Medical credentialing ensures patients receive the best quality care from credentialed providers; in other words, it’s basically an industry standard that helps maintain quality assurance. Credentialing also means that providers can file claims with various agencies, such as private insurance companies and Medicare. However, the medical credentialing process can take months and is tedious—that’s why it’s so beneficial to outsource this process. Keep reading to learn more!
What Is the Medical Credentialing Process?
Medical credentialing is vital for all new hires, but it’s also performed at regular intervals even after hiring to conform to the standards of regulatory organizations including The Joint Commission (TJC), The Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA).
The medical credentialing process typically involves three phases and can take up 180 days:
Credentialing
During this phase, a provider’s qualifications and experience are verified and evaluated. For example, the credentialing authority—known as a Credentials Verification Organization, or CVO—will contact the university or school where the provider received their degree; this authority will also contact certification boards and licensing agencies to confirm the provider’s standing and relevant credentials. Other employers will attest to work experience as needed; essentially, this phase involves verifying the background and experience of the provider going through the credentialing process.
Privileging
This intermediate phase of the credentialing process gives the provider permission to perform specific services at the proposed institution based on your credentials being verified. Basically, the provider has been recognized for demonstrating competency in their field. Privileging is an important step because it validates your credentials and enables you to perform the services you have experience in.
Enrollment
The final component of the medical credentialing process is enrollment. This allows you, the provider, to bill and be reimbursed for the services for which you have been credentialed and are privileged to perform. Naturally, this is the end goal for holistic providers who are billing insurance companies or programs like Medicare because this phase solidifies your standing in the healthcare and holistic marketplace.
Who Can Become Credentialed?
The medical credentialing process is for any healthcare provider who needs to be credentialed in order to maintain competitiveness and be vetted for insurance or Medicare billing. A multitude of different kinds of facilities and services are obliged to acquire and maintain the proper credentials to act as healthcare providers, including:
- Durable Medical Equipment
- Home Health Services
- Hospice Care
- In-Home Care Services
- Prosthetics/Orthotics
- Radiology/Diagnostic Imaging
Essentially, the medical credentialing process can apply to any individual or entity that provides healthcare services.
Top 3 Benefits of Outsourcing the Medical Credentialing Process
While the medical credentialing process is vital for a streamlined billing experience and for a high quality experience for the patient, it’s also a tedious and time-consuming process. It involves a mountain of paperwork and can take months to complete; luckily for you, you have the option to outsource this challenging process!
The top three advantages of outsourcing the medical credentialing process for your holistic provider include:
Your H Practice Can Accept Patients with Insurance and Medicare
Being able to accept patients who carry insurance or are supported by Medicare is a game changer for your holistic practice! Medical credentialing helps make this happen; private insurance companies, as well as government programs like Medicare, have an incentive to minimize the costs of their operations and part of this results in only working with providers who are credentialed. Credentialed professionals and providers demonstrate verified competency in their field and, therefore, pose minimal risk. Overall, the medical credentialing process further recognizes and validates your authority to deliver high quality care to members of your community.
It Enables Your Team to Handle Other Important Matters
Chances are you, as well as each member of the team at your holistic practice, wear many hats; this means you’re balancing administrative work with customer service all while delivering great care to your clients. The medical credentialing process is a significant undertaking that would further deplete your team’s time and efforts that might be otherwise better spent elsewhere. By outsourcing the medical credentialing process, you and your team can continue to support every other initiative at your holistic practice while a team of experts handles your important credentialing journey.
It Ensures Accuracy Following the Credentialing Process
What good is completing the medical credentialing process if the application has missing, outdated, or inaccurate information and has to be done again? Not much! Overlooking significant aspects of the medical credentialing application can result in significant delays and overall frustration for your holistic practice. Postponed credentialing means postponed opportunities to serve patients with insurance or Medicare, which essentially impacts your revenue cycle.
Furthermore, each state is likely to have different credentialing regulations and requirements. Not understanding your state’s regulations can also throw a wrench in the medical credentialing process. Outsourcing this process, however, means you don’t have to worry about inaccuracies or misunderstandings!
Outsource Your Medical Credentialing Process with Holistic Billing Services!
Medical credentialing maintains and perpetuates confidence in the quality of healthcare providers and works to keep costs down; medical credentialing is a win-win for everyone involved! If you need to gain or update your medical credentials but don’t want to deal with the headache of completing the process yourself, then let Holistic Billing Services handle it for you!
Our team of experts will ensure accuracy and navigate the process for you so that you and your holistic practice can continue doing what you love: serving your community! Contact us today to learn more!
The world of insurance billing is complex, and even more so for holistic practices. Accurate coding and billing practices ensure a streamlined reimbursement process so your practice can get paid and deliver the best care to your patients.
Current Procedure Terminology, or CPT codes, are used to document the majority of medical procedures performed by health care providers. These medical billing codes characterize the type of procedure being done so providers can properly bill insurance companies and receive reimbursements for administered services.
Acupuncture practices use codes that correspond to their unique services. Since services are usually coded in 15-minute increments, you will use one code for the initial 15 minutes of service and then a separate code for additional units of time; acupuncture CPT codes will only vary if you include electronic stimulation in your treatment.
Why is Using the Correct Acupuncture Billing Codes Important?
When it comes to holistic practices, ensuring accurate billing and coding is an important indicator of a practice’s financial health since mistakes can result in costly fines and reimbursement delays. Some estimates find inaccurate coding and billing can result in errors on up to 80% of medical bills – resulting in weeks of editing and resubmissions that delay reimbursement and waste time for your staff.
If your holistic practice continues to make mistakes with acupuncture codes, you can have increased denial rates and declining insurance reimbursements, which could put your practice at risk. Accurate acupuncture CPT codes and billing practices can help ensure your holistic practice reaches its full revenue potential.
New Billing Codes for 2022
The American Medical Association (AMA) stated that 43 percent of changes in the 2022 CPT code set are related to new technology services and the expansion of the proprietary laboratory analyses (PLA) code set; 15 codes tied to COVID vaccine procedures were also added.
New codes to handle remote therapeutic monitoring were added:
- 98975
- 98976
- 98977
- 98980
- 98981
Plus, new codes for principal care management were included:
- 99424
- 99425
- 99426
- 99427
These codes will allow providers to report care management services for patients with chronic conditions, such as lower back pain, in an effort to improve monitoring these complex health problems.
Top 4 Essential Acupuncture Billing Codes
The bulk of the services you will bill to insurance will likely fall under four essential acupuncture CPT codes. Since acupuncture services are always billed in 15-minute increments, your practice will use one code for the initial 15 minutes of service and then a separate code for additional units of time. Your acupuncture billing codes will only vary if you include electronic stimulation in your treatment.
- 97810 Initial Acupuncture: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97813; use one or the other.)
- 97811 Subsequent Unit of Acupuncture: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient after the initial 15 minutes, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
- 97813 Initial Acupuncture with Electrical Stimulation: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97810; use one or the other.)
- 97814 Subsequent Unit of Acupuncture with Electrical Stimulation: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
Acupuncture Billing Codes for Medicare
January marks the two year anniversary of Medicare expanding their coverage options to include acupuncture for treating chronic lower back pain. CPT codes related to billing Medicare for acupuncture treatments are as follows:
- 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 20560: Services with needle insertion(s) without injection(s) of 1 or 2 muscle(s)
- 20561: Services with needle insertion(s) without injection(s) of 3 or more muscle(s)
Prices will depend on the region of your holistic practice; look up specific codes based on your location here.
