Massage Practice Builder

Billing Insurance for massage services has been one of the ways I have been able to stay in the massage profession for 23 years. Right from the start of my career after a 250 training class in massage (which at the time in 1987 was the basic education requirement for me to get my massage license), I was able to work with people with injuries from car accidents and injuries at work.  It took a bit to figure out on my own at that time because there wasn’t any internet and there was only one book on billing (Chris Rosches – Insurance Reimbursement for Bodywork Professionals) but it was enough to get started.  Along with the help from my friends who were also learning to bill, we were able to put it all together and get auto insurance and Labor and Industries (workers comp.) to pay for massage.

There are many things you need to know in order to work with insurance companies.  In some ways with technology, it is getting easier to get bill and get paid but with insurance companies bottom line of making a profit, they are reducing massage benefits and allowable fees making it challenging to get paid.

Some of the things you will need to know are:

• How to find out if massage will be covered and what you need to do to get paid
• How to do a thorough intake with clients
• How to fill out the billing form
• What CPT codes you can use
• What to charge for your services
• What the prescription will need to say
• How to do SOAP charts that show improvement for clients and track their progress
• How to do progress reports
• How to track bills and payments
• What to do if you don’t get paid
• How to get referrals from doctors or other health care professionals

To make it all even more confusing, each insurance plan will be different.  You can have two people on the same plan and one may pay and one won’t.  Each state is different.  Each plan is different.  Each client is different.  What you will need to know is what questions you will need to ask to each involved party – the client/patient, the insurance company, the lawyers and the doctors – in order to get paid.

At first, billing insurance will be a challenging process to learn.  You will be learning as you go but eventually you can learn what cases to take and which ones to stay away from.  You will be able to decide what cases you want to take which will make getting paid a little easier although not totally foolproof.  Even with all that, you may still have challenges in billing insurance.

That is why I have created a section for it on my website and have written an Ebook/book on the topic – Insurance Billing 101 for Massage Therapists -  to get you started in understanding the process of billing.  With the many challenges with insurance companies, I think that the more people involved, the more we will be able to really show what massage can do.  Part of what insurance companies don’t understand is that massage can actually save them money in the long run.  When it was first proposed that the insurance companies in WA State would be required to let massage therapists be contracted providers and bill health insurance, the insurance companies thought that they would be having to pay $10,oo0 for the carpal tunnel surgery and then another $1,000-$2000 to the massage therapist.  They didn’t (and still don’t totally) understand that it would save them the 10k!

The more people who stand up and start billing insurance, writing accurate and informative chart notes, the more insurance companies and doctors will start understanding what we are really doing as massage therapists.

Massage Continuing Education is a vital part of the success of massage therapists and the massage profession.  Most states require some form of CE and some professional associations do to.  The process of deciding on what CE classes to take varies of course in many ways.  Some Massage therapists plan their classes for the year and take a serious look at what classes can enhance their massage business.  Others will just take classes to fill the requirements based on when they are offered.  Many just want to get the requirements and don’t look at it as a way to enhance or develop their massage business.

With so many classes and programs that are available it is hard to decipher what to take and what not to take.  With so many different types of massage it is often hard to know what will help you the most.  Some of the best ways to choose a type of massage to study is to get worked on by the teacher who is offering the class and also by others who have taken the class or training.

I personally have also been frustrated with CE to say the least.  In the mid-90′s I took about 500 hours of training with a group that at the time I thought would help my massage business.   I ended up more burned out and sick even because of all of the politics going on within the organization.  I am sure many ce providers will have their own issues too but I hope to be able to help massage therapists in choosing a CE class by offering my latest website – www.massageceguide.com where teachers will be able to provide much more than just a simple listing.  Teachers will be able to add pictures and videos of their work and write articles about their work engaging potential clients (readers) in the process.   Using Faceook, teachers will be able to connect with potential students and students to provide further support in the process of learning.  I will be teaching the teachers how to use Facebook and their website to share more about their work and build relationships with students so that they can better determine what courses of study to follow.

Readers will also be able to add their comments about the classes and review the classes too.  I also hope that you will provide your insights as to why you take CE classes and comment on the various articles the teachers and I will be writing.

