Providing “superbills” to your patients may be an excellent way to get more business and help your patients fully take advantage of the insurance benefits available to them. A superbill is a special type of invoice, also sometimes referred to as an “encounter form,” “charge slip,” or “fee ticket.”
What Is a Superbill?
A medical superbill is a detailed invoice about a medical encounter that includes medical billing codes for services rendered. The intended recipient is the payor—often a health insurance company—who uses the superbill as a primary data source to evaluate the healthcare claim and determine reimbursement eligibility and rates. This is different from a receipt or invoice provided to a patient, which typically does not include medical billing codes.
Why Mental Health Practices Should Provide Superbills
Keep in mind that many behavioral health providers do not take insurance, or they only accept certain insurance plans if they have an established relationship with the company (e.g., they are on a provider panel). One reason for this is that navigating insurance plans’ requirements for payment is tricky and there are many exclusions, particularly for behavioral health. But, it is still possible that your patients may have insurance that would fully or partially reimburse them if provided with a superbill. This is the main reason to provide superbills.
With a superbill, you collect full payment from the patient and then the patient seeks to be reimbursed by their insurance provider via submission of the superbill. Some practices also offer to submit superbills for patients, which nowadays is often done electronically through the provider’s document submission portal as an e-superbill.
Superbill Requirements
Beyond what would be found on a typical invoice, the main requirement for a medical superbill is to include detailed medical diagnostic codes for services rendered. If there are multiple dates of service, typically you would provide a separate superbill for each patient encounter.
Superbill Components Breakdown
Many of the components of a medical superbill are the same as what you would find on a typical invoice. Most superbills will include the following information:
- Date of service
- Provider’s first and last name
- Provider’s National Provider Identifier (NPI) number
- Address where service took place
- Provider’s contact information (phone and optionally, email)
- Referring primary care physician’s name and NPI (if a referral took place)
- Patient’s information: Name, date of birth, address, phone number
- Patient’s insurance information (if collected)
- Procedure codes and descriptions using Current Procedural Terminology (CPT) codes
- Diagnosis codes and descriptions using the World Health Organization’s International Classification of Diseases (ICD) codes—ICD-11 came into effect in 2022, but it has not been adopted in the U.S. and ICD-10 (the previous version) is still widely used
- Modifiers of codes needed to more accurately describe the services rendered (if any), such as 96127 for outcome measures
- Units or minutes for services rendered
- Fees charged for services rendered
- Provider’s signature is not typically required by payors but you may want to include it
The superbill can be delivered on paper, electronically, or both. An EHR with integrated billing features will allow you to streamline superbills.
How to Deliver Superbills to Patients
First, it is important to explain superbills clearly to each patient. As superbills are normally for out-of-network services, patients need to check with their insurance company on whether out-of-network behavioral health services are covered, to what extent they are covered (deductibles, co-pays, co-insurance, payout rates, etc.), and whether they need a referral and/or prior authorization. You may want to cover this on your practice’s website and in communications with prospective patients in advance of their appointment, so there are no surprises.
Next, explain clearly that the patient is paying up front and seeking reimbursement from their insurance company. Some practices opt to help patients with superbills, which may include submitting the superbills for patients and giving patients guidance on whether their insurance is likely to reimburse services (with a caveat that the practice will not provide a refund if the claim is, for some reason, denied). As the money is going to the patient, most practices choose to collect payment in full from the patient when services are rendered, to avoid financial risk.
It should be emphasized that even if the patient receives reimbursement, it may be for only a portion of what they paid. For example, if a patient pays $150 for a therapy session, it might be that their insurance company won’t pay more than $100 for the therapy session, and if they have a 30% co-insurance obligation, only 70% of that—so, in this scenario the patient would pay $150 up front and get back $70 from their insurance company later, for a net cost of $80. This, of course, is still better than paying the full amount without reimbursement.
You may give the superbill to the patient as a hard copy, and/or digitally as an e-superbill through your practice’s online patient portal. Just make sure they understand what it is and what to do with it.
Best Practices for Using Superbills
Superbills are for insurance claims; as a best practice, they should omit treatment details and other sensitive information. Many payors require them to be submitted within 90 or 180 days, but providing them sooner is almost always better. The purpose of giving patients superbills is for them to negotiate claims with their insurance companies on their own, so there is not generally a need to provide them to patients who are not interested in doing this. Overall, patients may be more likely to select your practice if they have a chance to be reimbursed by insurance.
The right EHR software can help you manage superbills as a seamless part of your clinical and administrative workflow. Check out Valant today.
