The Office of the Insurance Company (OIC) has published information on their website to help healthcare providers make contact with a health carrier to determine which of their plans are eligible or ineligible for 99072 PPE reimbursement.  It still requires us to make contact with the health carrier, so there are no short cuts. To look at the page, click on this link:

How to determine health plan fully-insured status

Some insurance carriers are starting to make payments on just submitted billings for 99072 and some are even going back and paying on older submissions.  If you haven't seen it yet, they are also changing their denial of claims for 99072 to specifically state that denial was due to ineligibility.

For our last blog on CPT Code 99072 PPE Reimbursement,  please click on this link:

Part 2 – PPE Reimbursement (CALL TO ACTION)

If you have been using CPT code 99072 to be reimbursed for PPE, you will probably have noticed that you are not being paid for it.  If you look at the EOB’s, you will generally see a rejection notice that states: “payment is included in the allowance for another service/procedure”, or something similar to this.  Healthcare providers across professions are not being reimbursed at this time.

Senate Substitute Bill 5169 (SSB5169) enables all healthcare providers to seek reimbursement for personal protective equipment during the state of emergency related to COVID-19. This bill became law and went into effect on April 16, 2021 when the governor signed it.  Healthcare providers treating patients in state-regulated commercial health plans who have incurred costs for PPE are able to bill the newly created CPT code 99072 and be reimbursed $6.57 per patient encounter.

The two important things to remember about using 99072 to bill are:

• It only applies to state-regulated commercial health plans which do not include: PIP, ERISA (federal plans such as medicare supplemental plans, or self-insured plans like Boeing or Microsoft), Taft-Hartley plans (trade-union bargained plans) or L&I.

• Only bill exactly $6.57.  Billing anything else gives the insurance companies an excuse to deny payment.

If you are unsure as to whether a client/patient’s plan is eligible for PPE reimbursement, ask your client/patient to contact their insurance company for a “summary plan description” which will indicate the set of laws that regulate it.  By law, the insurance company has to respond to the patient’s request, but it does not have to respond to the same request if it comes from the healthcare provider.

CALL TO ACTION!

If you are being denied the PPE payment, our only recourse is to file complaints with the Office of the Insurance Commission (OIC).  Without these complaints, nothing will be done by the OIC to require commercial health insurance companies to pay.  Each healthcare profession is asking its members to file.  To file a complaint, go to:

www.oic.wa.gov

On the left of this page, below the picture is a link in a green field for “File a complaint or check complaint status”, click on that and then click on the “File Complaint” button on the next screen.  To file a complaint, you need to provide specific information about your complaint.  Provide claim number and date of service, never include the patient name as the complaint becomes public record.  Complaints with patient names will be rejected.  Provide a statement of having billed 99072 for $6.57, that it was rejected and provide the rejection reason.  State that the insurance company is not following the SSB5167 signed into law on 4/16/21 and ask the Insurance Commissioner to make the insurance company follow the law and reimburse you.

Once you have filled out your first complaint and submitted it, if you file others, the form will remember the information from your prior complaint and fill it in, so all you have to do is update the information (claim number, service date, insurance company name etc) for the next complaint. The more complaints you file, the greater the weight is on the Insurance Commissioner to act.  Please only include information for one massage service provided on each complaint.

Thank you for supporting your profession!

To learn more about the details of SSB5167, read a prior posting by clicking HERE.

Annual Business Meeting and Continuing Education

• June 27 2021 at 9:30AM - 2:30 PM
• Zoom attendance is limited to 100 participants.
• Free to members, must be a member to attend. To become a member JOIN HERE
• 4 Continuing Education Credits

Annual Business Meeting

• Results of the 2021 election of Directors.
• Reports from WSMTA Clinical Practices, Government Relations, Membership Programs, and Treasurer. Our team of volunteers have been working especially hard for you and the profession this last year.

4 Continuing Education Presentations

Topic: Sustaining and Growing Your Business in Tough Times: Thinking Outside the Box During the Pandemic

In this live, interactive webinar our presenters will present creative healthcare business models. Thinking outside the box, they will share the benefits and risks of various models as well as the underlying values that inspire them.

Our presenters, from an array of healthcare practices, will inspire you to consider new ideas to grow your practice or recover from the effects of the pandemic with these topics:

• Direct Primary Care (Concierge Service) by Dr. Richie
• Understanding the Alphabet Soup of Supplemental Insurance Benefit Options - Taking Control of How Your Healthcare Dollars are Spent by Jessica Bradley 
• Widening Your Horizons and Adding Additional Services to Your Practice with Leslie Korn
• Developing and Running a Membership-Based Wellness Spa by Nicole Chryst, LMT
  

On 9/1/21, revisions and additions to the regulations in the Massage Therapy WAC Chapter 246-830 will go into effect.  One of the changes that will affect licensed massage therapists the most is that CPR will be part of our CE requirement to renew our licenses.

Historically, we only needed to have completed CPR in massage school to obtain our initial massage license. However, starting 9/1/21, it will also be a requirement to renew our massage license.  You can see the new CPR CE requirement at: WAC 246-830-475.    The new CPR subsection states:

(2)(c) Maintenance of certification in American Heart Association CPR or equivalent. A maximum of four hours is allowed per reporting period.

It is also a requirement in many insurance contracts, if you are an insurance provider.  We have always been able to use CPR for CE, but now it is a requirement.

At the time this article was written, online, classroom and online-classroom hybrid options were available and were easy to find on the internet.  If you live in a more rural area, check with your local fire stations and hospitals to see if they have resumed in-person CPR classes.

