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In this post, we’re doing a deep dive into two billing words you’ll hear often as a therapist in private practice: superbills and CMS-1500 forms. We’ll be outlining what superbills and CMS 1500 forms are, while also explaining what purpose both of these documents serve in your private practice and in the medical billing world at large.

For many therapists, generating superbills for clients and printing claims forms (CMS-1500, formerly known as HCFA) serve as the backbone of their income, meaning that efficiency and reduced costs in this area, can have a significant impact on their practice and sanity.

As we know, knowledge is power–this is no different in the medical billing world of therapists. Learning more about superbills and CMS-1500 forms will help you build a stronger and more stable private practice.

What is a superbill?

Even if you have made the decision to not accept insurances in your private practice, the chances are high that you will still be plagued with many insurance questions from clients throughout your career. The most common of these questions will likely be: can I get a superbill to submit to my insurance company?

This might leave you asking some very important questions like what even is a superbill and how is it different from an invoice or statement?

A superbill is an itemized form created by medical providers and given to clients outlining specific information about services rendered and payments made. Superbills contain information clients need to submit to insurance companies to (potentially) get reimbursed for services you provided as a therapist.

What sets superbills apart from typical receipts, invoices, and statements is the information and level of detail they include. Superbill templates must contain the following information in order for insurance companies to consider requests for reimbursements by your clients:

Superbill For Optometry

• Client Information
  • Name
  • Date of birth
  • Address
  • Phone number/ email
• Practice information
  • Provider name and credentials
  • Office address
  • Contact info (email, phone)
• EIN (Employer Identification Number)
  • If you do not have an EIN as a provider, you will have to provide your (therapist) social security number.
• NPI (National Provider Identifier) if you have one
  • The 10-digit identification number assigned by the Centers for Medicare and Medicaid Services (CMS)
• ICD-10 Diagnosis code
• CPT Code for services rendered
• Date(s) of service
• Fee for service

Icd 10 Superbill For Optometry

Though the list of “must includes” may seem initially daunting, creating superbills does not have to be a time-consuming process. With TheraNest, you can generate and print superbills for all of your clients with just a click of a button.

TheraNest makes the days of scouring the internet for free superbill templates obsolete–you don’t have to worry about templates or misentering information anymore. With TheraNest, you can even email or secure message superbills from right within the TheraNest application, saving both you and your client time and money.

What is a CMS-1500 form?

Icd 10 Superbill Optometry

If you submit claims to insurance companies (or plan on it), you should be familiar with the CMS-1500 form. The CMS-1500 form is defined as the “standard paper claim form” and it is used by medical providers to request reimbursement from insurance companies for services provided to clients.

Originally the CMS-1500 form was created by The Centers for Medicare and Medicaid (CMS) for providers to request reimbursement for services from various governmental insurance plans (Medicare, Medicaid, Tricare, etc). However, since then, it has become the standard paper claim form used by most insurance companies.

Any non-institutional provider, including therapists and counselors, should use the CMS-1500 form when manually (not electronically) billing for medical claims.

Private practice billing is not easy, CMS-1500 forms are no exception. Insurance companies are notoriously finicky, a small mistake on the CMS-1500 form (or even printing the form in black and white and not the traditional red) can cause your claim to be denied outright. A denied claim can sometimes lead to hours of more work for you.

That is all to say, make sure to double (and triple) check your claims before you send them out to ensure you’ll be paid in a timely manner. Another solution to creating more accurate CMS-1500 forms (and saving time while doing it) is to look into EHR and practice management solutions.

With TheraNest, for example, you can easily print CMS-1500 forms directly for the application. Our CMS-1500 templates print out pre-populated with your client information, diagnostic codes, CPT codes, etc. The version of the CMS-1500 form you find in TheraNest is also always the latest approved CMS-1500 version required for reimbursement so you have one less thing to worry about during your day.

Sample Icd 10 Optometry Superbill

As always, here at TheraNest, we are committed to creating better tools to help you get better outcomes for your clients and your practice. Check out our resource center for therapists to find other printable tools you can use for your practice including counseling form templates and self-esteem worksheets.