The medical and healthcare system is continually evolving and expanding. The insurance claims process is an increasingly complex system for providers to navigate, but providing accurate billing information remains a critical component of any provider’s revenue cycle.
Superbills are used by healthcare providers as a primary source of data to create insurance claims that make it more straightforward for the insurance company to keep track of what services were rendered.
In this blog, we’ll explore the intricacies of ABA therapy medical superbills. We’ll examine what they are, how they work, superbill examples, and how to submit a superbill for insurance purposes.
What is a superbill in healthcare?
So, what is a superbill for insurance in ABA therapy, and who is it for? Also known as “Charge Slips,” “Encounter Forms,” or “Fee Tickets,” a superbill isn’t really a bill at all. It is an extremely detailed receipt of services provided to patients by a counselor, therapist, physician, or other healthcare professional in your ABA therapy practice.
These superbills can boost ABA company billing processes by streamlining the insurance claim process. They contain vital information required by the patient to be reimbursed by their insurance provider. It includes everything from provider and patient information to diagnostic and procedural codes, costs, and more.
How do superbills work?
Superbill reimbursement is usually on the patient’s side rather than the practice’s. Under normal circumstances, when a patient visits an ABA therapy practice within their insurance’s network, the provider will submit a bill directly to the insurance company, depending on the plan’s benefits. The provider will then directly reimburse the practice (you).
However, it gets more complex if the patient visits an out-of-network provider. In most cases, patients must pay upfront for services they have received and then file an out-of-network claim with their insurance provider. This is where the superbill comes in. By providing detailed information about every patient encounter and appointment, the superbill provides the crucial data insurance providers need to reimburse the patient quickly and seamlessly.
What information is contained in a superbill?
The information contained in a superbill is crucial to its success, and the following information is necessary for successful superbill reimbursement.
Provider information
The provider information section contains all the details about the practice, the specific cover, and the healthcare professionals. This includes information such as the provider’s first and last name, the National Provider Identifier (NPI) number, the address and location of the office where the patient was treated, the practice’s phone number and email address, signature, referring physician’s name and NPI number, and more.
Patient information
This part is all about the patient’s personal information, such as first and last name, date of birth, address, phone number, and insurance information.
Visit information
This is the most critical component of the superbill as it details exactly what the patient is claiming for and what they received on their visit. This needs to contain information such as the date of the appointment, any fees the patient paid, and any medical codes describing the exact diagnoses and procedures involved in the visit. These will either be CPT procedure codes (medical procedures that a provider performs on a patient. CPT codes are issued and maintained by the American Medical Association (AMA)) or ICD-19 diagnoses codes (World Health Organization’s International Classification of Diseases (ICD) coding system that is used to capture diagnoses in all healthcare settings).
How to submit a superbill to insurance
As a provider, submitting the superbill for your patient is not your responsibility. However, it’s always good to be able to tell your patients how to do it. The easiest way is for the patient to send their Explanation of Benefits (EOB) and the superbill to their insurance via the website portal. Some insurance providers prefer hard copies or emailed versions, so your patient must check with their insurance provider what their preferred method is.
Outsource to medical billing experts
Superbills are just one aspect of a complex and intricate medical billing system that can be hard to keep on top of. There are myriad benefits to outsourcing ABA therapy medical billing, but we believe that freeing up your time to spend with your clients is one of the most important.
Missing Piece has over a decade of experience serving ABA providers all over the country. Our turnkey service covers everything from patient billing and claims management to pre-authorization, credentialing, and contracting. We do the heavy lifting so you can provide your clients with the highest level of care.
Contact us for more information on our medical billing services.