All About Superbills: A Guide for Mental and Behavioral Health Providers
Superbills are a document given by a provider to a patient for the express purpose of the patient billing the insurance and obtaining payment. Superbills are a popular way for providers to remain out-of-network but still allow patients to utilize the benefits of their insurance. There are some changes to this process with the No Surprises Act, but for the most part the process remains the same. We would like to provide you with the best guide to most effectively utilize superbills in your practice.
How to Use a Superbill
Using a superbill in your private practice is an important process question that mental health providers must think through before issuing a document to a patient. Let’s frame out the best process we can give you so that you can utilize superbills the best.
A superbill is generated using your electronic health record system. Each EHR is different but generating the document through your EHR is the easy part. We recommend contacting your EHR provider and asking them to show you how to generate a superbill so you or your staff can quickly generate a superbill.
Just generating a superbill is not enough information for issuing a superbill. You have to know what information to include on a superbill so your client doesn’t come back to you in a week saying that the insurance didn’t accept the superbill. Ineffectively using a superbill will create more work for you and more frustration for your client.
Make sure that when you generate a superbill you have the following information included:
Your practice name
Your name
Your NPI type 1
Your NPI type 2 (if applicable)
Your tax ID
Your address
The date of service that you saw the client
The diagnosis code
The procedure code that you would have used to bill the insurance company
How much the session cost
How much the client paid
A description of the service you performed
This list includes the most basic information that your client will need in order to effectively submit a superbill. One thing to keep in mind is that if you use your Social Security Number as your tax ID you must include that on the superbill.
If that is something that makes you uncomfortable you have a few options. You can always go the private pay route or you can obtain a tax ID by navigating to the IRS website and they can issue you a tax ID. If you do obtain a tax ID, make sure that you update this information with each insurance company that you work with before submitting any claims or superbills with this new tax ID.
Once you have all the information that you need to generate a superbill then you or your team can issue one to the client using your EHR system. The moment that your client has the superbill they will then submit that documentation to the insurance company and the client will handle all correspondence with the insurance company from that point forward.
Who Needs a Superbill
A superbill is usually generated at the request of the client. Sometimes practitioners will issue superbills as a standard process. Those mental health providers believe that by generating superbills the client will then take the responsibility to obtain reimbursement from the insurance company. This is true for the most part but a lot of clients will not submit the superbill for their sessions.
The other situation in which a superbill is necessary is when a therapist is out-of-network and the client does not want to pay the full fee for the service that the therapist rendered. In this situation the client will want to utilize their out-of-network benefits.
There are a few things to consider when talking with a client about using their out-of-network benefits that they likely haven’t thought through.
One, most insurance plans have a large out-of-network deductible so the client is going to need to pay the full fee of the session regardless. The out-of-network process doesn’t become valuable to a client until they have met their deductible and then pay a copay or coinsurance. Even when the insurance company does start to pay, they will typically only pay for 50% of the session with the therapist. Using out-of-network insurance benefits will still be more costly than in-network benefits.
Two, the mental and behavioral health provider must still be listed as a qualified out-of-network provider of health services with that insurance company. If the therapist or provider is not listed as an out of network provider of health services with that particular insurance company then the superbills will be denied and the client will most likely have to pay the full cost of the services with the provider.
Make sure that you do your best to help the client understand the risks that they assume when they are using their out-of-network health benefits before embarking down the road of using a superbill.
When and What To Charge Your Client
When and what to charge your client has been the focus of much discussion and debate since the No Surprises Act was finalized. Before the No Surprises Act was first introduced providers could issue a superbill and charge the client the full fee for a session. For example, if a therapist’s retail rate was $150.00 then they could charge the full amount for a session and if the insurance pays anything that payment would go directly to the client. This was a simple way for providers to collect their full amounts but still offer some concession to the insurance company.
Now that the No Suprises Act has been implemented it is up to the mental and behavioral health provider to understand what limitations they have when using the out-of-network benefits. For some states, providers can no longer charge their retail rate but now must only charge the patient the amount the insurance would have paid for the services.
Going back to our previous example, if the therapist charges $150 as a cash rate, but the insurance would only pay $145 for an out-of-network session, then the provider must only collect $145 from the client. This has made the out-of-network process a little more cumbersome for mental and behavioral health providers but there are still things that you can do to avoid bumps in the road. We are not attorneys so we cannot give legal advice and would recommend following up on the regulations within your state and with the insurance companies that you are not contracted with.
Conclusion
In order to avoid some of the pitfalls of working with out-of-network insurance companies there are a few actions we recommend taking before seeing the client for an initial session. First, we recommend that you verify the benefits and eligibility of the client with the insurance company that you are not contracted with. Verification is one of the most important parts of taking insurance and working within the healthcare system. We also recommend strongly encouraging, or requiring the client to verify their own benefits with the insurance company so they understand what they are getting into as well.
We recommend checking with your attorney to see how the No Surprises Act impacts you and your practice to see if you have to collect the insurance rate or if you can continue to charge the cash rate within your state. We recommend clearly communicating the expectations of payment with your client to the best of your ability and understanding of the rules and regulations that you have to abide by.
Ultimately, if this process seems too overwhelming or if you don’t have time to work through the details of the process we would love to have a conversation with you about what it would look like to take these processes and procedures off of your plate. Feel free to contact us whenever you would like to free up some of your time and spend more time on the things that you want to spend time working toward.
