Payment for services from third parties

nurseyperson · Dec 30, 2003

OK, here is a copy of a post I put on another thread on this board

I am an RN and Nationally Registered MT and work thru a clinic/Dr. office/hospital/nursing home combination, but only as a massage therapist. Altho in their system I am also an RN, but don't work as a nurse. So I am a nurse practicing massage in a medical facility, but as a massage therapist. Get it? The doctors order it just like physical therapy, and I decide how to bill it, as massage, neuromuscular therapy, soft tissue mobilization, myofascial release, depending on what I think they need. The doctor just orders "Therapeutic Medical Massage". They provide me with a room and submit the insurance and take out 20%.

Getting started.....

I had worked on the main doctor and his wife in the clinic, and so I just asked him if he thought it would work. He went to the board (Had also worked on a dentist who is on the hospital board) and we started it on a trial basis. It has worked well for everyone. I highly recommend it. There can be feast or famine, as I am working on my own, just as I am in my own office, doing the same thing for private pay. Sometimes I catch myself coming and going between my 2 offices!!!

Yes, I think it is work the time and money. I am my own boss, can take off to go to my daughters school stuff, schedule patient appointments when I want (I do a few evenings and weekends because not everyone can come in 9 to 5) I pay for my car, gas, etc thru my business and write it off.

And I never felt better than when I was going to massage school and getting worked on all the time. I also was in an MVA with whiplash, and nothing works better than Neuromuscular therapy, trigger point therapy, myofascial work, etc. It worked better than pain meds, muscle relaxants, physical therpy , chiropractic, TENS unit......I had it all!!!

Check with your insurance carrier to make sure they pay for therapy. Car insurance is good about it. They may say they won't pay for a massage therapist, but that means in MY office. Insurance won't give a massage therapist a provider number. But they will pay in the doctors office, and the treatment has to be given there and you must be paid thru the provider (doctor, clinic)

Just like a physical therapy aid can give treatments. The billing will go thru much easier and pay more if they bill it NMT, STM/MFR.

Some people will say that is physical therapy codes, but you don't have to be a physical therapist to use them.

OK, questions? Sorry I ramble, but this isn't a simple thing to start, do or follow!! So good luck!!!!

Crouton · Jan 26, 2004

I am interested in finding out more about nurse massage therapy. I have been a nurse for 9 years and am ready for a change but I still want to use my nursing knowledge and take care of people. Nurseyperson, you say you work as a massage therapist but not an RN. So how did you choose a massage therapy school? I saw there was some for medical massage therapy, but I do not know if any in my area do that. Did you go to a massage therapy school that anyone could enroll in or did you have to have your RN? And what do you look for in a good massage therapy school?

When you were done with massage therapy school was it easier finding a job since you had your RN degree? And is the pay comparable to when you were working as an RN? And how do you think I could go about seeing if anyone in this area was interested in hiring a nurse massage therapist before going to school for it?

Sorry to be asking so many questions, but if I did this it would have to be at night and part time as I work during the day. I just want to be able to justify spending the money to go back to school and ensure there is a need for this in my area.

I appreciate any information you have.

Crouton

nurseyperson · Feb 8, 2004

Crouton, Sorry it has taken me a while to reply. I have been extremely busy at work, home, ill family, etc.

OK, I got lucky and found a medical massage school that only did that, not swedish, spa stuff. They also had classes that we would do a lot at home, and attend Intensives (12 hour classes for 5 days in a row, Thurs thru Mon) and get our time in.

I was the only nurse. Whe looking for a good school, make sure they are recognized by the AMTA, American Massage Therapy Assn, a COMTA school, Commission on Massage Therapy Accreditation, or by the NCBTMB, National Certification Board of Therapeutic Massage and Bodywok, &/or approved by the state board of education of your state (if they are over massage schools) or the State board of Regents. Legit schools may have any of these, but I would look for NCBTMB or COMTA.

As for a good school, really look to see if they have what you are interested in. Research massage, Neuromuscular therapy, spa massage, Swedish, Shiatsu, etc. Know what you are getting into and what you want first.

AS far as finding a job, I just started my own business. Depends on your area and what is needed. I am the only one in my half of Kansas that does Neuromuscular therapy, let alone combine that with being a nurse. I get people from all over this half of the state. And the pay is better than nursing, but it all depends on how much business you have. If you only work on one person a day, then of course you will make much less.

Depends on how big of a town you are in, how progressive the doctors are, etc. on if you can work for them. Chiropractors often hire massage therapists. You can start your own business.

It is a little expensive and you have to look hard to find a school that meets your criteria, if you can.

