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Insurance Audit: Calling all Volunteers

One of our goals in the Clinical Practices Committee is to figure out how to get the Insurance companies back to the table to talk to our organization and to WA LMTs. It is a frustrating endeavor, in which we are constantly hitting brick walls and dead ends.

WSMTA wants to make a focused effort to see if insurance companies in Washington State are maintaining enough credentialed Massage Therapists in each region to be compliant with the state, thus creating a compelling reason for them to come to the table. We want to make an organized, timely effort to call specific regions in our state for an accounting of the massage businesses that are still open, accepting insurance and accepting new insurance patients within two weeks. This is the foundation to figuring out if the medical insurance companies have published accurate lists and if they have network adequacy. 

This effort is going to require volunteers. Volunteering your time can be difficult, especially if you are running a business, have family obligations or other life challenges. This is an opportunity to have a defined job that can be done anywhere, at most any time of the day and has a fixed end date. We will tell you where to find the contact information, what questions to ask and provide the documentation to report your findings. All you need is a phone, computer and internet connection to participate. The more people we get to volunteer, the bigger the sample and the more power we have. Our hope is our audit will motivate insurance companies to seek Massage Therapists and our professional organizations for renewed negotiations, give us the opportunity to make accepting insurance feasible for our businesses and ultimately, insuring they are complying with state law.

If this sounds like something you would be willing to help with, please contact Julie Johnson and say you are interested in the WSMTA Insurance Audit at jjohnson@mywsmta.org.

CALLING ALL MASSAGE THERAPISTS
IN WASHINGTON STATE

The Clinical Practices Committee has a plea and request of every Massage Therapist in Washington State who works with Medical Insurance Companies or who have patients/clients seeking Massage treatment covered by medical insurance. 

  1. Check your contact information on insurer's websites. Make sure it is current. If you do not have availability to accept new patients/clients or have a long wait to get in, make sure that information is also updated on the insurer's website. 
  2. If you are canceling your Insurance agreement, tell the insurance company why in writing.
  3. If you have problems with your agreement, communicate and try to negotiate with the insurance company. Call or write regularly through channels presented to you.
  4. If your patients are unhappy that you no longer accept insurance, tell them why you’ve stopped.
  5. If your patients are unable to find "In Network" practitioners, encourage them to contact their insurer for solutions. If none are given, have them file a formal complaint with the OIC if there is a significant delay to prescribed care. The OIC is there to advocate for the insurance consumer – not businesses who accept insurance. Until our patients start formally complaining about their inability to get access to massage services guaranteed by their contracts, nothing will change. We need to ask them to act.  
  6. Go forth and share this information to all WA Massage Therapists and have them do their part as well.

Stop assuming making a complaint won’t matter. Stop assuming your patients won’t make the effort to file a grievance. Stop assuming your voice doesn’t make a difference. We can’t make change happen unless every WA Massage Therapist who wants to be available to patients with insurance explains and communicates to the insurance companies and patients why medical insurance is a barrier. Please help the Clinical Practices Committee get to the table with medical insurance companies. If we can do this, we can open the communication channels for all massage practitioners.

REGENCE LEGAL REVIEW

Some Regence contracted LMTs had concerns about the latest contract that was sent out a few months ago by Regence. A respected and highly experienced healthcare attorney, John Conniff, provided the Washington State Massage Therapy Association (WSMTA) a legal review of the new Regence agreement. We all know that legal services are expensive, and this lengthy contract and regulatory filings (228 pages) required many hours of work and resulted in a thirteen page legal review that details the commitments that therapists enter into, the inconsistencies, and the conflicts with Washington statutes that exist in the contract. The review is available to members for $100 – the cost of one massage. If you are not currently a WSMTA member, you can go to our website, become a member for $40 and then be eligible to purchase the review for $100. Your payment helps us to continue to provide services like this in the future.