Codes for Patients
Medical billing codes for patients can be broken down into two categories, new and returning patients:
New Patients Billing Codes
Use these acupuncture CPT codes for when your holistic practice receives new patients. As a reminder, a new patient is defined as a patient who hasn’t received professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
- 99201 Evaluation/Management (Limited): Presenting problems are self-limited or minor: requires a problem-focused history, problem-focused examination, and straightforward medical decision-making; the provider typically spends 10 minutes face-to-face with the patient
- 99202 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making; the provider typically spends 20 minutes face-to-face with the patient
- 99203 Evaluation/Management (Detailed): Presenting problems are of moderate severity; requires a detailed history, a detailed examination, and medical decision-making of low complexity; the provider typically spends 30 minutes face-to-face with the patient
- 99204 Evaluation/Management (Comprehensive): Presenting problems are of moderate to high severity; requires a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity; the provider typically spends 45 minutes face-to-face with the patient
Returning Patients Billing Codes
These CPT codes for acupuncture can be used for your established patients. Returning patients are those who have received any professional services from you or another provider of the same specialty who has belonged to your practice within the past three years
- 99211 Evaluation/Management (Minimal): Presenting problems are minimal; the provider typically spends five minutes face-to-face with the patient
- 99212 Evaluation/Management (Limited): Presenting problems are self-limited or minor; requires a problem-focused history, a problem-focused examination, and straightforward decision-making; the provider typically spends 10 minutes face-to-face with the patient
- 99213 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, expanded problem-focused examination, and medical decision-making of low complexity; the provider typically spends 15 minutes face-to-face with the patient
- 99214 Evaluation/Management (Detailed): Presenting problem(s) are of moderate to high severity; requires a detailed history, a detailed examination, and medical decision-making of moderate complexity; providers typically spend 25 minutes face-to-face with the patient
Acupuncture CPT Codes for Physical Therapy Treatments
Acupuncture practices use a variety of treatments and modalities to help their patients. These treatments and modalities help strengthen, relax, and heal muscles. Below are a few commonly-used acupuncture CPT codes your practice may encounter.
- 20550 & 20551 Tendon Injection: Single tendon injection for the treatment of fasciitis. Could include multiple injections into a single tendon sheath (CPT code 20550) or the tendon origin (CPT code 20551)
- 20552 & 20553 Muscle Injection(s): Injections involving single or multiple trigger points. Could be used to treat one or two muscles (CPT code 20552) or three or more muscles (CPT code 20553)
- 97010 Heat Therapy: Application of a modality to one or more areas; hot or cold packs
- 97016 Cupping: The use of a vasopneumatic device may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema
- 97026 Infrared Therapy: The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling
- 97110 Therapeutic Exercise: One or more areas, every 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with direct (one-on-one) patient contact
- 97112 Neuromuscular Reeducation: Treatments to restore movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities with direct (one-on-one) patient contact
- 97140 Manual Therapy: Techniques such as mobilization and manipulation, manual lymphatic drainage, and manual traction, one or more regions, every 15 minutes with direct (one-on-one) patient contact
- 97124 Massage Therapy: Includes effleurage, petrissage, and/or tapotement (stroking, compression, percussion) with direct (one-on-one) patient contact
- 97530 Kinetic Activities: Use of dynamic activities to improve functional performance, every 15 minutes with direct (one-on-one) patient contact
Improve Your Acupuncture Practice’s Billing Processes and Revenue Cycle Management with HBS!
Documenting and billing the right acupuncture codes for insurance reimbursement can be a time-consuming process. No acupuncture practice wants to spend more time billing and coding than it does treating patients and expanding its practice. That’s where an experienced medical billing company with acupuncture CPT code experience can be an invaluable partner.
The team at Holistic Billing Services understands the unique needs of acupuncture practices and has extensive experience working with acupuncture codes to ensure you’re billing patients and insurance companies correctly. With our help, you can start seeing patients covered by insurance quickly and painlessly, no matter what type of acupuncture services you offer.
To learn more about how Holistic Billing can help streamline your practice and accelerate your revenue cycle management, contact our team today.
If your in-house administrative staff is overwhelmed with the medical billing process—or if you’re a team of just one or two people doing it all—then it might be time to consider partnering with a medical billing service. You might not realize how much your revenue cycle is affected by delayed claim submissions, claims rejected for inaccuracy, or new legislation that impacts the billing process until you let a firm manage it all for you.
Upon outsourcing your medical billing and coding, your holistic practice won’t have to worry about these significant factors negatively impacting your revenue stream; instead, accurate claims and prompt payments to boost your financial bottom line will be effortless. Let’s dig into the challenges inherent to the medical billing and coding process and look at how partnering with a medical billing agency can help streamline your finances and optimize your holistic practice!
Top Challenges in Medical Billing and Coding
Medical billing and coding can be intimidating and overwhelming for small teams to handle; some of the challenges include:
Submitting Inaccurate Claims
Inaccurate claims are inevitable if your team lacks the experience to handle them! It’s also detrimental to your holistic practice’s valuable time and money. In fact, the Medical Group Management Association (MGMA) approximates that the average cost to resubmit a rejected or denied claim is about $25 for each instance. Following that math, if your healthcare practice has to rework 50 claims per month, then that adds up to about $1,250 per month or about $15,000 per year due simply to inaccurate claims.
Maintaining a clean claims rate indicates that your holistic practice is efficient and your revenue cycle is optimized and that’s attributable to accurate medical billing and coding! When errors are repeatedly made on the administrative side of processing claims, your financial bottom line and reputation can be negatively affected.
Delayed Payments
This challenge perfectly dovetails with the previous one regarding inaccurate claim submissions. In general, delayed payments are a huge challenge to overcome in the medical billing and coding process. If you’re constantly having to rework insurance claims, chase down accurate billing records, and follow up on patients for payment, then your revenue cycle isn’t performing as well as it should be for your holistic practice!
Delayed payments make it tough for you to have a clear understanding for how your holistic practice is performing because the current snapshot of your finances will be distorted as you wait for payment or have to rework claims from the previous month. As you might imagine, this has a significant impact on your revenue cycle; delayed money is almost as bad as no money coming in at all.
Not Keeping Up with New Legislation and Regulations
When’s the last time you had the time to read up on new government legislation and regulations pertaining to the medical billing and coding process? Are you brushed up on the numerous Medicare and Medicaid initiatives and requirements that could have an impact on your holistic practice? Odds are you’ve got to spend time attending to other matters relating to your practice, such as taking care of clients or trying to keep up with paperwork. Understandably so!
However, new regulations can pose a major challenge for holistic practices. From new rules and when they take effect, to adjusting for them, many factors during the medical billing and coding processes might influence your revenue cycle.
How to Maximize Revenue with a Medical Billing Partner
Making the decision to outsource your medical billing and coding stresses to a medical billing partner has a variety of benefits on your revenue cycle, including:
Fewer Rejected Claims
When a medical billing partner takes over your medical billing and coding processes, you’ll notice an immediate drop in the number of rejected claims connected to your holistic practice. With an experienced team handling these complicated processes, your claims will include all pertinent information needed to properly handle them to the highest level of accuracy possible. Fewer rejected claims means your overall revenue cycle is instantly streamlined and you’ll be increasing the earning potential of your holistic practice.
Minimizing the number of rejected claims also saves your holistic practice time, money, and headache since you won’t have to worry about following up on errors or have to rework multiple claims. Between incorrect patient information, authorization errors, duplicate billing, and more, billing errors can be a costly expense. Outsourcing medical billing can help ensure your holistic practice is efficient, and that the medical billing process is up-to-date and free of human error.
