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What Is a Superbill?

What is a Superbill?

As a mental healthcare professional, you may need to create a superbill at some point. These documents are different from the usual invoices you submit to clients or their insurance, and understanding how they work allows you more options for taking client payment.

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About Healthcare Superbills

A superbill is a highly detailed invoice that outlines the services you provided to a client. They are generally created and submitted for each treatment session you conduct. They are sometimes called “coded bills” due to the codes included.

How Do Mental Health Professionals Use Superbills for Therapy?

Superbills contain all the information necessary for a health insurance company to create a claim. Accepting insurance is often challenging for mental health professionals, as it may require them to apply to a multitude of panels. Choosing superbilling shifts some of the responsibility of billing for mental and behavioral health services to the client.

With superbills, clients get complete information that may result in better reimbursement, and you don’t have to jump through quite as many hoops.

Benefits of Providing a Superbill for Behavioral Health Services

While obtaining a listing on an insurer’s provider panel is a good way to ensure you receive prompt payment for your services, there are drawbacks to doing so. The process is often drawn-out and requires significant involvement on your part, and you have to repeat the process for each panel. Given that there might be dozens of insurers operating in your region, it’s simply not practical to join them all.

Superbilling is one way of accepting insurance when you’re not listed on a provider’s panel. This is ideal in situations where a clinician:

  • Doesn’t want to go through the process of joining any provider panels.
  • Only wants to join a select number of provider panels
  • Is waiting to be accepted to a provider panel.

One of the most significant benefits is being able to take payments from smaller insurers without having to expend the time and resources to join their panels.

The Components of a Superbill — What Does a Superbill Include?

For a client to get full reimbursement based on a superbill, it must have all the following required components listed accurately.

Provider Information

The basic information needed for this section includes the name of your practice as well as your office address. If you have created more than one superbill for a specific insurer, you may notice that they routinely ask for other types of information like the name and National Provider Identifier (NPI) of the referring physician, if applicable. Other information to list in this section includes:

  • Your first and last name
  • Your NPI number
  • Office phone number
  • Provider email address
  • Provider signature

Patient Information

Required patient information includes the client’s name, birth date, physical address and phone number. It’s important to double-check the information with the client, as any small mismatch or error can affect the superbill’s viability. Something as simple as putting an N instead of an M for the middle initial can cause the superbill to be rejected by the insurer.

Visit Information

Insurers want to know exactly what you are treating and how you’re treating it. That means listing the details of what you went over in your session, with the proper coding.

ICD-10 Codes

Your superbill almost always has to include a diagnosis. Without one, most insurers won’t cover treatment. Additionally, some insurers only cover certain treatments for a specific set of diagnoses. You must use the codes issued in the 10th edition of the International Statistical Classification of Diseases (ICD-10), which went into effect in 2015.

It’s important to make sure you explicitly discuss specific ICD-10 diagnoses with the client before submitting the superbill. Clients don’t usually like hearing the diagnosis from a superbill first, and they may have questions or want confirmation regarding the accuracy of the diagnosis.

CPT Codes

Current Procedural Terminology (CPT) codes are used in conjunction with ICD codes, and both are needed to receive reimbursement. The ICD code provides the diagnosis, while the CPT codes tell the insurer what treatments you have provided. The diagnosis and treatment must match in order to receive reimbursement.

For example, if you are listing the ICD-10 code as F33.2 for major depressive disorder, you might pair it with the CPT code 90837 that indicates an individual psychotherapy session lasting 60 minutes. It’s helpful to be familiar with the ICD and CPT codes you use the most, as familiarity can speed up the process of drafting a superbill manually. Double-checking your code combinations is time-consuming but essential for accuracy when you’re not using any assistive software.

Who Can Submit a Superbill?

Superbills can be submitted by either the mental health professional or the client. Some clinicians feel more comfortable submitting superbills themselves, while others decide to save some time by requiring the client do it. When starting to treat someone for whom you will be drafting superbills, it’s important to make sure that you clarify who is responsible for the submissions to avoid any awkward situations.

How Do Superbill Payments Work?

With a superbill, the insurer pays the client rather than the mental health professional. You get paid directly by the patient at the time of service. The assumption is that the client has already paid for the service and the payment from the insurer is a reimbursement. Superbill payments only work for patients who can afford to pay for your services out-of-pocket and up front.

How to Create a Superbill for Therapy With ICANotes

There are many services that can assist mental health professionals with creating a superbill for therapy, but did you know you could be creating them directly in your EHR? ICANotes includes a billing feature that allows you to pull the necessary information from a patient’s chart and draw up a superbill with ease and accuracy.

To find out more about the billing capabilities of ICANotes, you can sign up to try it yourself with a free trial.

Related Posts

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Mental & Behavioral Healthcare Billing: How to Maximize Your Reimbursement Rate

CPT Code Basics: What You Should Know

 

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