Superbills in Private Practice | Out-of-Network Billing 

Superbills in Private Practice | Out of Network Billing
FREE Superbill Template:
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My experience being on insurance panels:
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When I first started in private practice, I had never heard of a superbill or out-of-network billing.. But it turns out that superbills are incredibly useful in private practice and are simple to use. In today’s video I share with you everything you need to know about superbills so you’re set up for out of network billing.
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This video is geared for therapists of all kinds, including psychologists, MFTs, LPCCs, social workers, and others in the clinical counseling field.
Welcome to Private Practice Skills! I’m Dr. Marie Fang, psychologist in private practice. I post videos offering tools I learned the hard way about starting and growing private practice so that you don’t have to.
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This video is not intended as professional or legal advice. Be sure to seek the services of a professional if you are in need of them.
So what the heck is a superbill? A superbill is a detailed itemized receipt that healthcare providers like us use to reflect the services we offer. These receipts are most often used to submit claims for reimbursement from third party payers, like insurance companies.
So how are superbills different than a CMS-1500 form?
For those of you not familiar, the CMS-1500 is a form used by insurance companies that healthcare providers fill out in order to bill insurance.
For the most part, the CMS-1500 form primarily only applies to providers who are in-network on insurance panels.
To really understand what I’m saying, I think I need to break down the difference between in-network and out-of-network providers.
To avoid any possible insurance fraud, the superbill involves some key information beyond simply your name and how much you charge the client. In fact, I’ve found even in just the last 12 months that insurance companies have really been cracking down on the information they require in a superbill in order to avoid cases of fraud.
So the superbill must also reflect key information about who you are to demonstrate that you are licensed in your field and that you are who you say you are.
Here are the key items required from the superbill receipt:
-Your basic information (name, address, phone number)
-Your professional information (Tax ID, NPI, License #)
-Your client’s name, ICD-10 code, and date of birth
-An itemized list of services including date of service, CPT code, description of service, and cost of service.
I also like to make sure I include:
-Place of service code
-A statement that the client has already paid the balance in full
Lastly, I sign and date the superbill for good measure.
Often clients are not aware that they may qualify for out-of-network benefits, so I always cover this when going over payment options during the initial phone screen. Sometimes clients have been surprised to find that their insurance will cover most of the cost!
As far as frequency, many therapists offer superbills at the end of every month, others every session. You can decide on a reasonable frequency that fits you and your practice.
Once you pass the superbill to the client, it’s up to them to coordinate with their insurance to ask about how they submit for reimbursement. Your work is done!
Superbills are a quick and easy way to make care more accessible to your clients while also allowing you to receive your full fee. It’s definitely worth considering offering them to clients you’re seeing in your practice.
Everyone has their own formatting for their superbill. If you’d like to borrow mine as a template, you can snag it for free at the link in the description box.