Prompt Claims Submission Means You Get Paid Faster
Gone are the days of letting claims pile up on your desk, collecting dust for days or weeks before action is taken. The medical billing and coding process is intimidating and can take a lot of energy to complete, which further stretches the resources at your holistic practice! However, claims that sit around for extended periods of time equates to leaving money on the table—literally and figuratively.
Partnering with a medical billing agency means your claims will be promptly submitted and with great accuracy. This means your holistic practice will get paid swiftly and you can stay on top of your finances with a more accurate, real-time understanding of how your holistic practice is performing.
Infinitely Up to Date on the Latest Regulations
When you partner with a medical billing agency, you gain a valuable resource: staying up to date on government regulations that might impact your holistic practice. Now you won’t have to worry about constantly checking on the latest legislative initiatives because you’ll have a partner who’s already doing that on your behalf.
This saves you time and prevents the headache that often comes along with reading bureaucratic documents; even more importantly, it keeps your holistic practice in compliance with government regulations. Falling out of compliance or being unaware of important changes to medical billing and coding policies can negatively impact your holistic practice, but partnering with a medical billing firm can streamline this aspect of your revenue cycle.
Boost Your Revenue with Holistic Billing Services!
With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.
Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you maximize your revenue!
One vital component for your holistic practice’s success is maintaining HIPAA compliance because it protects patient information, secures your operations, and prevents the chance of a breach that can greatly impact your practice’s reputation. We’ve compiled this comprehensive HIPAA cheat sheet to help you further understand this important legislation and how it pertains to your holistic practice.
History of HIPAA
The Health Insurance Portability and Accountability Act was signed into law on August 21, 1996. This vital piece of legislation created national standards to protect sensitive information regarding patient health from being shared or disclosed without the patient’s knowledge or consent. Basically, HIPAA prevents personal health information (PHI) from being discussed without the patient’s awareness and fortifies a patient’s privacy.
In addition to securing patient privacy and health information, HIPAA legislation aimed to prevent fraud and waste while also promoting medical saving opportunities across the healthcare industry as a whole. For example, certain tax breaks were established in this Act.
In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed, which establishes technological compliance requirements in alignment with HIPAA practices. This Act encourages the implementation of electronic health records to secure patient information and features the Breach Notification Rule stating that breaches exceeding 500 individual records must be reported to the Department of Health and Human Services’ Office for Civil Rights (OCR).
The latest legislation related to HIPAA was the Final Omnibus Rule, approved in 2013. The purpose of this Rule is primarily to refine HIPAA definitions and include compliance requirements for new pieces of technology, such as mobile devices.
Why Is HIPAA Important for Your Holistic Practice?
Besides protecting your patients’ information and safeguarding their privacy, HIPAA provides some administrative benefits to your holistic practice. Encouraging the transition from paper to electronic health records streamlines your practice and allows for more collaboration with other providers pertinent to your patients. Plus, all HIPAA-covered entities must utilize the same set of codes, so communication from one practice to another organization is further streamlined for efficiency.
Your HIPAA Cheat Sheet
Let’s break down some of the most essential components of HIPAA for your holistic practice’s reference:
PHI and ePHI
Personal health information, known as PHI, can take on a variety of forms that are all relevant to following HIPAA compliance. Here are the 18 types of information that are considered protected health information (PHI) under HIPAA:
- Name
- Address (Including any information more localized than state)
- Any dates (except years) related to the individual, including birthdays, date of death, date of admission/discharge, etc.
- Telephone Number
- Fax Number
- Email address
- Social Security number
- Medical record number
- Health plan beneficiary number
- Account number
- Certificate/license number
- Vehicle identifiers, serial numbers, license plate numbers
- Device identifiers/serial numbers
- Web URLs
- IP address
- Biometric identifiers such as fingerprints or voiceprints
- Full-face photos
- Any other unique identifying numbers, characteristics, or codes
ePHI, or electronic personal health information, simply refers to PHI that is transferred, accessed, or stored electronically. The same protections apply across PHI and ePHI.
Who Needs To Follow HIPAA Compliance?
Since PHI can be present in a variety of fields and formats, there are multiple types of individuals and organizations who must comply with HIPAA guidelines as they come across it, including:
- Healthcare providers: This is obvious, but it’s worth noting—healthcare professionals can have access to a plethora of patient information, so it’s crucial that they maintain HIPAA confidentiality when handling this sensitive data
- Health plans: Whether privately run or publicly operated programs like Medicare, health insurance-related agencies and their staff must adhere to HIPAA regulations
- Healthcare clearinghouses: These companies act as a kind of go-between for processing sensitive information and still need to maintain HIPAA standards
- Business associates: This covers the overarching third-party vendors or other businesses who interact with PHI for a variety of reasons
The ultimate aim of HIPAA legislation is to protect sensitive patient information across all platforms, so it’s vital that all parties follow HIPAA regulations when applicable.
Privacy Rule
The Privacy Rule essentially dictates that sensitive information is only used or disclosed with appropriate safeguards in place. It also stipulates that patients have rights to access their personal health information, obtain a copy of their records, authorize the communication of their records, and more.
The Privacy Rule is located at 45 CFR Part 160 and Subparts A and E of Part 164
Security Rule
Proposed in 1998 by the Department of Health and Human Services, and later ratified in 2003, the Security Rule sought to improve the security of a person’s health information that is shared between authorized parties, such as healthcare providers, health plans, and other pertinent organizations.
The Security Rule is located at 45 CFR Part 160 and Subparts A and C of Part 164.
Breach Notification Rule
The Breach Notification Rule was officially adopted in September 2009 and stipulates that any breach of electronic personal health information exceeding 500 individual records must be reported to the OCR and that each individual must be alerted to the breach, as well.
A breach is defined in HIPAA section 164.402 as:
“The acquisition, access, use, or disclosure of protected health information in a manner not permitted which compromises the security or privacy of the protected health information.”
When a breach occurs, the business or organization affected must determine the severity by considering what type of information was involved, who potentially saw this information, and evaluate the risk of the incident. From there, the organization can proceed with either patient notification—if the incident qualifies as a breach—or further risk mitigation.
There are also three exclusions to what counts as a breach:
- If the exposure was unintentional and is not expected to be a repeated offense
- If it was an accidental exposure from one HIPAA-certified person to another HIPAA-certified person
- If the covered entity—or organization—has reason to believe the unauthorized person wouldn’t be able to retain details of the personal information
Omnibus Rule
The Omnibus Rule is the latest piece of legislation to be associated with HIPAA. Taking effect in 2013, this Rule updates some definitions contained within the original act and expands the liability of businesses for not being HIPAA compliant. It also further protects patient information since it requires businesses to adhere to the Privacy and Security Rules which strengthen security measures when handling PHI and ePHI.
Maintain HIPAA Compliance with HBS
The experts here at Holistic Billing Services are HIPAA certified to handle your patients’ personal health information while streamlining your overall revenue cycle with excellent medical billing and coding processing. Your success is our success, and we offer a range of services to partner with your holistic practice including medical billing, consultation services, and more!
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
A recent consumer study found that 88% of respondents reported massage therapy was beneficial to their overall health and wellness. Want to offer massage therapy services to the veterans in your community, but aren’t sure how to manage billing the VA? We’re here to help you understand this process better so you can deliver quality care to veterans at your holistic practice.
