After my last post, I had some follow up questions about the specifics of the self-claim receipts I provide my patients. Given that my treatments are all one hour long with the majority of the time dedicated to Manual Therapy and always at least a review of the HEP, here’s what my receipts include (along with the obvious business and patient identifying info):
- Business Tax ID/EIN #
- ICD9 diagnosis codes
- CPT codes
- 3 x Manual Therapy (15 minutes each) at $30 each
- 1 x Therex (15 minutes) at $30
- My credentials, Texas License number, National Provider ID #, and signature
Author Note – Jan 2013: in addition to the above info, please also include:
- Location of Services: Outpatient Clinic (stand alone), code = 11
- A note at the bottom (in bold large font) that the patient has already paid in full for the services, and that any payment should be sent directly to the patient
Here is a template you can work from:
Cash-Based PT Receipt example template
Optimizing receipts for your cash-pay practice
Please note that the receipts your patients need for a successful self-claim may be very different from what I’ve outlined above. You know those insurance companies … they’ll do whatever they can to deny a claim. With that said, the above format has been accepted by most insurance companies when my patients send in self-claims. There are of course times when a company will say info is missing, and after 20 minutes on the phone, they admit that everything needed is actually all there. If time on the phone becomes a common issue with a particular patient and his insurance company, I inform the patient that this is one of the reasons I don’t deal with insurance; and that more of my time on the phone will need to be paid for. It’s tough to say these things, but you have to protect your time. After all, you didn’t move to a private-pay business model to continue spending time on the phone with insurance companies.
Over the past year, I’ve spent less than three hours dealing with insurance companies or insurance-related issues for my physical therapy practice in Austin. Take a moment to imagine how nice that is … no research or meetings to figure out how to comply with the latest Medicare reimbursement changes, no (re)negotiations of low-paying contracts with insurance companies, no more reports from your salaried billing staff (or outsourced billing company) on why you only received 45% of the enormous bill for Mrs. Jones. It’s awesome.
Interested in the cash-based private practice model?
Click Here to learn how to start your own Cash-Based Practice
Thank you, Jarod! You’re the best! Great inspiration!
Christine
Thanks Christine. Great looking site and so exciting to see you already have a cash practice going! I recently received an inquiry through the Private Practice Section from someone interested in creating a Women’s Health program. Could I refer him to you for some input?
This is so helpful I had no idea about how to manage all of the receipts correctly!
Jarod,
great post on receipts for cash pay patients.
A long time ago, when I was actually only a massage therapist, 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 and finally talking to someone, I asked her what this was, she told me, but also said she could not give me the information (the exact code) as it was not her job.
Anyway, 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.
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.”
Also, in your experience how do you handle it when an insurance company sends you a check made out to your business, when they should have sent the check directly to the patient? that might be another good blog post topic. This has happened infrequently but I just had a cluster of checks about 3 months ago.
If a company (insurance, law firm, etc) requests patient records, I ask for a $50 administrative fee up front. I learned the hard way by sending out notes before payment to a law firm, that offered to pay for the notes, which took 3 months and 6 phone calls, to recoup. also by asking for this ‘reasonable’ amount to be paid, 3 times and asking for the manager, one insurance company decided to reprocess the claim for my patient.
Aaron LeBauer
LeBauer Physical Therapy
Thanks for the great info Aaron!
I’ve never heard of the “place of service” issue, but it’s good to know the code if it ever comes up.
I also haven’t had any insurance companies send me checks directly, but that occasionally happened at the Cash practice where I previously worked. Like you, I would call the company and inform them to send the payment directly to the patient; then I’d go have a nice steak dinner with the check (Ha!). Since I hadn’t had to deal with this since starting my practice I forgot about adding the “this patient has paid in full… pay them directly” statement. But I just added it to my receipt template. Thanks!
For those who have not already read it, you can find my interview of Cash practice owner, Aaron LeBauer, here
Had to throw this in here…
Had a call from a patient today saying that United Health Care told her they not only needed my Employer Identification Number (EIN) listed on the receipt, but they also needed my Tax ID Number before they could process her self-claim. I had my accountant email her the explanation that these are two terms for the the exact same thing, so she could forward that to the geniuses at UHC. Like I said above… they’ll do anything to keep from paying.
Hi Jarod,
Want to say all your information has been extremely helpful. I recently have started a cash based private practice and one question I have is do I need to contact the insurance companies to become a “provider” in order for the treatment to be covered even as an out of network provider?
