Superbills in Private Practice | Out-of-Network Billing

Superbills in Private Practice | Out of Network Billing
FREE Superbill Template:
tinyurl.com/y4y4dme7
My experience being on insurance panels:
• Insurance vs Private P...
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.

[@summereggleston4556]

Thanks for the template...I'm looking at going out-of-network as I transition to private pay eventually to coaching. Got a reality check recently...Realizing I've been working with insurance companies for 20+years. Only one insurance company has ever given me a raise. Some insurances have even reduced their reimbursement. I threw a (small) rant at an EAP company that told me they would pay me HALF for Telehealth than for in office services. Gave them an earful about what is involved in delivering telehealth services. They are paying me full rate :)

[@rosenastroup5069]

This video is so helpful not only for therapist starting out but for people going to therapist who offer this! Thank you so much for going into detail about these things

[@PrivatePracticeSkills]

I'm glad you think so! Many of my clients don't realize their insurance provides out of network benefits, so I let everyone know about this option in the initial phone call. It's a great benefit!

[@saintinlower48]

After all of the research I've done for chiropractic superbills, this finalized what I needed to know. So helpful! Thank you!

[@jennifermorgan-binns6544]

Thank you so very much for this amazing demo of superbills. Also, I am grateful for the free template! Keep up the good work and keep paying it forward!

[@PrivatePracticeSkills]

I'm glad you found it helpful, thanks for the kind comment!

[@eunicejohnson7809]

Hi I enjoyed your video. Do you submit the superbill for your clients?

[@notenoughofus3460]

Seriously helpful...thankyou!!!

[@SodiumGated]

Thank you!

[@PrivatePracticeSkills]

HAHAHA Lemon thanks for watching!

[@tanheide6]

Wow thanks so much for making insurance clearer!

[@mariasd9711]

Thank you very much.

[@mariea5940]

Thanks so much. It helps me a lot.

[@Justin-zk8jq]

Love your channel, you definitely need a bigger following. I'm working on my ba in psych, but I really wanna go all the way and open a private practice. Your vids are really informative, not much else like them!

[@PrivatePracticeSkills]

Aw thank you so much Justin! Glad you're well on your way - we all start somewhere! Best wishes to you on your journey!

[@arctother5176]

Thank you for this and so many other videos! This comes in handy when the original super bill I provided didn’t have all the needed info. I guess too much info is better than having to do the bill over again.

[@RoyalTeaNation]

Thank you for this!

[@ryanrogers3610]

can you offer superbills and a sliding scale?

[@gummysprinkles8872]

Awesome Video!!! Do you need to submit Therapy Visit notes with the superbill?

[@MedicalBillingMaven]

Not usually

[@eleonorerayburn9039]

Thank you this was so helpful!!

[@sayoyamaguchi4972]

Thank you so very much for this video and the template. It was super helpful! I have one question though: What is the difference between place of service and location of service??? Thank you :)

[@ericfawcett2085]

Your explanations are always clear and super helpful. Thank you!

[@rebbyrebreb]

I don’t take any insurance. All my clients are self pay. Can I still use super bills?

[@CR-ou4hl]

Super helpful! Subscribed on the spot.

[@PrivatePracticeSkills]

Aw, thanks and welcome! I hope you find the rest of my videos helpful too.

[@taktoktek]

i love your fur family members....

[@RiserHealth]

Wow, what an awesome video! I am so glad that I found your channel! Thanks!!

[@nieceypiecey100]

You can still bill and receive pay directly from insurance companies if you are out of network using the cms 1500 form.

[@sarahcarr6253]

Could you explain how please? Is there anything additional needed to bill insurance directly as a OON provider?

[@kellibtravel]

Can you do a video talking about ICD-10 Diagnosis Code? I am brand new and have no idea what that is!

[@mbqueen24]

Can you please make a video on how to submit a super bill on the client’s behalf please? Wondering if this can be done through therapy notes or if another service is needed? I plan on charging the client at the time of service as an OON Provider. Thanks

[@CranialCrownProsthetics]

HI! I downloaded your template but cant edit it. How do I change the info for my company within the template? Thank you

[@johncanlasnutrition9570]

Super helpful even as a dietitian! So superbill lets you bill out of network even if you're not credentialed from an insurance company?

