What is a Superbill, and How Can Therapists Create One?
As a therapist with a private practice, you would've heard of superbills. Though it sounds scary, it is nothing but a detailed "out of network" billing in private practice.
For those therapists who are not a part of the client's insurance company's provider panel, you cannot bill the insurance company or claim reimbursement.
So, instead of billing the insurance company directly for reimbursement (in-network billing) of the therapy session with your client, you charge the client the full amount for the meeting and get paid. But, you provide a "superbill" to your client. The client will then use the superbill to claim reimbursement from the insurance company directly.
The "in-network billing" requires you to fill a CMS-1500 form for your client's insurance company. But, for out of network therapy billing, you issue an ICD-10 superbill with the appropriate diagnosis code for therapy.
What is a superbill?
Simply put, a superbill is a detailed invoice that is different from the traditional receipts. It thoroughly outlines the services your client received from you.
Even though a therapist creates a superbill, it is the responsibility of the clients to claim reimbursement from their insurer. So, the insurer pays the client and not the therapist. Whereas, the client pays the full amount to the therapist.
The insurance companies require you to fill out such superbills to ensure that you are indeed a therapist and have provided services to your client that they claim you have.
How to create a superbill?
There is no specific superbill template. To create a superbill, you need the following information:
- Name - Your first and last name
- Business Name - DBA or LLC (optional)
- Address - Your mailing address in case the insurance company decides to contact you
- Contact - Email id and phone number
- Your Signature
- EIN - Mention your Employer Identification Number (EIN) or Federal Tax Identification Number, a unique 9-digit number assigned to your business/private practice by the U.S. IRS.
- NPI - Mention the National Provider Identifier (NPI) number, a unique 10-digit number issued to health care providers.
- License - Your therapist license number that permits you to practice in your state or jurisdiction.
- Name - Your client's first and last name
- DOB - Client's date of birth
- ICD-10 Code - Insurance companies require a diagnosis to cover therapy and treatment. Use the ICD-10 diagnosis codes on the superbills.
- Date - Date of the therapy session with your client
- CPT Code - Current Procedural Terminology (CPT) codes are specific codes used by healthcare practitioners to describe the service provided by them to their clients. There are different codes for different types of psychological services.
- Description - For example, if you use the CPT code 96512, then you would describe it as, Health & Behavioral Intervention - Individual.
- Charge - How much you have charged your client for the service and diagnosis.
- Place of Service Code - Place of Service code is the location where you meet your client for the therapy session. The most common ones for therapists in private practice are - 2 (telehealth), 11 (office), and 12 (home).
You could issue a statement saying your client has paid the full amount to avoid confusion. Some therapists prefer to issue superbills after every session, while others issue by the month-end. It's up to you to decide when and how you would want to bill your clients.
Once you issue the superbill, you have completed everything from your end. It is up to the clients now to coordinate with their insurer for reimbursement.