NPPES). HIPAA mandated the adoption of unique identifiers for health care providers and health plans to help improve the efficiency and effectiveness of electronic transmission of health information.The NPI number must be used in electronic HIPAA transactions such as claims submission, eligibility and claim status requests, and referrals/prescriptions. You may also need to know the prescribing physician’s NPI number to submit your claims. You can look up any provider’s NPI number and get your own number from Health and Human Services. https://nppes.cms.hhs.gov/NPPES/Welcome.doTo obtain the number, go to the website and fill out the form. Use taxonomy number category 22 – restorative therapy/massage therapy. Massage Therapist 225700000X.
- Confirm the client has a prescription for massage and has opened a claim with the insurance company. The client will be assigned a case manager.
- Get the claim information and call the claim manager to verify benefits. Tell the manager you have a prescription and tell them the diagnosis code and number of sessions prescribed. Ask if it’s covered.
- Ask how much money remains in the PIP fund. Most policies have a dollar-amount limit. If benefits have been maxed out, the case will become a third-party claim, meaning you will get paid when it is settled.
- Ask if you need to send any paperwork in addition to the bill. Often the prescription and chart notes are required.
- Ask where to send the bills and if they should be sent to anyone’s attention.
- Find out when the accident occurred and how severe the injury is. This information often helps you determine if you want to take the case. Severely injured clients often use up all their PIP benefits. You then may have to wait until the time of settlement to get paid.
- If the case is a third-party claim, set up a contract with the client and, if applicable, their attorney. Create a lien with the county court house.
- Perform prescribed massage therapy.
- Chart all sessions and show the areas you worked on, the results, the plan of care, and progress of care (SOAP notes).
- Fill out a CMS-1500 form and send the bill and any other required paperwork.
- Call to make sure the insurance company received the bill and ask if there are any questions or problems.
- Continue care. Track prescription due dates and progress of client. Renew prescriptions when needed.
- Work with physicians to bring client back to pre-injury status.
- If you haven’t received payment approximately one month after sending the first bill, call to find out what is holding up payment.
- If an attorney is involved, find out what information they want and when they want it. Often, they only want the copies of the bills and SOAP charts when the client has finished treatment and is ready to settle the case.
- Use the attorney’s office to help you get paid, if necessary.
- Get the client involved too, if you are not getting paid promptly.
- You may be asked to take a reduced payment with end-of-settlement cases. You can and should say NO and make arrangements to be paid. That’s the purpose of the contract and lien: to ensure payment no matter what happens in the case. (If you are a provider with any affinity plans, you may be required to take a discount for your services if the plans are also contracting with vehicle insurance companies. You can opt out by contacting the affinity plan and requesting removal from that part of the network. Otherwise, you will be required to take the discount.)
Purchase the Massage Insurance Billing Manual (2019) Edition from my other site — www.massagepracticebuilder.com (It is not exclusive to WA State details but provides the basic overview that is used in WA.)