super-bills-and-receipts-for-a-physical-therapy-cash-practice

Superbills & Receipts for a Cash Practice

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 it so the patient will be reimbursed? Most insurance companies do allow for patients to submit the claims themselves and this process is fairly straightforward. I find that it is much easier of a 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 the co-pay amount.

Receipts for a Cash Practice

I provide all of my patients with receipts or a “super bill” that is customized using QuickBooks, so they can submit their charges for physical therapy to their insurance company. This “super bill” 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 tax id number or EIN.

Click here for a Sample Super Bill or receipt that I use in my cash-based practice.

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 sent 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.  I have also created a “Superbill” form that you can print, fill out and hand to your patients and it is included in The CashPT Toolkit.

People who have Health Savings Accounts or Flex Spending Accounts can pay with their HSA of FSA credit cards or check books.  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?

health-insurance cash practiceThe amount patients receive depends on their individual plan, benefits, deductible and co-pay.  I do not know exactly what my patients receive; occasionally an EOB or explanation of benefits 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 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 claim.

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 patients home, use the ‘place of service code’ 12.

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 providers offices.

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About The Author

Aaron LeBauer

Aaron LeBauer PT, DPT, LMBT started a 100% cash based physical therapy practice right after graduation. He enjoys sharing his experiences in private practice and helping other therapists find freedom in practice.

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18 Comments

  • Monika Szumilak

    Reply Reply June 12, 2014

    I am a Myofascial Release therapist in Sonoma CA. It is really important for me to support my clients in receiving reimbursement for their investment in therapy. I found information Aaron provided in this blog extremely helpful and clear. It is so hard to find clear information about insurance and how it works. It is an obscure topic and I Aaron did a great job clarifying it here. Thank you so much! Monika

    • Aaron LeBauer

      Reply Reply June 12, 2014

      Thanks Monika! I appreciate your comment and compliments!
      Aaron

  • marilyn

    Reply Reply November 10, 2014

    Wow. I’m a dentist billing occasionally for medical treatments. Thank you for sharing your template and such helpful information. I had no idea there was a place of service code. It’s also sad but hilarious the insurance rep couldn’t even give you a hint.

    • Aaron LeBauer

      Reply Reply November 11, 2014

      Marilyn,
      Thanks for visiting my blog and for your for your comments! I agree, it’s so absurd I still think it’s funny.

  • Kathy Conyers, PA-C, LMT

    Reply Reply November 11, 2014

    Thank you so much for invaluable information. I am moving into full-time practice from being a PA for 25 years. I never had to think about billing, marketing or client retention. Now that I do, it helps to have such vital information. I saved this link from the MFR facebook forum. I am so glad I did! Thank you also for the template for the super bill.

    • Aaron LeBauer

      Reply Reply November 11, 2014

      Kathy,
      You are certainly welcome. Thanks for your comment and congratulations on moving into full time practice!

  • Katerina

    Reply Reply February 12, 2015

    This was great and extremely beneficial to me and my business. I found a lot of information here that many other pages and websites just don’t mention at all! Thank you Aaron, your template and information are truly appreciated!

  • Whitney

    Reply Reply March 4, 2015

    Thanks for this post Aaron! I am starting my own business as a sole proprietor with plans on offering services to patients out of their homes. Do you happen to know what location code I would need or where I could find this information?

  • Erica

    Reply Reply March 1, 2016

    Hi Aaron, thank you for sharing this information! As a massage therapist, it is out of my scope to diagnose. How would I include an ICD-10 code in this case?

    • Aaron LeBauer

      Reply Reply March 1, 2016

      Hi Erica,
      Thanks for your comment and question. Most likely, your sate massage therapy practice act prohibits you from giving patients a medical diagnosis. You should double check your practice act. If a patient has insurance coverage for massage therapy in your state, there might be a stipulation that it requires a physicians referral. In that case (or even if they come see you directly) you can contact the patients physician for the ICD10 code.

      Technically as a physical therapist in North Carolina we can not provide a “medical diagnosis of disease.” At the same time we have Direct Access, physical therapy without a referral or prescription that is required. For billing, this does present a small quandry.

      What I do is provide a “physical therapy” or “movement” diagnosis and give my patients an ICD10 code that best matches the region of their body where they hurt. I use general codes such as M54.5 “Lumbago,” M54.2 “Cervicalgia” or M25.511 “Pain in the Right Shoulder” vs. a diagnosis such as M75.111 “Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic.”

      I hope this helps.

  • Hi there! Thanks so much for this info! It’s been very helpful! I just started my own pelvic floor practice and was wondering what programs or method you use for documenting? Right now I’m just doing word docs, but I can see this becoming somewhat cumbersome once my client load starts to build.

    • Aaron LeBauer

      Reply Reply May 26, 2016

      Hey Casie,
      Thanks for your comment. You are certainly welcome. I’m glad you’ve found my blog. Congratulations on starting your new practice! That’s really awesome and a pelvic floor practice is a great specialty niche.
      For 6+ years I printed out paper forms for handwritten notes in manilla 2 punch at the top folders. This worked really well. Recently I switched to using the same forms found in The CashPT Toolkit, but stored and edited in Google drive using an iPad with a bluetooth keyboard. There are pros and cons to both, and so far I’m enjoying the switch to “digital”. I hope that helps.

  • Jessica

    Reply Reply June 8, 2017

    Thank you, Aaron! I am also a PT in NC and have started my own clinic. I am cash-based and was uncertain about providing receipts to my patients for them to submit for insurance reImbursement. Your site was exactly what I was looking for. Thank you so much for sharing your knowledge!

    • Aaron LeBauer

      Reply Reply June 9, 2017

      Hey Jessica, Thank you so much!!! It’s always great to know other local PT’s and I’m glad you found my blog and that this has helped you. thanks!!! Aaron

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