If you're interested in working as an out-of-network provider then superbilling may be a great option for you to add to your practice. Superbilling requires certain conditions to be met in order for it to be applicable as a billing option. This article will review what a superbill is, why you may choose to add it to your practice, how eligibility and payment work, and what to include in your superbill.
A superbill is a receipt for services from an out-of-network healthcare provider that details the services performed for a client. As an out-of-network Applied Behavior Analysis (ABA) provider, you are not contracted or subcontracted (such as in the case of a Single Case Agreement) with an insurer. You establish your rates for services and bill the client directly. The client pays you out-of-pocket for services and then a superbill could be submitted to their insurance company. A portion of the client’s payments may be reimbursed (paid back) for qualifying services.
Getting credentialed with an insurer can make services more accessible to clients, especially if they cannot afford to pay out-of-pocket. However, joining an insurer’s network or complying with their requirements for services may be a laborious process, especially since each insurer has its own procedures and rates.
Superbills provide an opportunity for your clients to receive ABA therapy from an out-of-network provider, alleviating some of the out-of-pocket costs for services. This is a great option for you if you’re not wanting to join an insurer’s network or are waiting to be accepted in-network.
It is important for the client to know what their benefits are before beginning services. ABA therapy or out-of-network providers may not be covered by their insurance plan. If ABA therapy and out-of-network benefits are included in their policy then part of their costs may be covered. The key to getting any portion of their out-of-pocket costs reimbursed is through a superbill.
To learn if a client is eligible for ABA therapy and has out-of-network benefits, either you or the client can contact member or customer service (the number is located on their insurance card) and ask for information regarding the client’s individual plan. If the client’s insurance company confirms that they are eligible for ABA therapy and have out-of-network benefits, they may be reimbursed for some out-of-pocket costs. Each plan is different, and prior authorization may be needed to access benefits. Note that Medicare recipients do not have out-of-network benefits and will not be eligible to superbill.
Once the client has this information, they can make a more informed decision about working with you. If a client's plan does not cover ABA services with an out-of-network provider, they may still choose to continue with non-reimbursable private pay services. In this case, you must comply with the No Surprises Act and provide a Good Faith Estimate for private pay services.
If the client’s plan does cover ABA services for out-of-network providers then set up a superbill payment plan.
A superbill claim can be submitted to the insurer by either you or the client (although it’s recommended the client be responsible for submissions to reduce your non-billable time). When a superbill is received, the insurer assumes the client has already paid for services rendered and that the payment is, therefore, reimbursement, which is typically paid directly to the client. As such, a superbill statement should only be provided to the client or submitted to the insurer after payment for services has been made, otherwise, there is no guarantee of payment. Billing practices should be discussed prior to the onset of services and be included in the agreement for services.
In order for a client to receive reimbursement, they must provide a detailed invoice with specific information about the services rendered. A complete superbill includes all of the following information:
Superbilling is a relatively new concept to billing for ABA therapy. Here are the key takeaways from this process:
TreSource offers ABA providers numerous resources to establish, operate, and thrive in practice. If you would like assistance with establishing and operating your practice, check out the following resources: