A Beginner's Guide to Superbills & Receipts for a Cash Practice
By: Aaron LeBauer ∙ Estimated reading time: 5 minutes

Introduction

Hello! I'm Dr. Aaron LeBauer, PT, DPT, LMBT, RYT. I host The CashPT Lunch Hour Podcast and the CashPT Nation Facebook group and have helped thousands of passionate physical therapists create and grow successful businesses without relying on insurance. You can read my full bio at the end of this blog.

One of the most common questions asked about running a cash practice is 'What kind of receipts do I provide my patients?' And 'What should be included on them so that the patient will be reimbursed?'

Most insurance companies do allow patients to submit the claims themselves and this process is fairly straightforward.

I find that it is a much easier process for the patient to do this than for the provider.

Typically there is a 1-page form that needs to be completed for each visit and mailed in. Once the deductible is met, then the insurance company should provide a reimbursement payment to the patient for payments made greater than their co-pay amount.

If you're considering starting a cash-based practice, my free book, The CashPT Blueprint, is a great place to start. Get your free copy here.

Receipts for a cash practice

I provide all of my patients with receipts or a 'Superbill' that is customized using QuickBooks, so they can submit their charges for physical therapy to their insurance company. This 'Superbill' contains all of the information they need to submit their own claim to their insurance company. I include their ICD-9 diagnosis code(s) and CPT treatment codes along with all of my practice information, a signature, and a tax ID number or EIN.

You can also choose to use a practice management system, such as Embodia, that offers fully built-in Superbill functionality.

Instructions for patients

I instruct my patients to be sure to let their insurance company know that they have already paid for the services and that the reimbursement should be made directly to them. Patients are directed to contact their insurance company to obtain the form which they should fill out to submit a self-claim. Sometimes, all the patient will need to do is send in the receipts I provide them.

People who have Health Savings Accounts (HSA) or Flex Spending Accounts (FSA) can pay with their HSA or FSA credit cards or checkbooks. I let my patients know that I am happy to answer any of their questions and I will provide any documentation they need directly upon their insurance company’s request.

How much do patients get reimbursed in a cash practice?

The amount patients receive depends on their individual plan, benefits, deductible and co-pay. I do not know exactly what my patients receive; occasionally an explanation of benefits (EOB) is also mailed to my office. I do know that most of my patients do not spend $1000 in my practice and many people have large co-pays.

A typical patient with a $1000 or greater deductible may not receive a reimbursement unless they have already had out-of-network therapy elsewhere. This will still allow the payments to count towards their deductible. This is important if they require additional therapy or interventions later in the year.

Insurance questions

Most people do not understand or know what their insurance benefits really are. They may know what their co-pay is, but then have no idea what their deductible or other benefits are.

For this reason, I created an insurance benefits worksheet' that is also posted on my website. This is to help prospective patients navigate the phone call they can make to their insurance company to verify their benefits and figure out how to file their claims.

Essential & “secret” info. to include

A long time ago, when I was working in California as a massage therapist, where some people have massage therapy benefits, one insurance company wanted me to identify the ‘place of service’. I mean really? Did they not know it was at my business?

After calling, waiting on hold and finally talking to someone, I asked her what this was. She told me that is was a code for where the treatment was provided, but that she could not give me the specific information (the exact code) I needed as it was not her job.

Anyway, I finally found it elsewhere. The place of service code is: 'Office Code 11', which is for a stand-alone outpatient facility. I include that on all my receipts as well. If you travel to your patient's home (MobilePT), use the place of service code '12' and if the location your patients receive services is via video for Telehealth or Telemedicine, the place of service code is '02'

I also include a Bold Red line stating that "the patient has paid for the service provided in full and LeBauer Physical Therapy is NOT an insurance provider for this claim. Please provide payment directly to the patient.” Occasionally, I will still receive a reimbursement check made out to my practice. 

Request for medical records

If a company (insurance, law firm, etc.) requests patient records, I ask for a $50 administrative fee as a pre-payment.  Many requests have started to come in with this information already in the cover letter. Sometimes, there is a standard fee that is determined by law that will pay per page. I learned this lesson the hard way by sending out notes before payment to a law firm, which did offer to pay for the notes.

The payment took 3 months and 6 phone calls to collect. I only persisted on principle. On another occasion, I was asked to provide my treatment notes for a patient. When I called, I asked how they would like to pay for this ‘reasonable’ amount and the representative said they did not provide payment for treatment notes.

I restated my request two more times and then asked for the manager. After speaking with the manager the representative of this insurance company told me that they would just reprocess the claim for my patient.

Documentation standards

As you can see, this is still an important process, however, the patient evaluation, plan of care, and daily notes still need to be completed with the same diligence and accuracy as a traditional practice since they are still requested by insurance companies, law firms, and other provider's offices.

Tools mentioned in this blog

We hope that this fantastic blog from Dr. Aaron LeBauer inspires and helps you in your future or current cash-based PT practice. Dr. Aaron is on a mission to save 100 million people from unnecessary surgery by helping other passionate therapists succeed in business and learn how to market directly to patients. Here are some of the tools listed above that can help his mission, and your cash-based practice: 

• The CashPT Lunch Hour Podcast 
  
  
• CashPT Nation Facebook group
  
  
• The Free CashPT Blueprint Book
  
  
• Embodia's Practice management system with fully built-in Superbill functionality for your cash-based practice 
  
  
• Aaron's Insurance benefits worksheet to help prospective patients navigate the phone call they can make to their insurance company to verify their benefits and figure out how to file their claims.

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Date published: 2 Feb 2024
Last update: 2 Feb 2024