One thing about CPR classes, at the end of class you get a card showing that you passed, but it doesn’t indicate the number of hours you attended to obtain your certificate.  Our suggestion is to create a form and take it with you.  Make sure it has all of these details pre-filled in as indicated in CE WAC 246-830-475 subsection:

(4) A massage therapist must provide acceptable documentation of continuing education upon request or audit. Acceptable forms of documentation include, but are not limited to: 

(d) Other formal documentation that includes the following:

(i) Participant’s name;
(ii) Course title;
(iii) Course description;
(iv) Date or dates of course;
(v) Number of hours;
(vi) Indication of being an in-person course, self-study as referenced in subsection (3)(c) of this section, or distance learning as referenced in subsection (3)(f) of this section;
(vii) Instructor’s name or sponsor organization name or names;
(viii) Instructor or sponsor contact information; and
(ix) Signature of the program sponsor or course instructor. The self-study allowed in subsection (3)(c) of this section is exempt from this requirement.

On 9/1/21, revisions and additions to the regulations in the Massage Therapy WAC Chapter 246-830 will go into effect.  One of the biggest changes that will go into effect on 9/1/21, will be that 625 massage school hours will be the new minimum requirement to obtain a new massage therapy license in Washington state.  Historically, 500 hours has been the minimum hours required.  If you are already licensed in Washington State, this will not affect you, but it will affect massage schools and massage therapists transferring in from another state.

Back in 2012, the Coalition of National Massage Therapy Associations initiated the Entry-Level Analysis Project (ELAP) which analyzed our profession to determine the minimum level of coursework for a basic massage program that would keep the public safe and provide safe and competent massage therapists.  ELAP proposed a program which in total added up to 625 hours.  After much public discussion, including from WSMTA, the Board of Massage made some changes to the ELAP content to make it work for Washington State, but kept to the recommended 625 hours.

Although more and more states are moving to 625 hours as the new minimum number of massage school hours, most states have not.  Because many states still require only a minimum of 500 hours, credentialed massage therapists from other states can transfer in to Washington State if they meet the following new revised requirements found in WAC 246-830-035 Licensing by endorsement for out-of-state applicants (just click on the link, make sure to look at the revised wording effective 9/1/21).

Over the upcoming weeks, we will bring you more details about the WAC revisions and updates.  The Department of Health has the CR-103 language (shows the revisions) posted on the Massage Therapist landing page which you can read at: https://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/MassageTherapist (just scroll down the landing page to the third bullet under “Current Topics” titled “Rule Making Activity” and click on the link for the CR-103 document).  If you would like to see the current WACs listed with full language next to the revised language that is effective 9/1/20, click on this link, Massage Therapy WAC Chapter 246-830, and open one of the sections, such as  “Definitions”.  First, the current language will be listed and then the revised language.  Not all sections were revised, so you might see some sections that do not have revisions.

To see the latest news from the most recent Board of Massage meeting click here.

RCW 48.43.016 “Prior Authorization Standards and Criteria—Health carrier Requirements—Definitions”.  On March 22, 2020, the Governor signed into law ESB 5887 which amends RCW 48.43.016.  This is the RCW amendment which went into effect in June 2018 which provided for 6 consecutive treatment visits for massage therapy and other occupational therapies for plans requiring preauthorization. This 2018 amendment was meant to create stability of care with Premera and Regence patients/clients processed through eviCore.  Unfortunately, health insurance companies managed to create their own interpretation of this law which created havoc when trying to provide the continuity of care for our patients/clients using these plans, for the past two years. 

With this new 2020 bill, each patient may have “six treatment visits with a contracting provider in a new episode of care for each of the following: Chiropractic, physical therapy, occupational therapy, acupuncture, Eastern medicine, massage therapy, or speech and hearing therapies”.  Whereas the health carriers were interpreting this as “six sessions total” regardless of which profession provided service, it now clearly states 6 sessions per profession. The other major change is the health carrier cannot “deny or limit coverage on the basis of medical necessity or appropriateness or retroactively deny care or refuse payment for the visits”.  If you go to https://apps.leg.wa.gov/RCW/default.aspx?cite=48.43.016, you can review the current RCW and there is a link to see the new language which went into effect on 6/11/20.

Information on SB 5169

The WSMTA Government Relations Program wants to make you aware of a bill working its way through the current WA state legislative session. Senate Bill 5169 is, “AN ACT Relating to provider reimbursement for personal protective equipment during the state of emergency related to COVID-19; adding a new section to chapter 48.43 RCW; creating new sections; providing a contingent expiration date; and declaring an emergency”.

You can read the full text of the bill here,  https://app.leg.wa.gov/billinfo/

Here are the highlights of this bill.

• The bill's primary driver is the WA State Medical Association.

• The bill provides a code to bill for insurance reimbursement for PPE. The code is 99072. The max dollar reimbursement amount is $6.57 per patient encounter.

• The bill covers “all healthcare providers”.

• The bill will only be in effect as long as the declaration of a state of emergence continues.

• It is prospective and not retroactive.

There will likely be amendments (coming from the health carriers) to the bill, as this is alluded to in the testimony before the Long Term Health Committee.  You can watch that hearing here,  https://www.tvw.org/watch/?eventID=2021011450

 Likely amendments so far are (nothing has been made public as of the writing of the update).

• Only in-person patient encounters will qualify.

• The provider must have actually incurred cost. For example, you have cost for a new mask for each patient vs you reuse the same mask for multiple patient encounters.

• Tying the mandate to the federal state of emergency rather than WA’s state of emergency.

Governor’s Proposed Operating Budget – Summary

December 2020

DOH 21 Suppl _ 21-23 Bien Gov Ops Budget.pdf