Communication, Documentation, Insurance Billing & Ethics Package

• Identify examples of appropriate interpersonal skills in the therapeutic relationship.
• List the essential elements in interviewing clients using the team therapy model.
• Identify the essential elements in communicating with the health-care team.
• Describe the core concepts for professionally communicating with a client’s attorney.
• Identify examples of professional communication with a liability insurance company attorney.
• Describe why documentation is essential in establishing and maintaining clear professional roles and boundaries.
• Compare and contrast appropriate intake form documentation for wellness care and curative care.
• List the essential elements in establishing fees and policies and using health reports and pain questionnaires.
• Describe how to successfully complete injury information forms.
• List the essential elements of initial notes, subsequent notes, progress notes and discharge notes.
• Define core elements of successful wellness charting, including energy work, event therapy, on-site massage and spa and salon sessions.
• Define each of the following types of insurance: personal injury, workers’ comp and private health.
• List the key guidelines for insurance documentation and billing.
• Identify strategies for managing reimbursement challenges and appealing claims denials.
• List the essential elements in implementing the HIPAA regulations.
• Describe examples of appropriately resolving ethical dilemmas in billing and documentation practices, treatment practices and relationships in the health-care team.

"Most insurance carriers require a diagnosis to remiburse for services, regardless of your ability to diagnose. If diagnosing is not within your scope of practice, simply transfer the diagnosis from the prescription to the HCFA 1500. Filling in the diagnosis code (ICD-9) on an HCFA 1500 form will not be constructed as acting outside your scope of practice, as long as a referring HCP provided the codes for you and the prescription is on file...." from Hands Heal: Communication, Documentation and Insurance Billing for Massage Therapists, 3rd. ed. (2005) by Diana Thompson, page 197

When filing an insurance claim, the Health Care Financing Administration (HCFA) form asks for the client's diagnosis. Since medical diagnosing is NOT within a manual therapist’s practice, simply

a.  send the form to the attending physician and medical team
b.  transfer the diagnosis from the prescription to the form
c.  send the form to the patient’s attorney or legal team
d.  highlight the pre- and post-treatment assessments