Please join me in changing the face of Massage Continuing Education at www.massageceguide.com

After reading an article a few weeks ago in another magazine ( I am not sure if I should say the name or not!) titled “Massage Franchises – The Impact on the Profession” I have to say I was quite saddened initially.  The two most alarming things I read were about the new relationship that Massage Envy is creating with Corinthian Colleges saying that they will be teaching Massage Envy requirements in their schools and the other statement saying that this should be a positive wake up call for private practitioners!  A part of me wanted to get out of the massage profession right away if that is what it is coming down to!  What happened to massage being a calling and a lifestyle that I joined the career for back in 1987???  After much online discussion in various forums, massageprofessionals.com, Facebook and writing on my own blog I have to say I am more inspired then ever to continue teaching massage therapist that there is a different way!

You can just say no to low paying franchise jobs!  You can also use them to get where you want to go in starting and running your own business.  Running your own business is also different than being an independent contractor where you are half employee and half self employed (Paying your own taxes but working doing massage for someone!)

As a self employed massage business owner you do have the opportunity to make much more.  You can start a business without much investment but no it isn’t always easy and it does take a commitment to learning to step out and promote yourself!  It can be an extraordinary growth process!  Many massage therapists use the reason that they don’t want the hassles of running a business but even if you work for someone you have to do many of the same things as a self employed massage therapist would – get and keep clients.  You can hire a bookkeeper and a billing person if you hate that part of it!  You can hire a receptionist to take calls or use some of the tools that are available to streamline your business so you can focus on what you do best – doing massage!

Everyone seems to go back to the same reasoning that what other career can you make $25 (with tips) from a franchise on 500 -1000 hours of training?  If you compare it to an independent contractor where they often end up giving away half of what they gross (which is a whole other topic – most should really be employees!).

As a business owner you get to keep more!  As a self employed massage therapist I make $85 an hour average a week.  I am not sure why anyone would not want that.   Yes I have overhead but it doesn’t compare at all to how much you have to pay when you give 40-60% of your gross to an employer as a so called independent contractor!  I pay rent but share an office space with others doing massage keeping the costs low and I am in the center of downtown Seattle, cell phone, website and that is about it!  I don’t advertise or do much in marketing because my website does it all for me!

There are others who are also teaching massage therapists that you can make more with your own business- Meagan Holub author of  “The Magic Touch - How to Make $100,000 a year as a Massage Therapist.”  There is Woody Haiken with his work at “The Growing Practice”.   Laura Allen is a gifted author writing on the topic of building a business so that anyone can do it and our massage pundit!

There are so many good resources out there today to help you along the way!  There is no reason why you can’t learn how to start and run your own business.  If you don’t want to then don’t complain about those franchise jobs!  You can either go and get a higher paying massage job or start your own business!

I think with all of this talk of the end of the self employed massage therapist I should start a campaign – “Just say NO to low paying massage jobs” and also a new marketing campaign for massage therapists starting their own business ” I fix $59 massages!”  (OK I hate the word fix because I don’t think we do fix but it is just for the impact like a commercial on tv lately with a cheap hair salon offering $6 haircuts and a small business barber/salon who puts up a sign across the street staying “I fix $6 haircuts”)

Billing Insurance for massage services is one way of setting yourself aside from other massage therapists and also helping to build your massage business.  Each state and each insurance plan actually can be different making it a maze of paperwork and frustration.   Learning about what is needed in your state to bill insurance companies and get paid within a reasonable time is a process.

As far as I know, every state can bill for injuries on the job (workman’s compensation, labor and industries or whatever it is called in your state and for motor vehicle accidents.  I did hear that PA was having some issues around being able to bill for those so maybe someone could chime in.  I am also looking to create a list of states in which you are able to bill HMO’s and PPO’s and other resources for taking classes and finding a mentor to help you learn to bill in your state.

The first thing to do though before you do go out billing insurance companies is to take the time to figure out if doing this will be profitable for your business.   Figure out your cost per client using the simple formula that I have on the main site.

