Many people feel confused and upset regarding insurance, premiums, medical bills, and other things related to healthcare. In such cases most of the time you just need a quick, simple, and easy explanation to understand all. So is about the superbills. If you’ve heard the term, and want to know about superbill, how it works, and how you can submit one if you’re looking to be reimbursed for out-of-pocket costs to on-site or online therapy. Keep reading because Zee Medical Billing is here to help you.
What Is a Superbill?
A superbill is a detailed document that allows clients to bill their insurance company directly. It includes information similar to an insurance claim form, like the date of the service provided, procedure codes, and a total balance due.
Superbills are basically receipts for therapy or other healthcare services you get from an out-of-network therapist. They are created so you can submit an official receipt of your qualified expenses to your health insurance company for reimbursement. Immediately the insurance company receives your Superbill, they’ll decide how much money you’re likely to receive.
Fundamentals of Therapy superbills
In most cases, you will need to submit a separate superbill for each treatment session. Generally, therapists ask clients for payment instantly after a therapy session. If the clinician is an out-of-network provider for a client, after payment they can give the person a superbill. The client uses the superbill to get reimbursed for the session by their insurance company.
In 2015, the 10th edition of the International Statistical Classification of Diseases (ICD-10) enact. That means that all providers must issue ICD-10 superbills with updated diagnostic codes. Some therapists may also have to update their forms or treatment notes to make it easier to comply with ICD-10 and issue the right code for each service and diagnosis. A superbill with incorrect codes can be rejected, and delaying payment.
Therapists with very busy practices may select clients who pay in cash or who have insurance that directly pays for the therapist’s services.
Why do some therapists choose superbills?
Enlisted on an insurer’s provider panel is a great way to be swiftly paid for therapy while making services more approachable to clients who cannot afford to pay out-of-pocket. To link a provider panel can be a long and involved process, especially since you have to apply for each individual panel and there may be several insurers in your area.
A superbill lets you accept insurance without being listed on a provider panel. This is a great choice for therapists who:
- Don’t have any interest in joining a panel
- Don’t want to join every provider panel
- Are busy and don’t have time to get on a provider panel
- Haven’t been accepted to a provider panel yet
- Would like to be on multiple panels, but don’t have the resources or time to join them all
How do superbill payments work?
Superbill is different from a conventional invoice submitted to the client or insurance. This is because the insurer pays the client, not the therapist, even if the therapist is the one who submits the superbill. With a superbill, the insurer assumes the client has already paid, and that any payment is, therefore, a reimbursement.
Therapists who regularly draft superbills or who do not directly accept insurance payments should bill clients at the end of each session. Otherwise, there is no security of payment, even if a client ultimately receives reimbursement after submitting a superbill. A clear and specific discussion of billing practices can protect the therapeutic relationship and save the client from harmful financial surprises.
What to add in Superbill?
Superbilling software is designed to help quickly fill out superbills. If you go this way, it’s important to assure the protection of client confidentiality and ask for the correct information.
A perfect superbill includes all of the following information:
- Client information
This includes name, date of birth, address, phone number, and any other information the insurer requires. Confirm this information with your client, because small differences and errors may trigger a rejection.
- Practice information
This includes the name of your practice and office address, as well as any other linked information the insurer routinely requests.
- Referrer description
If a medical provider referred the client to you, include this provider’s information and address, as well as their National Provider Identification (NPI) number. All providers practicing in the U.S. have this 10-digit identification code.
- ICD code
Most insurers will not cover treatment without a diagnosis, and some only cover specific treatments for specific diagnoses. You must use ICD-10 codes. If you have not previously discussed a specific diagnosis with your client, do so before submitting the superbill. Some clients are disturbed to see their diagnosis, and others want to know that the diagnosis is correct.
- CPT code
The CPT code uses a list of American Medical Association codes to identify treatment procedures. Record all relevant CPT codes, not just the first one you find, since reimbursement rates may be based on the specific codes.
Accepting insurance can be a challenging process that requires a therapist to apply to various panels. Zee medical billing offers therapists numerous resources to run more efficient, profitable, and helpful practices.