Hallie Bulkin explains why private practice clinicians who don't bill insurance still need superbills and CPT codes. A superbill must include the date, provider name, diagnosis, fee paid, and the exact service rendered. CPT codes must match what was actually done and who did it.
Because I run a private practice, I want to speak directly to clinicians who might be thinking, but like, I don't take insurance, Hallie, so do I really need to care about all this? Yes. Yes, you do. Sorry to say. Sorry, not sorry. So you may not be submitting the claim, but you're providing the document the patient uses to request reimbursement, right? If they are requesting. That superbill needs to accurately reflect date of service, the rendering provider, the diagnosis, the fee they paid needs to show that it's— that needs to be zeroed out so that insurance understands they paid you already to reimburse the family. And then the service provided needs to be on there too. We cannot promise that insurance will reimburse the patient. We should not tell a family insurance will definitely can't cover this because we don't control their insurance plan, right? Or who's reviewing it that day. But we are responsible for making sure the information that we provide to them is accurate. And so that means we cannot choose a code because we think it's more likely to get reimbursed, right? The code has got to match the service. It also has to match the provider who performed the service. So if the service was feeding or swallowing treatment, the superbill should reflect that. If the service was speech treatment, the superbill should reflect that. If 2 distinct services were provided, right, and they were appropriately documented so we can see that both were provided, then maybe the superbill has both.
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