One of the most common questions asked about running a cash-based practice is what kind of receipt do I provide my patients and what should be included 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 patient's out-of-network 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 a receipt or “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 self submit. Sometimes all the patient will need to do is send in the print out of the receipt 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?
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 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, which is important if they require additional therapy or interventions later in the year.
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 have an “insurance benefits worksheet” posted on my website and in my FAQ page, that can help prospective patients through 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 only a massage therapist and working in California where some people have massage therapy benefits on their plans, 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 and the place of service code is: “Office Code 11”, which is for a stand-alone outpatient facility, so 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.
The beauty of a cash-based or out-of-network practice is that I do not need to meet the burdensome documentation requirements of private insurance and especially Medicare. 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 may still be requested by insurance companies, law firms and other health-care providers offices.
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
Keeping it Eclectic...