Look at the old posts here on this bulletin board, under this heading, nurse massage therapy, to answer questions. Good luck! Nurseyperson

MMT · May 24, 2004

to 5150dx: Sorry to hear about your car accident back in December. You've probably already gotten a bill for the services at your follow up. You should check it pretty carefully, since massage therapists are not allowed to charge out for physical therapy services. The P.T. diagnosis and treatment codes are based on the expertise of educated, licensed physical therapists, and their abilities to provide a certain level of care. To my knowledge, massage therapy programs don't educate their students to a Master's level education the way P.T. programs do.

nurseyperson · Jun 7, 2004

FYI, to all, and 5150dx.

The codesyou refer to are most often used by Physical Therapists, but they are not all restricted to use by PTs.

First of all, the codes I use for evaluation are Nursing eval codes. I can do this because I am an RN, along with a massage therapist. I do NOT use the codes specifically identified for use by PT And OT. In the Special instructions section of the guidelines for coding, it does say "To be used only by Registered Physical Therapists".

The decision on what needs to be done to the patient is based either on the doctor or the physical therapist. If the MD writes a specific procedure, then that is what the PT must do. If the MD writes "Evaluate and Treat" or something in that way, the PT may do whatever they decide from their evaluation. But it is not only the PT who does those things. There are also Physical therapy aids, assistants, etc. who often actually carry out the procedures. MDs, Chiropractors, and Nurses may also do these things. So saying that a Massage therapist cannot do the procedures is not right. But it certainly does depend on the MT and the certification, education and experience she has. An MT also must be employed by the Provider (which is the doctor, clinic, or hospital) cannot be contracted, must do the treatment at the provider site, and many other stipulations, which I follow.

My MD writes "Therapeutic Medical Massage", and that is what I do.

But what is included in a Therapeutic Medical Massage? Certainly not just a simple massage. There is Soft Tissue Mobilization, Myofascial Release which is coded. Under the description of the procedure, it states "The Clinician" performs the procedure. It does not specifiy Physical Therapist, as it does in other descriptions or special instructions.

ALSO, if you would like information from the American Medical Massage Therapy Association, http://www.AMMTA.org on their multitude of classes whichare available to become a Certified Master Medical Massage Therapist. These include eval and treatment of the entire spine, pelvis, extremties, and so much more.

There are also specific classes for Neuromuscual Re-education Therapeutic exericse, Manual Therapy Techniques, (All of which are coded)

and extensive classes on Insurance Reimbursement.

I have also not had ONE claim denied in two years. I often talk with the PT about my patients and ask advice. The info I have written about PTs came from them. We work well together.

Our education is different, and of course there are things a Massage therapist should not be doing, but there are those of us that are doing things right, have a good education and see significant results in our patients. After all, that is what everyone in health care should strive for.

nightingale, RN · Sep 2, 2004

Here in CO, Massage Therapy is not licensed. As a Nurse, Nurseyperson, do you think I would be able to bill through a Dr. without the certification?

I have been providing chair massage at a local senior center free of charge.

nurseyperson · Oct 9, 2004

Here in CO, Massage Therapy is not licensed. As a Nurse, Nurseyperson, do you think I would be able to bill through a Dr. without the certification?
I have been providing chair massage at a local senior center free of charge.

Niightngales 1998, Sorry it has taken a while to answer. What kind of education do you have? You must be hired by the provider (doctor, Chiropractor/hospital, etc) You are working under their license (provider number, in insurance eyes) and they ultimately have the responsibility in this situation to determine your ability, accountability, and if they want you to take care of their patients.

Of course, you are responsible for yourself, also!!! You must have Liability Insurance, malpractice insurance. And you must have graduated from an approved school to get that.

Massage Therapy isn't regulated by the state of Kansas yet, either. But I have National Certification from the National Certification Board of Therapeutic Massage and Bodywork. NCBTMB. There are many stipulations to billing for massage therapy. I got my info from Blue Cross and Blue Shield Insurance of Kansas, because they are the main Insurance company here and they also run Medicare and Medicaid in Kansas. You have to check for your state. A few of the stipulations were I had to work for a provider, be paid by the provider ( NOT contact labor), do the treatments at the hospital/clinic, not in my own office. The treatments had to be specifically ordered by the doctor. ETC.................

And of course, just because it is ordered doesn't mean insurance will pay for it. That is in the contract between the insurance company and the patient. The diagnosis and treatment have to match in their eyes. For example, they might not pay for a soft tissue mobilization for a diagnosis of Asthma. And it depends on the patient's contract. Maybe it states they won't pay for any type of out patient treatment!!! THEY need to know what their insurance contact says.

OK, let me know if you have any questions.

yves · Nov 10, 2004

To Nurseyperson

Do you think I could give you my phone number or vice versa. I have a lot of questions and want to get started right.

Yvonne

my email address is [email protected]