Thanks for you input.
Suzanne
Hi Suzanne,
I’ve never heard of having to contact an insurance company to become an “out-of-network” provider. I’m pretty sure you are either in-network with them or not. However, I should say that I’ve not looked deeply into this idea and haven’t called any 3rd Party payors to see if they have a list of out-of-network providers that I could be on (to get my patients better reimbursements). It may be worth it to call a few of the most-used payors in your area and ask them directly. If you do, please let us know what they tell you.
Jarod,
Thanks for all the great info. on cash-based service. Insurance companies aren’t going to increase reimbursement rates until we, as a profession, offer a little push-back.
I am currently working for an employer 2 days per week offering insurance-based PT service. I am self-employed 3 days per week offering cash-based PT and renting a space at a high-end Fitness Facility. It’s a great arrangement for me and I’ve been fortunate to stay completely booked. I am looking to expand and do things completely solo. I am torn about going completely cash-based as I still want to provide services to those who can’t afford the cash yet have decent insurance. I’m just curious: have you ever heard of anyone operating 2 businesses at one physical location? I am thinking about starting up a second company for the purpose of accepting insurance contracts on limited basis. My established company, Balanced Body Rehab, would continue to offer out-of-network/cash options for wellness PT and option of greater one on one care. Is this legal? I don’t see why it wouldn’t be but I guess it depends on the language in the contracts. Your thoughts? Thank you.
Josh
Josh,
First of all, congratulations on your booked cash-based schedule. Sounds like you won’t have a problem expanding to full time. As for your question … you’ll have to be very careful about the contracts you sign with any insurance companies because they can have clauses that mandate you bill them directly for covered services provided to anyone who carries that specific insurance. For example, let’s say you sign a contract with BCBS that has such a clause, and you have people who want to see you on a self-pay basis (to get longer one-on-one treatments) but are insured by BCBS; though they want to be self-pay, you could be in violation of your contract by Not directly billing BCBS for those services.
The take home point is that if you want to have both cash-based and insurance-based patients, you should have a health care lawyer look over any contracts with insurance companies before you sign them. You also need to keep in mind that there could be clauses in contracts that dictate what you are required to charge your cash-pay patients. One example is a “most favored nation” clause that essentially mandates you charge the insurance company no more than you charge others. So you have to make sure the definition of ‘others’ does not include cash-pay patients … otherwise you could be forced to charge them as much as you charge the insurance company (which could be prohibitively expensive for many of your patients).
There are probably more legal components to the question you asked, so definitely consult with a lawyer before making any moves. The idea of having two completely separate and different legal entities may provide a solution, but I really can’t say for sure.
Thanks for the great question. Best of luck!
Thanks Jarod! I appreciate the time you took on your response. It’s refreshing to see PT’s working together rather than in perpetual competition with one another. I will definitely seek the advice of a health care lawyer before signing the contracts. Once I get my hybrid model of business established, I’ll try to share any helpful insight to the post. Keep up the great work!
your fellow t-DPT USA grad,
Josh
Jarod,
Thank you for the comprehensive information you have been providing.
If you would be kind enough to provide to the best of your knowledge clarification on the following:
1. I’m a cash based PT having nothing to do with Medicare. I am now seeing those patients who come under the heading of wellness, maintenance, general fitness.
With that being said, how should my receipts be formatted? Should I be including specific CPT codes rather than something more general?
2. It has been my understanding from some other PTs that if a Medicare patient falls under the above-mentioned categories, there is no need & it is actually better not to give an ABN. Your thoughts?
3. How & where do I go to find out if patients have capped out so I can treat them as well? I don’t have administrative staff; will I be spending an inordinate time on the phone trying to get accurate info?
Thank you again for your excellent work.
Hi Mindy. Thanks for the great questions.
1. The first is one of those questions where the first part of my answer has to be that you should ask an attorney to be sure. There may be rules that CMS has on this and there may also be components of your state’s PT Practice Act that mandate the use of CPT codes even with non-covered services. I honestly don’t know. I personally make sure to list the term “fitness,” “maintenance,” etc depending on what I’m providing. I think it is important to have those non-covered services specifically listed on the receipts you provide, just in case your client tries to send a self-claim to Medicare.