Link to Regence Legal Review Document in the WSMTA Store

CONTINUING EDUCATION AUDITS

Every month the Department of Health audits 2% of the license renewals which have continuing education due. A shocking 50% of therapists fail the audit. This is not always due to a lack of education hours, but can also be due to not having hours in the required categories. The Board of Massage has developed a handy tracking form which lists the requirements and space to enter your continued education classes.

Print out the form, write in any classes when you take them, attach your certificate, and you are ready for a successful audit.

There will likely be some changes to CE requirements in the near future. We will let you know when the regulations become effective and supply you with the link to the updated form.

WHAT CLINICAL PRACTICES DOES FOR YOU

In Washington State, massage therapists are in a unique position, licensed by the state and credentialed by insurance as health care providers.  LMTs are included in insurance provider networks.  The Clinical Practices Program (CPP) mission is to be a communication portal (conduit) to address issues that impact clinical practices at the state level, while bringing best practice information to individual massage therapists and clinics.  We bring our voices, our knowledge, our experience and collaborative approach to Washington State's regulatory, legislative and insurance arenas.  We also prioritize effective communication with our members as well as other professional organizations in the healthcare field, particularly rehabilitation therapy.

Our current and ongoing focus is to provide the most up-to-date and accurate information for Best Clinical Practices and for compliance with our massage laws as well as other regulations that apply to healthcare providers.  We seek and participate in opportunities to work with networks and insurers on behalf of Washington LMTs to address issues including but not limited to credentialing, improving access to provider networks, network adequacy, prior authorization requirements, payers compliance with reimbursement regulations.

COVID-19 FORMS

Clinical Practices Program is providing a variety of examples of forms from active WA massage practitioners to use as templates for resumption and provision of in-person healthcare treatment during the COVID-19 public health crisis. These may include:

  • informed consent
  • advisory and acknowledgment of risk
  • protocol descriptions
  • checklist for verification of no COVID symptoms or increased exposure

These are provided as a starting point. They do not reflect any legal requirements or the only way these forms could be created. They should be customized so it reflects your actual practice and process.The purpose of these forms is to:

  1. Set expectations for the use of your services
  2. Advise and explain to patients/clients procedures and protocol during the COVID-19 Pandemic
  3. Facilitate your clients understanding, acknowledgment of new procedures and protocol
  4. Obtain your client’s agreement to comply with all COVID-19 protocols
  5. Acknowledge that in spite of all precautions there remains a risk of transmission
  6. Consent to treat

Whether they are sent in a pre-appointment email, reviewed at time of service or posted on the website, the key is to communicate your practice has changed its delivery of services to optimizing safety and health. Obtaining signatures or initials on the forms will hopefully assure they have read it, but it is not a liability waiver or legally binding agreement. 

The documents below are in MS Word format for easy modification to your practice needs. We hope you find them helpful.

COVID 19 Integrated Form (.docx)

COVID 19 Symptom Check (.docx)

COVID 19 Office Protocol (.docx)

COVID 19 Informed Consent/Office Protocol(.docx)

VOLUNTEERS

Our Board and Committee members are all unpaid volunteers working for you. Our little group could use individuals willing to take on jobs big and small. It allows you to connect with other LMT professionals, receive mentorship, find out the latest discoveries in our profession, receive CE hours for certain activities and support other up and coming LMTs. We are looking for volunteers interested in helping with, but not limited to:

  • Making contacts with medical insurance companies, provider networks/provider services including those with open panels, 3rd party payers and other professional healthcare organizations.
  • Research
  • Content development for the website like forms, articles and imagery.
  • Suggestions and organization of educational opportunities
  • Attendance and reporting on professional meetings and conventions

Our Board and Committee members are all unpaid volunteers working for you. If you have a story idea, an educational experience or ideas to share, please contact us. Please specify your interest in the Clinical Practices Group, our coding subcommittee or if you are looking for volunteer opportunities.

info@myWSMTA.org


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