There are numerous methods of massage therapy, including:
- Medical massage
- Hot stone massage
- Swedish massage
- Reflexology
- Trigger point massage
- Thai massage
Each method implements a particular set of movements that target muscles in order to increase blood flow, promote relaxation, alleviate physical pain, and encourage overall wellness.
Does the VA Cover Massage Therapy?
It depends on the specific circumstances and location. Some VA facilities may offer massage therapy as a form of rehabilitation for veterans, but it is not a widely covered service under VA benefits. It is best to check with your local VA facility or speak with a VA representative to determine if massage therapy is covered in your area.
Benefits of VA Massage Therapy
Massage therapy has been proven to treat a wide array of conditions veterans might be suffering from, including:
- Chronic pain: Massage therapy treatments help stimulate blood flow to parts of the body experiencing pain, which helps promote the release of natural painkillers; since massage therapy results in relaxation, overall chronic pain conditions can be managed with treatments. This is an especially timely holistic approach in light of the ongoing opioid epidemic.
- Depression: One study found that 11% of veterans were experiencing elevated levels of depression; massage therapy can help alleviate the physical symptoms of this mental condition, such as back pain, body aches, sluggishness, and more.
- Anxiety: A 2016 research study demonstrated that Swedish massage therapy treatment was successful in reducing the symptoms of Generalized Anxiety Disorder (GAD). Veterans often experience complicated symptoms of anxiety linked to PTSD and homelessness, which can increase the risk of suicide; incorporating a massage therapy treatment plan into an overall wellness plan can help mediate these symptoms.
How To Start Treating Veterans at Your Massage Therapy Practice
The US Department of Veterans Affairs recognizes clinical massage therapy as “one of the evidence-based, complementary and integrative health (CIH) approaches within the VHA Whole Health System of care” and covers the cost of this care when deemed necessary. Follow these steps to start treating veterans with massage therapy at your holistic practice!
Apply for Your National Provider Identifier (NPI)
A National Provider Identifier, or NPI, is a 10-digit identification number issued to healthcare providers in the U.S. by the Centers for Medicare and Medicaid Services. Your massage therapy practice will need to apply for an NPI if you are a HIPAA-covered health care provider or if you bill insurance for your services.
Determine Your Region
The VA Community Care Network (CCN) is divided into six regions that cover the continental United States in addition to Hawaii, the Caribbean, and the Pacific Islands. TriWest manages the western networks while Optum handles the eastern regions. Find out which region your practice resides in.
Get Credentialed
In order to provide quality care for veterans at your holistic practice with massage therapy, you’ll need to be credentialed with the region’s third-party administrator. This process typically takes at least three months to complete. Depending on your region, contact the following to get started with the credentialing process:
- Region 1: 888-901-7407 (Optum)
- Region 2: 844-839-6108 (Optum)
- Region 3: 888-901-6613 (Optum)
- Region 4: 866-286-4174 (Triwest)
- Region 5: 877-226-8749 (Triwest)
The VA has not officially contracted with an agency for Region 6; contact information is pending for that region.
Complete Registration Paperwork
Upon completing the credentialing process, you’ll need to submit the necessary paperwork to become fully registered with the network. This paperwork is submitted electronically and will include details regarding any final requirements that must be met in order to finish the credentialing process.
Receive Patient Authorizations
Once your holistic practice has been verified and authorized by the VA’s network, you’ll start to receive referrals to treat veterans who are approved to start massage therapy treatment. Your CCN administrator will provide the patient’s authorization letters before the patient’s first visit to your practice.
Checklist for Initial Claims Processing
When submitting an insurance claim to the VA for the first time, you’ll need to submit all the authorization letter pages together with the claim. Make sure you transmit all the following information with your massage therapy claim to avoid a denial:
- A cover letter
- The date range for services
- Authorization numbers
- The total number of visits authorized
- The patient’s demographics including address, date of birth, and social security number
- Documentation and CPT codes of treatments administered
By following this checklist, you can ensure your Veterans Administration insurance claim will have all the accurate information it needs for a smooth billing process.
Maximize Your Reimbursements for VA Insurance Claims with Holistic Billing
As a medical billing provider with a special focus on holistic and integrative health practices, such as massage therapy practices, Holistic Billing Services can help you get credentialed by your region’s CCN and help you start treating veterans right away. We have plenty of experience navigating the unique VA billing guidelines, which allows us to maximize your reimbursements and keep your practice’s revenue flowing.
To learn more about how you can get started providing acupuncture for veterans and active service members without worrying about having your VA claims denied, talk to our massage therapy billing and coding experts today!
Referrals are a fantastic method for gaining new patients at your massage therapy practice, but you can’t rely solely on them as a sustainable marketing strategy. Part of your future growth and success depends upon having a comprehensive advertising approach that can target a few different audiences across a variety of platforms. Keep reading to learn more about leveraging marketing to sustain a successful massage therapy practice!
Why Are Marketing and Advertising Important Avenues of Growth For Your Massage Therapy Practice?
Running a successful massage therapy practice means you’re marketing and advertising your services to the community you serve. After all, marketing and advertising are how you attract new customers, outline the services you provide and maintain relevance in your target market. Without utilizing strategies that promote your massage therapy practice, what are the odds of someone stumbling across it? Word of mouth is just one component of a comprehensive marketing strategy—there are several other avenues to take advantage of!
Marketing your massage therapy practice in the community you serve, explaining who you are and what your story is, and providing blurbs of meaningful content are all great manners to get noticed and attract your most loyal patients. After all, your massage therapy practice can’t grow if you don’t show it off!
How Much Should You Budget For Massage Therapy Advertising?
A good rule of thumb is to invest approximately 5% of your gross revenue on marketing activities if you want to maintain the size of your massage therapy practice. For example, if you collect $10,000 per month you should be budget around $500 per month on marketing and advertising tactics.
On the other hand, if you’re ramping up to grow your massage practice, it’s recommended that you spend between 7% and 15% of your gross revenue on marketing—depending on your goals and available budget for growth. It’s also understandable if your marketing budget changes a little bit over time; it should be somewhat flexible to account for the status and potential growth of your massage therapy practice.
What Is A Customer’s Lifetime Value?
As the name suggests, a customer’s lifetime value (CLV) is a prediction of the total financial worth of a patient to your massage therapy practice. CLV can be applied to any industry, but it’s incredibly practical to calculate it for the healthcare and service fields.
A Customer’s Lifetime Value can be measured in the following way:
Average Annual Value x Relationship Years + Patient Referral Value
= Customer Lifetime Value
First, we determine how much the average patient generates per year. For example, if you have a patient who visits your massage therapy practice once per month and each visit costs $100, then the total revenue generated is $1200. Factor in a 20% profit margin and the Average Annual Value of a massage therapy patient is $240.
Let’s say this patient continues going to your massage therapy practice for 10 years before moving to another state:
AAV ($240) x Relationship (10 years) = $2,400.
Patient Referral Value is the amount of additional revenue the original patient brings into your massage therapy practice by spreading the word about your services. If a patient refers two additional clients to your practice, and the total Average Annual Value for those patients combined is $480—which is $4,800 over 10 years—then the original patient’s official lifetime value is $7,200.
How Does CLV Impact Your Holistic Practice?
The lifetime value of a patient is equated to the anticipated total amount they’ll spend at your massage therapy practice. Knowing this figure for each of your patients is essential for planning your financial future and determining how much to invest in acquiring new patients or retaining current ones. Overall, CLV is directly connected to the profit level attached to each customer relationship; if you estimate a patient’s CLV to be $500, you wouldn’t want to spend more than that number to maintain the relationship since it wouldn’t be profitable to your massage therapy practice.
