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Insurance TipsTips for More Effective Billing to Insurance Companies
This section contains excerpts from the authors of The Medical Massage Office Manual 4th edition. Authors, David Luther and Margie Callahan, were kind enough to allow us to post this information on this web site. Should you wish to purchase the entire book, please visit their web site: www.tmmo.biz.
Chapter 14, which you can Download in WORD format covers the following subjects:
- How Usual and Customary charges are derived from Relative Value Units, geographic area adjustments, and dollar conversion factors.
- How The Rules in Chapter 2 apply to Usual and Customary charges.
- The repercussions of not practicing true to the definitions of the CPT™ codes.
- The importance of documenting curative care.
- The repercussions of charging for units beyond the expected time MMI should be reached within the treatment.
- The repercussions of charging for units beyond the allowed amount for the diagnosed body areas.
- The repercussions of charging too low or too high for units.
- Three reasons the massage industry has previously lacked accountability.
- Why charges for patients are higher than for clients.
- Price discrimination.
- Using National Fee Averages for finding Usual and Customary charges.
- The importance of a posted price list and a signed copy on file for each patient.
What Usual and Customary Charges Represent
Within the system that bona fide medical massage therapists want to practice, there is a structure for the pricing of procedures and services. The system is known as Usual and Customary (UC) charges. There is no debate about UC charges. It is a system set up by the AMA in conjunction with economic and medical realities, and insurers have every reason to expect providers who bill them to follow this agreed-upon system.