As a therapist or healthcare professional, you will likely encounter superbills in your practice. These documents are critical for helping your out-of-network patients get reimbursed for their care.
What Is a Superbill?
A superbill outlines the services you provide to a client or patient. It includes detailed information for those services, including CPT codes, ICD-10 codes, pricing and your practice information. A patient typically submits a superbill to an insurance company alongside a receipt, showing they’ve paid for out-of-network services.
Superbills are sometimes called “encounter forms” or “charge slips.”
What Is a Superbill for Therapy?
Superbills are more common in specialty medical fields, such as behavioral health. Therapists and psychologists often use superbills instead of becoming an in-network provider. Creating a superbill is often easier and quicker than joining an insurance panel. The superbill enables the out-of-network provider to collect payments from the patient instead of submitting claims to an insurer for reimbursement.
How Does a Superbill Work?
A superbill itemizes and details the services you provide a patient, which gives the insurer the information they need to decide whether to provide superbill reimbursement. Meanwhile, the patient typically pays your practice up-front for the services.
Patients can use superbills to file an out-of-network (OON) claim with their insurer and, ideally, receive reimbursement for some out-of-pocket costs. Patients can typically file these superbills and OON claims through an online portal with their insurance company.
What Does a Superbill Look Like?
The superbill contains important patient demographics, practice details and treatment information.
Patient Demographic and Contact Information
The patient’s information includes:
- Patient first and last name
- Patient address
- Patient phone number
- Patient date of birth
- Insurance type
- Insurance name
- Insurance ID number
The provider’s information includes:
- Practice name
- Practice address
- Practice tax identification number (TIN) or employer identification number (EIN)
- Rendering provider’s name
- Rendering provider’s phone number and email address
- Rendering provider’s National Provider Identification (NPI) number
- Rendering provider’s license number
If there is a referring provider, make sure also to include:
- Referring provider’s name
- Referring provider’s phone number and email address
- Referring provider’s NPI number (if applicable)
Ensure you include all details about the treatment and services you provide the client, such as:
- Date of service (appointment date)
- Place of service
- Diagnosis codes from the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Statistical Classification of Diseases (ICD-10)
- Common Procedure Terminology (CPT) codes/ Healthcare Common Procedure Coding System (HCPCS) codes
- Modifiers for the CPT and HCPCS codes (if applicable), such as place of service codes for telehealth
- Time spent on services (units or minutes)
- Balances due or paid
Remember that some insurers may require additional medical documentation on a superbill, such as progress notes or treatment plans.
Do I Have to Provide an Insurance Superbill?
No, you do not have to provide your out-of-network patients with an insurance superbill. However, creating a superbill for insurance can be helpful for both your practice and your clients.
- Your practice gets paid up-front by patients, meaning you don’t have to wait for claim reimbursement from insurance providers.
- Generating a superbill may take some time, but likely less time than you would spend filing claims with insurers and dealing with denials or rejections.
- Insurance superbills allow your patients to be reimbursed for care, even when out-of-network. This can help improve patient retention and satisfaction.
- You can expand your patient pool by offering insurance superbills, as more out-of-network clients may be willing to try your practice knowing that they can get reimbursed for care.
If your billing tasks take too much time, consider hiring a biller for your practice. This individual or vendor can take on any insurance-based work and in-network claims, leaving you to only worry about the out-of-network or self-pay clients. Ultimately, this extra billing support could give you the time and space to grow your practice and reach more patients.
Ready to let go of time-consuming billing tasks? Gentem’s billing and revenue cycle management (RCM) platform takes on the tedious insurance back-and-forth. Our AI-powered software and team of experts will handle your in-network claims, including denials and rejections. That leaves you time to focus on what matters: caring for clients and growing your business. See how it works with a free demo.