Learning everything you can about insurance billing before you start will help you prepare the proper forms and have an understanding of what to do.  Getting a mentor or finding a class in your area is really one of the best ways to learn.  Once you learn the basics then it is a matter of keeping up to date with the latest forms and codes that you need to know.

After you have decided that you do want to bill insurance companies here are some other things you will need to look into?

• Do I need a National Provider Number (NPI)?  You can sign up for one easily at NPPES
• Get the proper forms in order.  You will need an intake form that asks the same questions that are on the required billing form the CMS 1500.   You can see what a form looks like here.
• You will need to know how to do chart notes and progress reports.  Efficient documentation is one of the keys to getting paid.
• Learn what questions you need to ask the client and the insurance company.  You can start with some of the questions I use and then figure other questions that will be necessary in your state or for various insurance companies.
• Learn how to work with doctors and create a marketing plan to contact doctors and create a referral network.

The thing to remember is that the information I am providing is based on my experiences and work in WA State.  Some of it may or may not apply to your situation and state.  You will have to find out for yourself what YOU need to bill effectively!

I am also starting a group at a ning.com community (free to join and use) of massage professionals to hopefully connect more people with others in their state and get more help with learning to bill insurance companies more effectively.

Do people really still do New Years Resolutions?  Everyone knows that they don’t really work or last very long.   A New Years Resolution without a plan and without the beliefs to back it up don’t really work.

This year instead of creating those new years resolutions that actually set you up to fail just by the fact that you are focusing on what is wrong most of the time like :  I want to get out of debt -really says I hate being in debt so I want to get rid of it.

I want to lose 20 pounds says  – I hate being overweight.

When you focus on what you don’t want you get more of the same.  Focus on what you do want.

You want to have enough money to pay your bills, save for retirement and take vacations and that equals xx amount of dollars that you will need to make each month.  There – that isn’t a resolution it is a concrete goal.

I want to be healthy, be fit and weigh my ideal weight of xx pounds by xx date.   Another goal.

But then how do you really achieve those things.  Most of the trouble lies in the unconscious and conscious beliefs that we have about those things we want for ourselves.  The unconscious is of course difficult to figure out because it is unconscious.  Your feeling will be what tell you about what your unconscious thoughts are telling you.  Whenever you are feeling anything but love or joy you are believing in an unconscious thought that just isn’t true.  I know that is really hard to get your head around and apply.  It is really an ongoing process of learning to tune into your feelings and honor them.

So maybe the new years resolution could be – pay more attention to my feelings!  Make this year the year that you allow yourself to have desires and let it be OK.

It is OK to make $100,000 a year as a massage therapist.  It is OK to take vacations and have a retirement fund.  It is OK to have the clients that you need to be successful.

Make 2010 different by changing your thoughts!  The rest will follow!

What I wish Massage therapists would get for Christmas… or well just get anytime…