Once you start consistently measuring customer lifetime value, you can begin to implement specific strategies around pricing, sales, advertising, and patient retention with the goal of reducing costs and boosting profit. After all, when you know what to financially expect from a typical patient over the course of their relationship with your massage therapy practice, you can make educated spending decisions to ensure you maximize profitability and continue to attract the right types of customers.
5 Massage Therapy Marketing Ideas
When outlining an advertising plan for your massage therapy, keep these tips in mind:
Network with the Health Practitioners in Your Area
Whether you’re an experienced massage therapist or new to the industry—or your community—a great way to gain reliable patient referrals is through the doctors, naturopathic doctors, chiropractors, physiotherapists, and other holistic practitioners in your area. These providers work with clients who might desire a holistic approach to take care of their wellbeing, in addition to medical services. Plus, patients who are referred to you in this manner have a high probability of following through and becoming long-term, paying clients.
Invest in the Patient Experience
Patient experience entails every instance of connection between your patients and your massage therapy practice’s brand, including visits to your practice, phone calls to your front desk, engagement with your online presence, and even their exposure to advertising and social media. Optimizing the patient experience is a practice-wide effort that’s a process of monitoring, listening, and incorporating feedback from patients that add up to a continuous improvement of your massage therapy practice.
Leverage the Power of Social Media
Social media is ever more essential for patient communication and for potential patients to learn more about your massage therapy practice. Your overall online presence will affect the opinion a potential patient has of your brand moving forward, so be sure to take social media accounts, mentions, and responses into your customer experience strategy.
Start a Loyalty Program
A loyalty program incentivizes patients to continue visiting your massage therapy practice by offering discounts or benefits in return; it might take the form of a punch card or a points system that patients acquire with each visit. Although it’s not intended to be the sole method of retaining patients, a loyalty program can yield great results when it’s well done and implemented smoothly.
Facilitate Word of Mouth Marketing
Word of mouth marketing is a cornerstone of any massage therapy practice’s advertising plan. Potential clients who hear wonderful things about your practice from current patients are more likely to trust those reviews than almost any web presence or standalone marketing plan. Social media and other online review sites are excellent avenues to encourage your patients to talk about your massage therapy practice.
Massage Therapy Advertising Examples
- Massage Envy’s website boasts a holiday incentive program that promotes giving the gift of self-care to a loved one—a form of word of mouth marketing—yet treats the buyer with a $20 gift card in return. Plus, their site includes headers for the services offered—massage, stretch, and facials—so clients can easily navigate to what they’re looking for.
- Massage Studio, a local practice in Tampa, Florida, utilizes imagery to convey the goal of relaxation at their practice. Headers make it easy for clients to make appointments and a featured Etiquette page lets hesitant clients know what to expect, which helps break down trepidation about getting a massage. Promoting pertinent information on the homepage helps the site’s visitors feel that the practice is trustworthy, which benefits the brand’s image.
- CityTouch Massage Therapy, based in New York City, appeals to clients by proclaiming they now accept insurance. This can help make massage therapy more accessible to potential patients who might not explore massage options if not covered by their insurance plan.
Holistic Billing Services Supports Your Massage Therapy Practice’s Growth!
With these tips for marketing your massage therapy practice, we’re sure you’ll see sustainable growth! You can’t expand the community you serve unless your audience knows about how great your massage therapy services are—and part of ensuring the success of your practice entails having a streamlined medical billing strategy that minimizes errors while maximizing profits.
Partner with Holistic Billing Services to help grow your massage therapy practice in a variety of ways, including medical billing and coding, and facilitate the growth of your practice. Trusted since 1999, we’re here to help you put more time and attention back into your day of delivering quality care to patients.
Contact us today and let us help your massage therapy practice reach its potential!
When evaluating the success of your holistic practice, where do you start? It’s too short-sighted to worry only about keeping the lights on, but planning for the future on a broad, subjective scale can feel intimidating or overwhelming. That’s where tracking top healthcare KPIs can benefit your holistic practice. Healthcare KPI tracking can provide a tangible record of your operations across a variety of categories and aspects.
What Are Healthcare KPIs?
KPIs, also known as Key Performance Indicators, are metrics that can objectively measure various components of your holistic practice over time so you and your team can reflect on how the practice is performing and make educated decisions for the future. There are dozens of potential healthcare KPIs to track at your holistic practice, but try not to feel overwhelmed by the amount of data you’ll be collecting—each facet of your practice can be analyzed and optimized, but it doesn’t have to happen all at once. To start, select a few of the most important metrics that need immediate attention, then expand to measure other aspects of your operations.
Common Healthcare KPI Examples
As mentioned above, there are a variety of healthcare KPIs track that may or may not apply to your particular holistic practice, with categories including:
- Operations: These metrics focus on how efficient and effective your practice is at delivering care
- Finance: KPIs related to the financial performance of your practice measure the top and bottom line of your practice—your cost of operations and how much is returned
- Internal: Metrics relating to your internal operations track staff performance and administrative efficiency
- Public health: These KPIs reveal how your practice is impacting your community, whether in terms of child immunization doses, vaccine clinics, or educational seminar attendance numbers
- Emergency: In an emergency healthcare environment, it’s crucial to monitor how effectively your patients are receiving care, average wait time, patient mortality rate, and more
- Care quality: By keeping tabs on how many providers you have in relation to the number of patients you serve, patient satisfaction survey results, and more, you can evaluate how well your practice is serving your community
Why Are Healthcare KPIs Important for Your Holistic Practice?
It takes a lot of time, energy, and resources to operate an efficient and effective holistic practice. How can you be sure you’re succeeding in every aspect of your practice? Key performance indicators are your best bet to gain a comprehensive insight into your operations, finances, public perception, and more. These figures can help you understand the current status of your practice, observe historical trends, and make informed decisions regarding how to improve or further grow your practice.
The Best Healthcare KPIs and Metrics to Track For Your Holistic Practice Management
There are numerous key performance indicators you should consider tracking when evaluating the performance of your holistic practice; be sure to consider the specificity of your holistic practice, community, and overall operations when outlining which healthcare KPIs to monitor. The following breakdown is a foundational place to start and is by no means a comprehensive list of potential metrics to keep track of:
Patient Experience Metrics
The goal of your practice is to deliver quality care to your patients; after all, your practice can’t sustain itself without them! When measuring patient experience metrics, consider the following factors:
- Patient satisfaction: Utilizing patient satisfaction surveys can tremendously benefit your holistic patient care because you can solicit feedback or points of improvement from the very people you’re trying to please: your patients. Plus, by implementing a method of communication regarding their perception of your practice, you demonstrate how important they are to your success. When you establish an objective manner of measuring subjective components of your practice, such as ease of scheduling follow-ups or how comfortable the waiting room is, you can gain valuable insight into your practice’s performance.
- Referral mix: This healthcare KPI indicates what type of patients your holistic practice is treating and who referred them to your practice. Tracking this metric helps you understand which patients are finding you from word-of-mouth recommendations, which in turn affirms the success of your holistic practice’s mission of delivering quality care.
- No-show patients: It happens. Patients forget appointments or simply ghost your practice and never return your calls or attempts to reschedule. However, when this becomes a pattern at your holistic practice, do your best to get ahead of it and monitor these behaviors. If you find that a significant number of your monthly appointments are no-shows, it might be time to implement a no-show policy to discourage that!