[@kiilcancer]

Great videos! Have you made a video on CPT codes for Super Bill? Is there any recommended link/video on CPT codes?

[@aubrey1008]

The surgeons office asked for my ID and insurance card before I had surgery. I received a statement from this nationwide insurance company that the two surgeons were out of network. Each charged about $20,000 each and paid about $250 each to each surgeon. So far I haven't received any bill but this is crazy. I can't pay $40,000 since I don't have anywhere near the money. I had prior surgery from this surgeon in the past where they paid the bill. What's up?

[@MsGear001]

GREAT video! Questions: what's the difference between "Place of Service" and "Location of Service?" And, is the "Amount Due" referencing what's due the therapist (e.g., $0.00) or what's due the client (e.g., $125.00)?

[@MedicalBillingMaven]

Place of service refers to office, home, outpatient, inpatient, etc... Location of service is the address of where services were rendered and Amount due in this case would be the patient.

[@SodiumGated]

I found the Place of Service codes on the CMS website. Where do I find the location service codes? Is there a difference?

[@eyecandie2004]

Would you use a super bill if you need to bill secondary insurance?

[@PrivatePracticeSkills]

This is a great question, and I don't currently know the answer! My suggestion would be to either follow up with the insurance directly or to offer a superbill to your client and they can address the question with their insurance if they choose.

[@amis2388]

Very helpful! Do you create the superbill yourself (e.g. on Microsoft Word) or use some other virtual platform to do so? Does the superbill look any different for telehealth services?

[@shrinktfit]

Good presentation, however one issue with superbills not mentioned: The insurance company can still reference a discount tied to a bill processing company you have never heard of. This discount is communicated to the patient whether or not the insurance company reimburses them. Good luck trying to prove you don't belong to their network.

[@Enchanteralle]

So my client submitted her superbill to her insurance company for the last few sessions and then the insurance company called and left me a voice mail asking me to submit a W9 form. Also told me to call back for them to verify some info. I called back and was bounced around to different depts without anybody able to assist me. I was not aware that I have to complete a W9 form...also not sure if insurance companies need any additional paper work even though I'm an out of network provider. I just faxed over my W9 form today, but it has caused a lot of headache for me when I was being transferred from one dept to another. What is your experience?

[@jasonrosa447]

ive been taking insurance for a year now and its terrible. i want to go oon. What I'm not understanding is why after negotiating a higher rate, do we just charge our clients a fee that makes sense , and then submit the bills from the insurance to myself so i get paid directly. For example , oon rate is 200 and insurance pays 70%. If i charge the client 20 and then submit a claim to the insurance company and the remittance goes to me I will get another140 from them. This will increase my income and decrease the clients charge. Is that wrong to do?

[@eyecandie2004]

Do all insurance companies pay out of network?

[@PrivatePracticeSkills]

eyecandie2004 great question! From my experience, it’s less about which providers offer out of network benefits and more about what specific plan your client has. Even within each insurance company there are an array of plans they provide so each client needs to call their provider to see what benefits they qualify for. Hope this helps!

[@karieye4truth]

Hi there, so would this even pertain to a non medical Life Enrichment LLC? I am just digging into the research of this as I have a background of working with the TBI and Spinal Cord Injured community, as well as ABA Therapy - however my certificate for that has expired. I want to provide an array of services for folks I have a detailed plan of services however I am thinking more private pay rather than accepting insurance. Any idea of this Superbill is something that the client could get reimbursement for without a ICD-10 code? I am looking to provide - light house keeping, companion care, respite care, activities, indoor and outdoor for life enrichment, errands and doctor appts. I would love your feedback - Thank you

[@justinevecchione2444]

Do you have another link for the free template?. I'm getting an error message with the current link

[@PrivatePracticeSkills]

Uh oh! I've been hearing from folks that my links are getting buggy. See if this link works: mailchi.mp/7becd9560283/superbill-template?rfsn=4810182.eff115&subid=knyxnxkdwl0002cl0ntyp if not, feel free to send me an email: [e-mail]

[@justinevecchione2444]

@@PrivatePracticeSkills it worked!thank you so much

[@mbqueen24]

C