When it comes time to submit a claim for reimbursement, navigating alternative insurance billing processes can be the most dreaded step. Different billing types come with various patient needs and networks, including superbills and courtesy bills. These enhanced billing terms can leave PT professionals a bit intimidated when it comes time to submit information to insurance providers.
However, a thorough understanding of superbill and courtesy billing is a must to treat any patient that walks through your door effectively — and ensures all parties receive proper reimbursement. Here's a look at physical therapy superbill versus courtesy billing, along with a courtesy adjustment in medical billing to help streamline the billing process at your physical therapy practice.
A superbill is a document that details the treatment services a patient has received from a health care provider. This sort of billing invoice is typically requested by insurance providers for practices not currently in their company's network. It requires in-depth treatment details to assist in the reimbursement process effectively.
As part of the physical therapy claims process, a superbill is extremely important for both the patent and the provider. With a vast collection of PT treatment services often provided to a single patient, a superbill helps break down each treatment process for which the provider or patient is seeking reimbursement, so all parties receive the proper compensation.
A physical therapy superbill can be used for reimbursement purposes by either the patient or the PT provider. For instance, it's common for a superbill to be used when a patient has self-paid for PT services but has an insurance provider. In these cases, patients request a superbill to submit a detailed invoice to their provider to recoup their self-paid expenses.
As with traditional insurance claims, every physical therapy superbill must contain specific patient and provider details and a conclusive patient diagnosis to receive reimbursement. These bills must also include specific treatment details, such as CPT codes. However, a superbill expands a bit further than other types of the billing process also to include additional information like:
With the above details relating to the patient and the physical therapy practice, an out-of-network insurance provider can more effectively review and agree to issue reimbursement amounts to the patient or PT practice. Failure to include some of these details can result in reimbursement delays or even potential denials that can dramatically prolong the period for repayment.
A courtesy bill is a claim submitted to a patient's insurance company by a medical service provider on the patient's behalf after the patient has self-paid in full for the services rendered during their visit. Unlike a superbill that either the patient can submit for reimbursement, courtesy billing is always completed by the medical provider.
In many situations, the insurance will only reimburse for the amount that is contractually obligated by the patient's insurance plan. Many PT providers often charge more for services than an insurance company agrees to reimburse. This would be indicated when the patient gets reimbursed and reflected on an explanation of benefits. It's important that the practice communicate this to a patient so that they are aware of what may happen.
A typical example of courtesy billing in the physical therapy space is elderly or sports medicine patients who come in for routine therapeutic exercise or manual therapy and self-pay at the time of the appointment. A therapist may bill for Therapeutic Exercise or Therapeutic Activities on behalf of the patient.
Though physical therapy superbills may exhaust your current PT billing system, there are benefits that come from that extra work. For one, cash-based PT practices that don't accept insurance can use superbills to attract and retain clients who possess insurance coverage. Providing a superbill to these patients allows them to seek ongoing reimbursement while PT providers continue to be paid immediately.
For such patients who seek reimbursement following a PT visit, providing superbills will also streamline their personal reimbursement process by providing all necessary claim details upfront for effortless submission and reimbursement. This eliminates any need for PT providers to deal with the claim paperwork and simplifies the personal reimbursement process on the patients' behalf.
The same can be said for physical therapy practices that accept insurance but do not fall under the patient's insurance network. Superbills help streamline the provider reimbursement process by providing extra line details on the services provided to avoid any reimbursement delays or further requests from an out-of-network insurance provider.
There is no singular template or layout requirement that must be followed for physical therapy superbills. However, each superbill must contain the aforementioned patient and provider details to fulfill the criteria established by the insurance company. So, it's always best to organize these details in an easy-to-digest manner for a more efficient, quicker reimbursement process.
Here are a few superbill examples physical therapy professionals can use for inspiration:
Remember, the most critical aspect of a superbill is to include all relevant claims information, including the appropriate ICD, CPT, and claims modifiers. With the above superbill examples, physical therapists can construct a superbill template that works best for the practice, the patient, and the payer.
From the patient to the provider, no one wants to encounter difficulties when seeking reimbursement. To avoid frustrations during the claims process, physical therapists require a physical therapy billing software to help get the job done. MWTherapy is here to help.
With MWTherapy's robust billing software, PT professionals can optimize their cash-paying patient receipts to aid in creating a comprehensive physical therapy superbill. Rather than pouring over charge sheets, integration with EMR and scheduling modules helps to ensure all visits are automatically documented, supporting accurate superbills every time.
To see what MWTherapy can do for your cash-based or insurance-based physical therapy super billing processes, schedule a demo today.