Staff Performance Metrics
Your team is a reflection of your practice and keeps your practice running smoothly for your patients; when gaining insight into your staff performance, consider the following:
- Staff-to-Patient Ratio: Do you have dozens of weekly appointments for only a handful of providers at your practice, resulting in faster burnout or longer patient wait times? It’s crucial to consider how much time and attention your providers can give to patients for top quality care. If they’re stretched too thin, it’ll catch up to your practice sooner or later and you’ll have to hire additional staff to manage.
- Trainings and Certifications: When working in healthcare, it’s absolutely essential that your staff is HIPAA certified and follows best practices when handling patient information; it’s also beneficial that each member of your team have certifications in their pertinent areas of service.
- Mistake Events: This self-explanatory metric simply refers to the frequency and type of mistake or error made, whether administrative, related to medical billing, patient confidentiality, or another type of mistake. This metric can provide insight and help you determine the best course of action to correct the problem, preventing it from becoming an internal pattern.
Medical Billing Metrics
How well do you know the details of your holistic practice’s finances? If you’re only measuring the short-term successes of paying your monthly bills, there’s a lot you’re missing! Dig into the many facets of your financial performance and learn which areas to improve moving forward, including:
- Days in Accounts Receivable (A/R): This metric reveals how many payments remain outstanding at your holistic practice, either due to insurance reimbursement processing delays or out-of-pocket services. Ideally, the average time a bill spends in A/R should be about 30-40 days—the less time spent waiting for payment, the better. By tracking this metric, you can identify friction points along the payment cycle, such as billing and coding errors or not following up on claims, and redirect your efforts to streamline this process.
- Net Collection Ratio: One key financial metric to monitor is the net collection ratio, which calculates how much potential revenue your practice nets after insurance adjustments are made. While the exact figure will fluctuate from specialty to specialty, aim for collecting about 95% of potential revenue for services, whether by patient payers or submitting clean claims. If this healthcare KPI falls consistently dips below 90% then that tells you something needs to be addressed in your revenue cycle.
- New Patient Ratio: You can probably guess which figure this metric tracks; part of overseeing the financial health of your holistic practice is to sustain and grow your practice, which means a certain percentage of your patients are first-time visitors. When monitored over time, this healthcare KPI can help you determine if your holistic practice offers a desired balance of services for the price. Like with many other metrics, the exact figure to aim for can change from specialty to specialty; however, for general wellness practices, new patients can make up about 25% of visits, while specialty care practices could see up to 50% new patients each month.
Transform Your Medical Billing with Holistic Billing Services
By creating a monthly summary sheet to track healthcare KPIs, you can begin to identify and resolve problem areas in your holistic practice that are holding back growth and revenue.
Our experts here at Holistic Billing Services believe our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house. With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.
As demands for holistic medicine increase from people seeking relief from a variety of conditions, more research is conducted to determine and affirm how effective these treatments can be. These studies are important both for validating the effectiveness of holistic medicine and quantifying how alternative treatments can be used. For example, acupuncture is often incorporated into a wellness plan relating to a variety of ailments and new research examines just how this practice affects patients with certain chronic illnesses.
3 Common Types of Acupuncture
Originating from traditional Chinese medicine practices, acupuncture entails inserting thin needles, through a patient’s skin, at strategic points along the body at various depths, which interrupts pain signals throughout the body and thus delivers relief.
There are several types of common acupuncture treatments, including:
Cupping Acupuncture
Cupping involves utilizing special suction cups on the patient’s skin to stimulate blood flow under the cup, which provides relief for a wide array of symptoms ranging from muscle inflammation to arthritis. While cupping alone doesn’t actually involve the use of needles, it’s often used in tandem with needles to deliver deep relief.
Scalp Acupuncture
This particular form of acupuncture is self-explanatory in that it involves specifically placing needles along the patient’s scalp at certain points and has been known to manage spinal and motor-impairment issues.
Body Acupuncture
Body acupuncture entails—you guessed it—placing needles all along a patient’s body to supply relief in an all-over manner that can be used to treat a plethora of conditions as well as deliver stress relief.
Benefits of Acupuncture
Since acupuncture treatments can be entirely customized to each patient, there are several benefits inherent to the practice, such as:
Proven Alternative to Opioid Drug Usage
While almost two-thirds of Americans have been prescribed an opioid for pain issues, 49% reported knowing someone who has been addicted to prescription opioids; in other words, opioids are not to be taken lightly.
What’s a healthy and effective alternative? Acupuncture. One meta-analysis of almost 18,000 patients across 29 randomized controlled trials found that licensed, precise acupuncture treatments were significantly more effective than the absence of the holistic approach. Acupuncture is a great alternative to such traditional, pharmacological methods of treatment because it’s minimally invasive and doesn’t have any damaging side effects.
Pain Relief
As mentioned earlier in this article, acupuncture treatments are becoming complementary—if not primary—approaches to treating chronic or acute pain. In fact, according to the National Institute of Health (NIH), several studies have found that such holistic treatments were proven to reduce pain for a variety of conditions and even manage constant pain such as low-back pain, neck pain, and osteoarthritis/knee pain.
Furthermore, in 2017, the American College of Physicians issued recommendations for treating patients who live with enduring lower back pain, including acupuncture as an effective drug-free treatment plan. As providers reduce prescribing opioid drugs to manage pain, patients are directed to therapies like acupuncture as a holistic alternative that maintains an effective pain management quality.
Overall Health Benefits
While the NCCIH notes that acupuncture treatments have been proven to help treat lower back pain, neck pain, osteoarthritis, knee pain, and chronic migraines, the Acupuncture Evidence Project reviewed the effectiveness of acupuncture for 122 treatments over 14 clinical areas and have found some evidence of effect for 117 conditions. These include:
- High or low blood pressure
- Chemotherapy side effects and symptoms associated with it
- Facial pain
- Morning sickness due to pregnancy
- Dental pain
New Acupuncture Research On the Effects on Chronic Illnesses
It’s important to conduct research on holistic treatments like acupuncture in order to objectively determine how effective it can be on certain chronic illnesses. Check out these recent studies on a variety of chronic illnesses in relation to acupuncture treatments:
Meniere’s Disease
Researchers recently conducted a study on 30 patients regarding the effects of acupuncture in treating Meniere’s Disease. Results demonstrated that Meniere’s symptoms, including dizziness, tinnitus, and hearing loss, were significantly reduced in all patients with the use of the warm-promotion needling method wherein acupuncturists manipulated needles in a methodical technique to induce desired effects.
Gout
From a sample size of 120 patients, researchers found that combined auricular acupuncture—treatments performed on the patient’s ears—with warm needle acupuncture significantly enhances the efficacy of drug therapy in relieving gout pain, boosting the 82 percent effective rate to 95 percent effective.
TMJ Pain
Research conducted on 60 patients determined that warm needle acupuncture was 93.3 percent effective while standard manual acupuncture was 86.7 percent effective in reducing pain associated with TMJ.
COPD
Acupuncture was proven an effective treatment for patients living with COPD after a study of 62 patients determined this holistic plan reduces small airway obstructions, increases breathing volume, ventilation, overall respiratory function, and exercise tolerance.
Stroke
In a recent study of 60 patients, traditional treatments for stroke patients were found to be more effective in conjunction with acupuncture treatments than without them because acupuncture “increases the thrombolytic effect of urokinase for the treatment of acute cerebral infarction.”
