Getting started: Superbills
A Superbill is a specialized receipt outlining the services you have provided your Client. Clients can submit these to their insurance companies to (potentially) get reimbursed for services rendered; we've alternatively seen some providers submit Superbills on behalf of their clients. Importantly, even when preparing a Superbill for a client, you still collect payment from client at time of service, and any reimbursement provided by an insurance company goes to the client directly. This is distinct from completing and submitting the CMS 1500 form directly to an insurance company.
Healthie's platform makes it easy to automatically create and electronically share Superbills with your Clients.
IN THIS ARTICLE:
Generate a Superbill
You are able to electronically generate a Superbill within the Healthie platform, that is automatically shared with clients.
To do this, navigate to Billing > Superbills > New Superbill > Complete Required Fields
To share this Superbill with your client, Navigate to Superbill > [...] > Share. The Superbill is then shared with your client and accessible via their web portal. Details below.
Completing Fields Required in a Superbill
Superbills require specific information about the nature of your services, including personal and business information, your NPI number, CPT codes, ICD-10s, and more. Healthie's Superbill platform will automatically pre-fill information on file for a client and yourself to save you time when generating a Superbill for a client. You'll notice that fields will pre-fill as you Generate a Superbill, based on information stored in a Client's Profile.
Here are the required fields of a Superbill. Items with an asterisk are REQUIRED and are meant to guide you in completing a Superbill that will be accepted by your client's insurer.
- Client Basic information: Includes basic information about your Client, including Name, Date of birth, Address, Phone Number, Insurance Information
- Provider Basic information: Includes basics about your practice, including your Name, E-mail address, NPI number, Organization Name, Tax Number, and Office Address. After you create an initial Superbill, basic information, including NPI and Tax Number, will auto-populate within subsequent Superbills.
- NPI Number: Your NPI number is a 10-digit numeric identifier given to all covered providers as an Administrative Simplification Standard under HIPAA. Your NPI number is not your Social Security Number. To get your unique NPI number, you must apply through CMS.
- Tax Number: Your Tax Number, or Employer Identification Number (EIN), is a unique nine-digit number that you use when filing taxes for your nutrition practice. When submitting a Superbill as part of an organization, be sure to include your organization's EIN, not your individual EIN, as the organization is who is submitting the claim and receiving payment.
- Referring Provider information: If your client was referred to you by another provider, you’ll want to include this provider's information, including their Name & NPI
- ICD-10 code(s): The International Statistical Classification of Diseases and Related Health Problems, usually referred to as ICD-10, is an official listing of health issues that providers can encounter. Healthie includes a dropdown of ICD-10 codes within the platform for your use and inclusion within a Superbill.
- CPT code(s): The Current Procedural Terminology code is an index of medical and health services created by American Medical Association. We recommend listing all codes that correspond to services you have provided, as insurance companies reimburse based off of CPT-codes indicated. You'll also want to complete the # of Units, the Fee per Unit
- Billing information: This is the amount paid by your client for the service, typically related to the Units & Fee Per Unit
- Units: typically represent 15 minutes of care. So if you worked with a client for 60 minutes, you would bill 4 units.
- Fee: this is your fee per unit. If you charge $100/hour to see a a client, this would represent 4 units at $25 per unit. So in the "units" you'd enter 4 and the "fee" 25.00.
- Amount Paid: the total amount that your client has paid for your service. Typically with Superbills, your client will pay out-of-pocket for the fee, and then seek reimbursement from their insurance payer. If you client paid $100 for your service, you'd enter "100" in the amount paid.
- You'll see the billing details auto-calculate on the completed Superbill, including any "client-owed" amount if there is one.
- Modifier codes: You are able to add in modifiers on a Superbill as another line item.
- Diagnostic Pointers: this allows you to match WHICH client diagnosis services were rendered for. You can only select one diagnosis as your primary. Add all of your diagnosis codes in the "Diagnoses" section, and then choose ONE code in the "Billing Items" section as your primary.
Adding another service date
When creating a Superbill, you can add another service date. To do this:
1. Navigate to the "Billing Items" section
2. Select (+) Add Billing Item
Note: for each service that you add, you must choose a diagnosis code that correlates to the service rendered. You will also have the option to add specific modifier codes, units, and billing fees for each service added.
Line Items & Payments
In some cases, your client may have made a payment for a non-service that you'd like to include within the Superbill (ie. a lab test). You can add a "Line Item" along with a description within this section. Some providers also use a Line Item as a way to include taxes, however, please refer to your state & insurance payer regulations re: taxation.
The Payments section is meant to include the total amount that your client has CURRENTLY PAID.
Typically, Superbills are given to clients who have self-paid for a service, and they are seeking reimbursement directly from their insurer. That means, as a healthcare provider, you have already collected payment for the rendered services. Please include the amount collected in the "Payments" box.
How clients access Superbills
When you create a Superbill and share it with a Client, they will receive an e-mail notifying them that you have shared a Superbill with them. They will be prompted to log into their Portal > Superbill > View / Print Superbills. To preserve HIPAA-compliance, the Superbill will not appear as an attachment in the e-mail notification sent to a Client.
Downloading a Superbill on behalf of a client
There may be instances in which you'd like to download and Print a Superbill, for example, to share this with a client when you are working with them in person. To do this:
- Navigate to "View details" on the Superbill you'd like to Download and Print
- Click "Download"
- You will be prompted to view a PDF, which you can then print for your / client records.
Editing a completed Superbill
To edit a completed Superbill, Navigate to Superbill >View Details > More > Edit. Immediately as you save these changes, they will go into effect on the client's version of the Superbill.
Why offer Superbills to Clients
If you are not credentialed by an insurance company, or considered out-of-network for your client's insurance company, you are able to provide a Superbill to clients, for the possibility that some or all of the services they received from you will be covered. You are required to have an active NPI number in order to generate Superbills for your clients. You still receive payment at time of service, but this may potentially reduce the net cost of care for your clients, as some insurance companies will cover a % of services from out-of-network providers, and/or apply services towards a client's deductible. Coverage from a Superbill will depend on variables like ICD-10 codes and CPT codes, and coverage on a Client's particular plan.
We recommend that Clients call their insurance company to look into benefits coverage, and find out the likelihood of reimbursement from a Superbill.
To track the outcomes and reimbursement rates for Superbills, you can navigate to Billing > Superbills. This page will give you quick-glance insights into the status of claims, and the reimbursement amounts.
This brief overview video walks through the core features of Healthie Insurance Billing, including how to create CMS 1500 claims and Superbills, and how to share a Superbill with a client.
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