• That being a massage therapist is one of the most rewarding careers where you do get to help people but you do also get to make a Great living.
• That giving to others begins with giving to yourself first in every way.
• That being a massage therapist does not mean you have to live in poverty or live without.
• That having desires is not a bad thing (Desires for a house, retirement fund, nice vacations and a full savings account along with relationships that nurture you are what make you human.)
• You are getting paid for your time and knowledge.  You aren’t getting paid to care.  That you give for free.
• It is OK to charge the fees that you need to make a great living and stay in business.  Charging less than you need to make will lead to feeling resentful of clients and is also the biggest part of burnout.  Just because massage is so wonderful doesn’t mean you have to give it away.
• That you can’t do it all alone.  It is OK and even advisable to ask for help in the way of marketing, promoting yourself, getting your finances under control.  Hire a bookkeeper, financial adviser, marketing adviser and a webdesigner who knows how to get you business. You can also find a mentor or supervisor or create your own peer supervision group to help you along the way.
• That even when you have a job in massage it is your job to get and keep clients coming in.
• You don’t have to take low paying jobs under $20 an hour.  You can create or find higher paying jobs if you put the effort into it.
• That having a job doesn’t mean that you just get to do massage.  You still can have a say in what is going on in the place where you work if you do it wisely and without complaining.
• You teach employers how to treat you so taking low paying jobs is teaching the employers that massage therapists don’t value their own work.
• That burnout can be avoided if you learn to take care of yourself first.  That is financially as well as emotionally, mentally and spiritually.
• That being a successful massage therapist will probably be the hardest thing you will ever do.   It just isn’t about doing massage.
• Taking classes in ethics and participating in supervision will take your career farther than most technique classes.
• There isn’t any one technique that will make you a successful massage therapist.
• Because you are working closely with people it is important that you be doing your own self growth work.
• That you have to take responsibility for your career.  You can blame your lack of clients on the economy or take responsibility and creatively figure out a way to keep your own economy stable.  It isn’t easy and you won’t like to hear that, I know.  Is it the economy or your not having a website that gets you new clients every week and makes you additional income or that you haven’t networked enough or done a mailing every week or gave presentations or the other millions of massage marketing ideas that you can do?
• Clients do not magically appear on your table.  It takes believing in yourself and skill and taking action.  Action is what prepares you to receive.
• It is your basic beliefs about yourself and success that are really are what get in your way of success.  These are mostly unconscious beliefs.  Most of our lives are run on unconscious behaviors and patterns.  It is like driving a car- how often do you think what you are doing?  If you don’t know what your beliefs are just take a look at what you have in your life and start asking – what would someone believe to have that in their life.
• Continuing education is a very important part of creating a successful business and promoting the profession.  Plan and choose your classes accordingly.  Don’t wait until the last minute when your license is up for renewal.
• Figure out what it is that you want for yourself and don’t stop until you get it.  Focus on what you do want rather than what you don’t have.
• Get a massage once a week and better yet -pay for it.  Go out and find a massage therapist that you can work with on a regular basis.  You can learn so much about your own business just trying to find a good massage therapist that meets your needs and of course it will help you maintain your own health.
• Share your knowledge and experience with other massage therapists as often as you can.

That is my wish for you (all the massage therapists out there) this Holiday and MORE!

OK I am a bit of a geek which is unusual for a massage therapists.   I have a system that I use and recommend but it is fairly time intensive yet anyone can do it.  So the other day I started researching various website design systems for massage therapists and was wondering what people are using and what is effective.

An effective website to me is one that gets 3-5 clients a week AND also makes you an additional stream of income from promoting affiliate products. (Affiliate marketing is promoting things that are related to massage – like I promote a stretching program, Traumeel, Biofreeze and books on health that I have read)

The reason that I feel a website is so important is that it is more than just a calling card for your business.  It is also an opportunity to be more professional and educated doctors and the general public about what massage really can do and how it is used.   You know the drill – it’s good for stress, injuries, wellness but most people are clueless really about their bodies.

A website is one of the easiest ways to get clients I think because people are already looking for a massage therapist.  They aren’t looking for you when they start out – but they are just looking for someone to help them with whatever issue they are having – stress  or pain in some combination usually.   People want to know that you have experience working with the kinds of things that they are dealing with.  They want to make sure they are spending their time wisely.  What do they think when they find a site that doesn’t have any more info than just a few pages on how much the massage therapists charges?

One of the best exercises you can do is to go online and try to find a good massage therapist.  Go through all of the process of searching online.  Actually go and do it and follow through and go and get the massage.   See what you find out there!

The components of an effective website are many.  It has to do with keywords and a little simple search engine optimization and also just writing all of the things down that you really just talk to people about – how muscles work, how massage works, what happens with stress and injuries.  Writing this all down will also improve the way you communicate with clients in person.

While all of the technical details might seem too overwhelming they are worth learning about to create an effective website.  I have it all laid on on my website at www.thebodyworker.com

If you would like some help with your current website just leave the address and I will give you some pointers on how to get your site to the top of the first page of Google (which is really the goal of every website. )

Happy Halloween!

Julie

One of my concerns in the massage profession is the way massage therapists are treated by employers and also figuring out what is the appropriate status for a massage employee.  Most massage therapists work as independent or subcontractor status which is basically saying that you are self employed.   It is my personal belief from the research I have done through the years that most are being hired as subcontractors when they should really be full employees with full employee benefits.   I have yet to find a concrete legal reference and there is a lot of conflicting information.  After talking to and reading many questions from massage therapists there is not of course one clear answer.  Figuring it out is actually the responsibility of the employer because they are the ones who will be hit with back taxes and penalties.