How Educating Prospective Patients Increases Holistic Practice Acquisition
In 2019, the US National Health Council approximated that 133 million Americans were dealing with a “generally incurable and ongoing” chronic illness; of this group, about 40 million were “limited in their usual activities due to one or more chronic health conditions.” Imagine how many individuals in your community are part of these statistics and could benefit from treatment at your holistic practice!
But first, your patients have to have an awareness of your practice and how it can specifically benefit their overall health. That’s why keeping up on recent studies pertaining to acupuncture’s effectiveness on chronic illnesses can be a vital tool in connecting you with your community and speaking directly to prospective patients.
You can spend more time, energy, and resources on staying current on research, educating your community, and ultimately treating patients by taking one easy step: partner with a medical billing firm to manage your revenue cycle!
At Holistic Billing Services, we deal exclusively with holistic healthcare practices that deliver acupuncture, massage therapy, and chiropractic treatments to communities around the country. Whether you have questions on acupuncture insurance billing or other methods to enhance your revenue cycle management, feel free to contact our team today and let us know how we can help your acupuncture practice.
Massage therapy is in increasing demand across the country; nearly 48 million people had a total of 214 million massages in the U.S. in 2018 alone. If you’re a licensed massage therapist feeling compelled to establish your own holistic practice, the odds are in your favor for finding clients in your community who are seeking your services.
However, starting your own practice or brainstorming a plan for sustainable growth doesn’t happen overnight—and, unfortunately, it’s not enough to be passionate about serving your community! While that passion is a great foundation and motivation, you really need a business plan to establish a strategy for your massage therapy practice and its successful future.
What Is a Medical Massage Therapist Business Plan?
Broadly speaking, a business plan is a formal, written document outlining the goals of a business, the means by which those goals will be achieved, and the metrics for measuring those goals. Essentially, a business plan provides a comprehensive strategy for the future of your business and helps you, as the owner, address the many components of operating a successful business.
With that understanding, a massage business plan is all of the above but tailored to establishing a massage therapy business. Along these lines, you’ll need to determine the general outline of your business but also navigate the medical billing and coding practices, understand the laws and regulations pertaining to your specialty, and how to market yourself to the community. Your work is important, and establishing your own holistic practice will be a fantastic asset to the patients you serve!
3 Benefits of Creating a Massage Therapy Business Plan
Owning and operating a successful massage therapy business entails managing a wide array of responsibilities; it can be overwhelming! Here’s why you need a massage therapy business plan:
Set Yourself Up For Success
There’s a popular saying: fortune favors the prepared—what seems to be “luck” on the outside is actually the result of your hard work and preparation! Taking the time and effort to compile a well-rounded business plan demonstrates to yourself and potential investors that you have a vision and a plan to bring it to fruition. Leverage your passion to bring massage therapy services to your community with a practical business plan that holds you accountable for making it a reality. After all, a business plan creates a 30% greater chance for growth—and a chance to double your success!
Keep Everything Organized
Starting a business is, unsurprisingly, a complex and complicated process that requires you to handle numerous decisions and factors. Thus, having a business plan that accounts for your holistic practice’s marketing strategy, potential supply and demand in your community, legal paperwork and certifications, and so much more will keep you and your team organized by putting everything in one place. As you learn more about the process of starting a massage therapy practice, you can just add information to the business plan and compile a list of questions with resources to find the answers.
Ensure Accountability at Your Holistic Practice
What does success look like for you and your massage therapy practice? Your practice needs to attract new patients, operate on sustainable financial practices, and have a strategy for growth over time or else risk falling stagnant and behind the competition. A business plan for your massage therapy practice can ensure accountability in terms of financial, operational, and even emotional success simply by putting your goals into writing and checking them over time.
7 Essentials You Need In Your Massage Therapist Business Plan
The business plan for your massage therapy practice needs to have some fundamental elements that set a solid foundation for your practice, both internally and externally. These essentials include:
- Executive summary: This is basically the mission and vision statement of your massage therapy practice; it’s your first impression and elevator pitch
- Business concepts: In this section, you’ll outline the who, what, and how of your practice; who is your audience, what value are you providing, and how are you going to deliver that to your patients
- Market analysis: Put your research skills to work by analyzing the market for massage therapy in your community and across the industry in general; this also can set up your marketing strategy by learning how best to attract patients
- Competitive analysis: Scope out the competition in your target area by getting insight into their pricing strategy, where they attract clients, and more
- Business strategy: This section distinguishes your massage therapy practice from the competition; for example, are you a value-based, accessible holistic practice, or do you offer specialized treatments for a small pool of clients?
- Financial plan: Divulge the costs of running your business, the current financial status of your practice, plans for medical billing and coding, how you’re funding your practice, and more; anything related to money matters goes in this section
- Operation & Implementation plan: Outline the daily operations of your practice—for example, the business hours and number of personnel you’ll have in the office—and what it’ll take to make it happen, such as the equipment or number of parking spots you’ll need
Your business plan will likely have tangents that branch off of these elements, which is to be expected and further illustrates how methodical you are regarding your practice’s future. Just be sure to start with these umbrella terms and return to them along the way of formulating your holistic practice’s plan for success.
How to Write a Massage Business Plan to Support Your Growth
The aforementioned seven essentials for your business plan set forth the sections required for a well-rounded, thoughtful business plan. In an effort to further break those broad sections down into manageable components, be sure to do the following when writing the business plan for your massage therapy practice:
Create SMART Goals
Articulating your goals is an essential step for writing your massage business plan; after all, studies show that 90% of people perform better with relevant and challenging goals.
SMART goals will help further define your business plan and establish metrics by which to determine how your massage therapy practice is operating. SMART is an acronym that fleshes out each individual goal:
- Specific: What exactly are you trying to accomplish?
- Measurable: How will you objectively judge your progress?
- Attainable: Make sure you’re not trying to wrap up too many things into one goal.
- Realistic: Carefully evaluate your available resources and skillsets when making your goal.
- Timely: Give yourself a deadline—and stick to it as best as you can.
For example, you might set a SMART goal to gain 10 new patient reviews in one month. If you have an established practice of 50 patients, that might align well with your goals, but if you only have 7 patients, then you’ll need to adjust your aims.
Do Your Research
This might be an obvious point, but it’s worth repeating: your massage therapy business plan should be researched from start to finish so you can make informed decisions regarding your practice’s strategy for growth and overall success. To start:
- Learn more about your market and how best to market your practice to acquire new patients
- Scope out the competition to see what they’re doing well or where you would improve on their methods
- Network with physicians in the area to establish connections and gain patient referrals
- Find out what events are happening in the community that you can host a table at to get more awareness about your holistic practice
- Ask current patients for feedback and for them to write a review to see if there are pain points you can address
While there won’t necessarily be a finish line when doing research—since new ideas, opinions, and strategies can emerge at any point—it’s still an important factor in the planning process and one that will greatly benefit your massage therapy practice.
Consider Strategic Partnerships That Support Your Growth
Running a successful massage therapy practice doesn’t happen overnight and it takes a lot of work that can feel overwhelming on your own. When writing the business plan for your massage therapy practice, consider one or two aspects that might be able to be automated or delegated to a partner organization.
One crucial element of your massage therapy practice’s success lies in your revenue cycle management process, which includes medical billing and coding, insurance reimbursements, compliance with important laws and regulations, and more. You don’t need to navigate those complicated components of your practice alone—the team of experts at Holistic Billing Services can take care of it all for you!
Established in 1999, Holistic Billing Service is an integrative health services firm focused on streamlining your documentation, billing, and coding process to enhance your revenue cycle management. We empower holistic practitioners to focus on delivering quality patient care and growing their practices.
