All LMTs who attended an Oregon massage school should be aware of PIP (Personal Injury Protection) payments. Last month we covered the basics of insurance billing for massage therapists. In this post we discuss one particular form of insurance billing, mandated by Oregon law for those who have been in a car accident.
Introduction to PIP Billing for Massage Therapists
Oregon legislation requires automobile insurance companies to cover treatment following an accident. Personal Injury Protection covers wage loss and medical treatments for all occupants of involved automobiles. It also covers cyclists and pedestrians. (If the cyclist or pedestrian does not have auto insurance, the drivers’ insurance covers PIP payments.) Medical expenses up to $15,000 for one year following the accident are generally covered, and in certain cases patients may receive higher payments.
In general, there are two types of PIP insurance billing: First party, which is covered by the patient’s insurance company, and third party, which is covered by the other driver’s insurance policy.
Challenges of PIP Billing
1. Payments may be delayed 4-8 weeks, so therapists must have income flexibility and patience.
2. Communication with insurance companies is necessary, especially if your patients’ claims are denied. If you choose to accept PIP patients, be prepared to invest time on the phone.
Adding PIP Billing: Resources and Tips
• Form relationships with local medical providers. Insurance companies generally prefer to see treatment recommendations from doctors. Following an accident, patients should make an appointment with their primary care physician for injury assessment to determine if massage therapy is indicated. You will face fewer billing headaches if you receive referrals from family doctors and follow the doctors’ prescriptions for care.
- Seek to treat specific diagnoses. Again, to avoid billing hassles, it’s best for the referring doctor to state a specific diagnosis, such as cervical strain/sprain. Ideally, the doctor should also specify the number of massage therapy treatments required, as well as the CPT (Current Procedural Technology) code for insurance billing. Two commonly used codes for PIP treatment are 97124 for massage therapy and 97140 for manual therapy. The more you work with insurance companies, the better you’ll understand the coding requirements for receiving payments.• Invest in massage therapy billing resources. You didn’t learn Kinesiology in a single day, and neither will insurance billing be immediately intuitive. To deepen your knowledge on this complex issue, we recommend Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists as an excellent written resource. Our school also offers continuing education courses on massage therapy billing and coding.
- Require patients to fill out an extensive intake form. This will protect you in the case of legal issues later. Hands Heal features a excellent intake form that you can modify for your needs.
Strong massage therapy careers often feature multiple income streams. While some therapists may consider it irritating to have to wait for insurance billing payments, others may see those payments as nest eggs that will soon hatch. If the therapist gets sick or needs a vacation, insurance billing payments will continue to arrive. By accepting PIP payments, LMTs can achieve increased financial stability. Moreover, because fewer individuals with a massage therapy license accept insurance payments, you’ll face less competition. Indeed, insurance billing specialist and medical massage therapist David Luther has said that only 3% of massage therapists are billing insurance companies. If you place yourself in that 3%, and invest time in creating consistent billing procedures, you can enjoy consistent work to sustain a lifelong massage therapy career.