Over the years, we have had a few questions surrounding billing privileges, direct billing, online billing, and receipt submissions. As this is an incredibly important part of having a successful massage therapy/manual osteopathic practice, and as fraud can have a long lasting impact on a therapist, this information is meant to make you aware of the definitions of each of these phrases, what they mean to your practice, and how you can prevent being the victim of fraudulent acts committed on your behalf, which you could be monetarily liable for should they occur.

Let’s start by defining each of these phrases.

Billing Privileges are defined as your right as a Full Massage Therapist Member, a Spa Therapist Member, a Registered Massage Therapist Member, an Associate Massage Therapist Member, or a Full Manual Osteopathic Therapist member to issue a receipt containing your CMMOTA membership number for the professional services (massage therapy, spa therapy, or manual osteopathic therapy) which you provide to your clientele. This must be done in such a way that you are compliant with the CMMOTA Receipting for Services and or Products Policy for your professional designation which can be found here.

Direct billing is available to CMMOTA Full Massage Therapist Members, Registered Massage Therapist Members, and Full Manual Osteopathic Therapist Members. Other membership categories do not have this privilege.

Direct billing allows you to submit claims directly to a client’s insurance provider for reimbursement to you as the treatment provider. To do so, you must:

1. Be registered with the insurance provider for direct billing.

2. Have written client permission (valid within one year) to file claims on their behalf and share treatment information (e.g., treatment notes) with the insurance provider.

Below, we’ll discuss the risks of assigning your direct billing privileges to third parties (e.g., a clinic or receptionist), which could lead to potential fraud.

For Manual Osteopathic Therapists, direct billing has recently expanded to include most companies under the TELUS Health portal. For a complete list of participating insurance companies, please contact info@cmmota.com.

Online Billing is available only to CMMOTA Full Massage Therapist Members, Registered Massage Therapist Members, and Full Manual Osteopathic Therapist Members. Other membership categories do not have this privilege.

Online billing allows you to submit a claim on behalf of a client to their insurance provider for reimbursement directly to the client or policyholder. In this case, you would collect payment from the client and then submit the claim for their reimbursement.

To use online billing, you must:

1. Be registered with the insurance provider for direct billing.

2. Have written client permission (valid within one year) to file claims on their behalf and share treatment information (e.g., treatment notes) with the insurer.

Below, we will address the risks of assigning your online billing privileges to third parties (e.g., a clinic or receptionist), which could result in potential fraud.

Receipt Submission is defined as a client submitting the receipt, which a therapist provides to the client under their Billing Privileges, to their health insurance company for reimbursement to the client or policy holder. Here it is important to note that if you are currently not providing any direct billing, that you may need to take the time to register with the insurance companies as an eligible provider. We will talk more about this a little bit later in this article.

Fraud Prevention Steps

If you assign your direct billing privileges to a person or business, it’s essential to take precautions to prevent fraud. As a therapist, you could be held responsible for repaying any fraudulent transactions made through your direct billing privileges to a health insurance company.

Key Steps for Fraud Prevention

1. Create a Written Agreement: Ensure you have a written agreement with any person or business you authorize to use your direct billing privileges. This agreement can be included in your employment or subcontractor contract and should clearly outline their responsibilities. This protects you from liability if fraud occurs.

What to Do If You Suspect Fraud

1. Notify the Insurance Companies: Report your concerns directly to the insurance companies, providing as much detail as possible. You can do this through this link provided by the Canadian Life and Health Insurance Association (CLHIA).

2. Inform CMMOTA: Contact the Association to report the issue. CMMOTA can issue you a new membership number and cancel the old one to alert insurance companies of potential fraud.

3. Revoke Privileges: Revoke in writing any previously assigned direct billing privileges to ensure they can no longer use your credentials.

Taking these steps can help protect you from liability and maintain the integrity of your professional practice.

Returning to receipt submission – as a therapist, one of the first steps you will want to take once you are able to start providing receipts to clients once you have obtained your billing privileges as described above is setting up your insurance profiles. You will want to provide each insurance provider with your business information, and CMMOTA membership number so that when your clients start to submit their claims, they will be able to find you in the system and submit their claim. Please keep in mind that this step will still need to be done even if you will not be providing direct billing or online billing services to your clients. For more information on how you can complete this important task, please contact the CMMOTA office at info@cmmota.com.