What is a Superbill for therapy?
June 2, 2022
Private mental health practices have been accepting cash for as long as they’ve existed, but there has been growing pressure from clients to accept health insurance. There are many reasons for this push, including the fact that in hard economic times, clients will have less cash on hand. As therapy and counseling grows in popularity, clients now view their therapists in the same way they view their family physicians, who they assume will readily accept their health insurance for therapy.
What is a Superbill for therapy?
A Superbill is essentially a receipt for an out-of-network therapy session. It contains the basic information needed by insurance companies before they can approve payment. It will serve as a statement of service(s) from a provider which reflects the date of service (DOS), the service code or CPT code, the diagnosis code, the amount the provider has billed their client for the session, and the provider’s credentials.
A private pay therapist requests payment for each session up front from their client, then issues a Superbill for them to submit to their insurance company. The reimbursement received will depend on the individual’s healthcare plan at the time the claim is processed. While there might not be anything unethical about this process, the way Superbills are presented to clients can be seen as misleading and confusing, as is the health insurance industry overall.
Can you submit a Superbill for teletherapy?
The way therapy sessions are rendered has changed significantly in the last few years. KRR estimates that about 36% of all outpatient mental health and substance abuse visits are still being done via telehealth, as compared to 1% before the COVID-19 pandemic. Conversely, filing claims hasn’t changed much at all. Clients can still submit Superbills for a teletherapy session as long as it includes certain telehealth indicators that insurance companies expect to see. These indicators are called place of service (POS) codes and modifiers. 2022 telehealth regulations from the Centers for Medicare and Medicaid Services (CMS) have revised the description of the original telehealth POS code ‘02’ and created a new code ‘10’ as follows:
- POS 02 - Telehealth Provided Other than in Patient’s Home
- POS 10 - Telehealth Provided in Patient’s Home
A modifier of 95 should accompany either one of these POS codes to let insurance companies know that a session was done via phone or video call. Luckily, most EHRs can be configured to automatically add these indicators to your Superbills depending on the location selected. If you’re not sure how to update your location options for a session or change your coding sessions, you can always reach out to your EHR’s support team. If you have any questions, we’re here to help. Feel free to email us at email@example.com - we aim to get back to all inquiries within 24-48hrs.
Are Superbills the best way to get reimbursed?
Problems inevitably arise when clients try to obtain insurance reimbursement. Simply having a Superbill does not guarantee reimbursement from an insurance company. It will still be up to the client to check their own benefits. Some insurance companies will also ask their members to fill out a separate member-submitted claim form along with the Superbill and submit both online.
In addition, many clients don’t realize that their insurance doesn’t pay a therapist’s full fee. In most cases, an insurance company will only pay up to half of it. Insurance plans, even those with out-of-network benefits, will seldom pay above their own customary rate. In fact, out-of-network benefits will often only cover a percentage of the customary rate. This can be seen as a type of “penalty” for choosing a provider that is out of their network. Another downside is that some insurance companies have separate deductibles for out-of-network and in-network services. So even if a client has out-of-network benefits and has met their deductible for in-network benefits, they might not have met their out-of-network deductibles. This means they might not get any reimbursement after all.
A majority of clients do not have out-of-network benefits in the first place. As health care costs continue to increase, most individuals are choosing HMO (health maintenance organization) plans over PPO (preferred provider organization) plans. This means out-of-network benefits are nearly non-existent. Note that in these situations the client will not receive any reimbursement from their insurance companies after seeing an out-of-network therapist.
Why take out-of-network insurance?
Some therapists experience such high demand that they will never need to consider accepting insurance to help bolster their clientele, and for them, cash will continue to be king. However, for many therapists, especially those beginning their journey in private practice, accepting health insurance means getting to say yes to more clients. Said in another way, by not accepting insurance (even just out-of-network insurance) therapists, especially starting out, run the risk of having to turn away potential new clients. Nirvana believes that by making mental health insurance more transparent, claims filing more automated, and reimbursements more streamlined, we can help you grow your practice.
How to get out-of-network claims paid with Nirvana
Nirvana Health is an automated eligibility, benefits, and claims filing software that can help you take care of your mental health insurance billing without interrupting the flow of your operations. We provide therapists with a variety of services like insurance eligibility and benefits verification, medical coding, rejected claims management, clearinghouse edits (data scrubbing), provider enrollment services, data entry, and customer support. Most importantly, with Nirvana you won’t need to generate paper Superbills for your out-of-network clients anymore. Using Nirvana can help you reduce your practice’s overhead costs, increase the amount of reimbursements you receive, and decrease claim denials and rejections, all while allowing you to put your focus back on your patients rather than spending hours on billing reports.
Nirvana offers instant verification of benefits through our eligibility calculator, automated claims filing for out-of-network provider reimbursement, and insurance reimbursement tracking. Contact us at firstname.lastname@example.org or schedule a live demo with us if you would like to learn more.