There are many different criteria for figuring out your own status and I have a bunch more info on my regular blog citing articles online from many different sources -www.thebodyworker.com

There is the legal aspects of this that are important not only for who pays taxes but the legal aspects also fold into the ethical aspects – do you want to work for someone who may be taking advantage of you?   It will not only come out in how you are paid but also how much you are paid.  It will show up in how you get along with the person who hires you and the company itself.   Ethically speaking you want a nice place to work and one that also respects you and makes you a part of the team.

If anyone has any other legal references let me know and of course all stories you have would help others in trying to figure this all out!

So what do you think?  Is massage a profession or a hobby?

I have been doing it for 20 years so I think it is a profession.  The frustrated massage therapists at indeed.com think it is just a hobby and that they are not valued or respected for what they do.  Some came from high paying jobs with big degrees and feel that massage is just not respected.

Massage is still so commonly thought of as a massage parlor and those ‘other’ massage therapists.   Even here in Seattle where I have never really had a problem being respected every once in awhile I will hear that someone’s doctor said something like “Massage doesn’t work” but not very often.  What can we learn from the people here in the NW?  Or maybe it is just that people have migrated here who want more and are more open.

What is it exactly that makes for a profession?  The white paper from Rick Rosen “On Becoming a Profession” (pdf)a few year ago talked about some of the issues and we are working on them all.

If you think it is a profession will you be respected more or care less about what other think?   Is it a hobby just to be done part time and not make any money?  Is it just your perspective that makes it a profession?  If you don’t think it is a profession you then get everyone who thinks the same?  How does your perspective influence what others think as far as respecting the profession?  If you don’t think it is a profession why would anyone else?

Just some questions I have been wondering about?  What makes a profession?

Article marketing is one of the many online tools for promoting your website, your massage business, your massage school, your massage ce classes, your related massage products that is not very well known by massage therapists.

Article marketing is writing short, to the point articles and posting them on various free services such as ezinearticles.com or one of the many article marketing sites.

The main goal of article marketing really is to get the link to your site.  It doesn’t necessarily about getting people to click on the link but that can help too.  The search engines love to see that you have other sites out there that are linking to you.  They want to know that you are popular.  Most search engines rate and find your site based on the keywords you use in your site and pages and also how many backlinks (other sites linking to you) you have to your site.  They don’t really care if you create your own or not!

Writing in depth articles can also help you become recognized as an expert in your area, field or whatever it is that you are promoting.  Massage schools and massage ce teachers could benefit by writing articles about what their classes are and will do for people.  So many teachers miss the boat for promoting themselves.

Article marketing is fairly easy.   I also have set up a free article directory for massage therapists to add their articles too.  It is just a blog really that I have set up on my site www.thebodyworker.com The way it works is that you just create a free login.  You have to have a valid email address to get the login information.  After you get that you can login and post articles through the dashboard.   It works just like a word processor really.   Here are some ideas for articles that might help you get going:

For massage therapists promoting their business

• massage and fibromyalgia
• massage and cancer
• how muscles get tight
• the real benefits of massage
• describe your unique blend of techniques

For massage teachers/authors/massage schools:

• write articles on a topic that you talk about in your class or school or book and just write enough to want people to know more and then leave a link where they can find out more.
• Write why your class or school is different and what it will do for massage therapists – what will it do for their massage business or in getting a job?
• Write personal things about why you are doing this and what doing massage and doing the things you do mean to you.

In each article you can leave a link to your website.  To create a link just select the text you want to make into a link and click on the link symbol at the top and it will pop up a new box where you enter the exact address.  Select open in new window.   To get people interested in your link use it in an example or put something like :  For more information (on my very interesting class/school/topic) see my website

I started this awhile ago but only have a few articles written.  I don’t think people quite understand the reasons or methods of article marketing so let me know if you have questions.   I started doing an intensive article marketing campaign last month and my website traffic is increasing quickly which in the summer it is usually quite the opposite as far as traffic goes.