6 ASHA Superbill Considerations for the Private Practice SLP

private practice slp asha superbill

The first thought many SLPs have when considering private practice is to avoid insurance at all costs. For some private practice SLPs, that is not an immediate option, but for others, it is. When going that route, it’s also important to understand that some of your clients may still want to access their insurance benefits. In those cases, instead of the therapist filing the claim, they often opt for the client to file the claim themselves. This is done with a superbill. 

WHAT IS A SUPERBILL?

A superbill is an itemized receipt that documents the client’s visit after payment. This document includes several components, and each must be completed before the insurance company accepts submission as proof of services to possibly reimburse your client’s visit. The components of the superbill include:

Contact Information

This includes the client’s name, date of birth, and address. The SLPs contact information, NPI and EIN are also required for this document.

Diagnosis

Although some clients may choose private pay to avoid the labels of a diagnosis, if they seek to be reimbursed by insurance for the visit, you must include an associated diagnosis.

Services

This is represented by Current Procedural Terminology (CPT) codes, which describe that you actually did with the client. Also considered are the Place of Service (POS) code and modifiers.

PRIVATE PRACTICE SLP CONSIDERATIONS
  1. A superbill is still an insurance claim and requires much of the same information that appears on a CMS-1500 form.
  2. Verification of the member’s benefits is paramount to avoid financial surprises and future claim hiccups.
  3. Use of superbills still requires the rules of the plan to be followed. This may include submission of notes or requesting a preauthorization. Failure to provide defensible documentation or not submitting a request for pre-authorization before the first visit can lead to negative outcomes.
  4. Selecting the correct diagnosis matters. Choosing a diagnosis without a clear understanding of coding rules can result in a denied reimbursement request.
  5. Companies like Advekit and TheSuperbill will submit your client’s superbill for you, while offering your private pay rate. For this convenience, these companies accept the difference received from the insurance company after courtesy billing the claim for you.
  6. Private practice SLPs who choose to submit their own courtesy billing can receive up to 50% more on their claim than their private pay rate. Your success and efficiency in submission depends on your understanding of billing and coding rules
  7. One more thing to consider: Are you setting your rates accurately for providing superbills?
  8. BONUS: Medicaid beneficiaries usually do not benefit from the provision of a superbill.

If you are ready to challenge what you think you know, The Superbill & Your Rates will help you put all of this information into perspective.

ASHA has taken the liberty to provide a robust superbill template, which requires some editing: Superbill Template for Speech-Language Pathologist.

Note: ASHA’s superbill templates do not dictate which services should or should not be listed on the bill and do not imply coverage by payers. Some procedures, codes, or other pertinent information required by a payer may not be included in the templates. Practices and clinicians are responsible for understanding individual payer policies and coverage guidelines to ensure complete and accurate claims submissions. Documentation by the audiologist or SLP should support the selection of diagnosis and procedure codes and justify the medical necessity of services submitted to payers for reimbursement.

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