Contact us today to see how we can accelerate your massage therapy practice’s growth!
Treating Medicare patients not only entails serving a greater population in your community, but it also means that your holistic practice may be subjected to Medicare audits. These can lead to suspension of payments and Medicare fees if your holistic practice isn’t up to snuff with current regulations and laws.
Unfortunately, healthcare waste, fraud, and abuse lead the Centers for Medicare and Medicaid Services (CMS) to be diligent in recovering as much federal money as possible. Of course, there is no way to avoid facing a Medicare audit—sometimes they’re random. But there are ways to prepare for one to reduce any negative outcomes.
Which Holistic Modalities Does Medicare Cover?
While Medicare currently doesn’t fully cover the many services offered by holistic practices, there has been a significant push to include coverage for practices that manage and promote holistic wellbeing.
For example, CMS recently introduced verbiage to cover acupuncture—with a few clauses related to back pain. According to Medicare, back pain can be covered if it meets the following conditions:
- It has lasted 12 weeks or longer
- There is no known cause (not related to cancer that has spread, inflammatory, or infectious disease)
- Pain not associated with surgery or pregnancy
Additionally, original Medicare pays for only one chiropractic service: manual manipulation of the spine if deemed medically necessary to correct a subluxation when one or more of the bones in your spine are out of position.
This procedure, when performed by a chiropractor or other qualified provider, is covered through Medicare Part B, the component of original Medicare that includes outpatient services; Medicare will pay 80% of the Medicare-approved rate for this procedure.
Overall, Medicare won’t cover therapies unless deemed medically necessary. Regardless of coverage status through Medicare, many insurance companies follow the same policies. Staying up to date on these regulations and the consequences attached to them is important for your holistic practice to stay efficient and effective.
How Audits Impact Your Holistic Practice
By identifying errors and devising remedial actions to eliminate them, audits serve a vital role in a healthcare organization’s compliance plan.
Medical audits provide a mechanism to:
- Review quality of care provided to patients
- Defend against federal and payer audits, malpractice litigation, and health plan denials
- Educate providers on documentation guidelines
- Optimize revenue cycle management
- Ensure appropriate revenue is captured
- Determine if organizational policies are current and effective
What Are CMS Audits?
The goal of audits—in any industry or business—is to see how compliant that organization is with whatever set of rules and regulations is established and relevant. That’s essentially the same goal of audits conducted by CMS of holistic practices.
These program audits measure compliance in terms of its contract with CMS, in particular, the requirements associated with access to medical or holistic services, drugs, and other enrollee protections required by Medicare.
The program areas for the 2021 audits include:
- CDAG: Part D Coverage Determinations, Appeals, and Grievances
- CPE: Compliance Program Effectiveness
- FA: Part D Formulary and Benefit Administration
- MMP- SARAG: Medicare-Medicaid Plan Service Authorization Requests, Appeals, and
- Grievances
- MMP- CCQIPE: Medicare-Medicaid Plan Care Coordination Quality Improvement Program
- Effectiveness
- ODAG: Part C Organization Determinations, Appeals, and Grievances
- SNP-MOC: Special Needs Plans – Model of Care
What Is the CMS Program Audit Process?
There are four phases to a CMS audit:
- Audit Engagement and Universe Submission: Six weeks before fieldwork is conducted, an organization is notified that it has been selected for a program audit and is required to submit the requested data, which is outlined in the respective Program Audit Data Request document.
- Audit Field Work: Over the course of three weeks, program audit fieldwork is conducted, mostly via webinar with the exception of the CPE review, which may occur onsite during the last week.
- Audit Reporting: Audit reporting occurs in multiple stages beginning at the conclusion of audit fieldwork. CMS first shares audit results with the holistic practice at the exit conference via the preliminary draft report, but the findings in a preliminary draft report are subject to additional review and evaluation after all supporting documentation has been received and evaluated, at which point classification occurs.
- Audit Validation and Close-Out: This is the longest phase of the program audit process, taking approximately six months to complete. During validation and close-out, an organization has an opportunity to demonstrate to CMS that it has corrected the noncompliance that was identified during the program audit.
What Does CMS Look For in Audits?
By conducting audits, either at random or as suspicious activity is reported, CMS works to prevent, reduce, or address a holistic practice exploiting CMS money or information, regardless of intention. Such issues to address might include falsifying claims that are billed to Medicare, charging excessively for Medicare services or supplies, making false statements on applications to participate in federal programs, and more.
Part of this stems from CMS regulations updating from year to year, so paying attention to their regulations on a continuous basis is important to maintaining compliance.
How Much Will CMS Increase Audits in the Future?
CMS’s budget for fraud, waste, and abuse mitigation doubled from 2021 to 2022 as the agency sought a $50.5 million increase in funding for “conducting greater levels of review.”
Medical review activities include pre- and post-payment audits and also encompass the Targeted Probe-and-Educate (TPE) process. CMS also requested additional funding for modeling and analytic tools aimed at identifying fraud, waste, and abuse.
The funding increase also allowed CMS to hire more administrative law judges (ALJs) in an attempt to reduce the backlog at the third level of Medicare provider appeals, which currently sits at five years.
5 Tips to Avoid CMS Audits
Perform a Self-Audit
Perform your own random mock audits based on the same criteria as a Medicare auditor to uncover what they would find and address any issues before they bring them to your attention. Visit the CMS website for the most up-to-date information on submitting claims that comply with Medicare guidelines.
Conducting internal audits at your holistic practice is important because it further ensures your practice is following all policies and procedures. Or, on the other hand, it points out areas of improvement for yourself and your team.
Prevent Billing and Coding Mistakes
Generally, Medicare pays claims based solely on your representations in the claims documents. Utilizing a standardized set of medical billing codes facilitates the billing process by bringing uniformity to the billing process.
When the coding on the claim does not meet the Medicare requirements and Medicare pays the claim anyway, the audit may discover this mistake. That’s why it’s so important to submit accurate claims and ensure appropriate coding is employed.
Provide Accurate Documentation
Holistic organizations need to make sure that everything is documented, including data presented on meaningful use reports generated by EHR and all other evidence. Auditors will be looking for discrepancies along the practice’s decision-making process.
By knowing the right procedures and eliminating errors with better technology, discrepancies can be kept to a minimum. Practices that have the appropriate documentation of every decision made—and each process change—will be able to easily find any potential trouble areas.
Review Every Process
Reviewing every process pertinent to the medical billing and patient information systems side of your holistic practice is important in preventing CMS audits.
As medical billing and patient information systems become more integrated, the need to review every process becomes more critical since a simple change could require an organization to upgrade multiple other systems to be successful. This is a good habit to establish with your holistic practice, especially if the coding of a specific holistic procedure changes.
Train Your Staff
One of the most common reasons a healthcare organization fails an audit is due to human error. This is where a well-trained and experienced billing team can be considered the most important driver of revenue for holistic practices. Billers and coders who are credentialed and certified from the proper associations are less likely to make mistakes and understand how to properly manage these solutions.
A qualified and confident staff is also more likely to be aware of industry changes that impact operations and can implement changes to remain up-to-date. This kind of staff is also more likely to advance principles that can make a bigger difference in the revenue cycle.
Avoid CMS Audits with Holistic Billing Services!
Our experts here at Holistic Billing Services believe that our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house.
With a focus on holistic practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.
Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone holistic care practices. To learn more about how outsourced medical billing with Holistic Billing Services can empower your practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.