graphic of superbill in medical billing

What Is a Superbill?

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

Provider/Practice Information

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)

Treatment/Service Information

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

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With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

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