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How to Help Private Pay Clients Get Reimbursed

 
 

Even if you are not an in-network provider with health insurance companies, a client may still request a ‘superbill’ from you so they can submit a claim on their own behalf for reimbursement. 

So what is a superbill?

A superbill is an itemized receipt form that describes rendered medical services to healthcare providers. It provides the data needed for a patient to submit their own healthcare claim to their health insurance plan for reimbursement, that includes:

  • Provider name

  • Provider office address

  • Provider phone/fax #

  • NPI #

  • License # (if applicable)

  • SSN or EIN # (If you do not have an EIN, you will have to provide your highly-sensitive SSN...a good reason you should form a legal business entity!)

  • Patient name

  • Date of service

  • Diagnosis code (ICD-10)

  • Procedural CPT code (for example, 97802 for initial assessment)

  • Number of units (one unit = 15 minutes, so 60 minute session = 4 units)

  • Fee for service

  • Amount paid

  • Balance due

  • Provider signature

Offering superbills as an out-of-network provider is a convenient avenue for insurance without being directly contracted with a health plan.

However, it is not a sustainable, long-term strategy because:

  1. Potential clients are more likely to go with in-network dietitians where there is full coverage or a low-co-pay for a number of sessions.

  2. Out-of-network providers may not be covered by health plans at all.

  3. Most potential clients often do not want to go through the trouble of finding out their out-of-network coverage or submitting their own claims.

Visit Healthy Bytes if you’re considering becoming an in-network provider with an improved reimbursement process that benefits both you and the client in the long run!