2. If the patient is continuing care on a “maintenance” basis, then it is necessary to provide an ABN (which would only apply to your situation if they had met their therapy cap at a different clinic and then wanted to continue care with you on a self-pay basis). If you are seeing a Medicare beneficiary for fitness/wellness/prevention (“Statutory” reason), then you are not mandated to provided an ABN. However, I’m simply repeating the advice I received from the APTA that it is “best practice” to provide an ABN anytime you’ll be providing any service that will/may not be covered. As I understand it, the ABN is a way to make sure your MC-aged clients are completely clear on what they will have to pay out-of-pocket. I can’t see why a practitioner wouldn’t want to do this, so I’m curious if the PTs who told you the above information also told you why they thought it was better to not provide an ABN?
3. That’s a good question … perhaps other PTs who have had to do so could also chime in here and give us some guidance? I see very few MC beneficiaries, and I haven’t had a situation in which they may have capped elsewhere and wanted to continue maintenance care with me.
When it comes to my patients and any type of insurance reimbursement questions, I leave it in their hands to figure things out with their insurance company. I know of out-of-network PTs who do have staff to help people find out what their reimbursement would be with self-claims. However, this is obviously different with the Medicare population because you really don’t want them sending in any claims trying to get reimbursement. If I were you, I would just call CMS and start asking around. It may take some time, but perhaps there is in fact a person/office you could call and quickly confirm if a cap has or has not been met.
Can any other readers out there help us on this one??
Thanks for the post Jarod.
Quick question. What software/program do you use for the itemized receipt? I’ve heard quickbooks isn’t HIPAA complaint, so wouldn’t want to use patient names to create receipts/invoices through that system. Are you just using a template for this? Any help would be appreciated.
I go the cheap simple route and use a template I created on MS Word.
Hi Dr. Carter,
I have a small private PT/personal training business that is an LLC that has an address listed out of my house, but I rent a space at a different office for treating patients. Since the LLC and the EIN are associated with my home address, is that going to be a problem for patient’s to receive reimbursement since the address is residential and not the location where I am treating?
Thanks so much for this website, it is really helpful for starting up a cash based business.
Hi Aron, I think you should be okay because I’ve done the same thing…. PLLC at my home address but all billing/receipts have my office address, and there hasn’t been any issues so far. Let me know if this proves different for you.
Hi Jarod,
Thanks for a great post!
I’m sorry if I missed this earlier in comments. I have a new cash practice and my patients are just starting to submit for out-of-network benefits.
1. I have a set flat fee for my evals and treatments, but I don’t mark each charge as a set fee (i.e. $30 per 15 min manual). Does this need to be delineated? I use WebPT and just put “4 manual” and then charge the patient the set fee and provide a receipt. Is this enough for patients to get reimbursed?
2. I’m in a direct-access state, so patients are finding me and coming in without scripts. However, I’m concerned that they won’t get out-of-network benefits if they don’t have an RX from day one. What has been your experience? (I realize that this will vary for each insurance company). I try to alert patients about this, but they still come in without an RX and then want to try seeking reimbursement.
I hope this makes sense.
Thanks!
Tracy
Thanks for the questions, Tracy. And congratulations on starting a new cash practice!!
To answer your questions…
1. Delineating the charges per unit (15 minutes) is necessary for your patients to get reimbursement, so you are correct there. AND the receipts you provide your patients still need to utilize CPT codes and all other information needed to process a claim (ICD9 codes, Tax ID number, NPI number, location of service, etc).
Here is something it sounds like you need to consider: your State Practice Act may dictate that you charge specifically for the procedures you perform. For Example, if you are doing 15 minutes Evaluation, 30 minutes Manual, and 15 minutes Therex, but then giving everyone a bill that says “4 units Manual Therapy,” you might be breaking the rules of your practice act, so this is something you need to look in to.
Many private-pay practices charge Flat Rates per treatment session. That can work, but like I said above, billing must still be split into CPT codes and the different procedures performed, and your pricing per CPT code and total units performed obviously need to add up to that flat rate. So flat rates can cause problems if your treatment times and procedures are somewhat varied from one patient to the next.
If you want to go the route of having a flat rate per visit, then it’s easiest if the time spent in each session and the CPT codes used stay fairly consistent.. which doesn’t have to be that hard actually.
For example, before I raised my rates in January 2013, I collected $120 for each one-hour treatment, which I showed on the patient’s bill as 3 units of Manual Therapy and 1 unit of Therex at $30 each unit. If my treatment veers from these procedures, then I change it accordingly, but I charged $30 per unit of any procedure to keep things simple and consistent. Now that my rates are higher, my fee schedule is slightly different, but still adds up to the total flat fee and is properly delineated on the patient’s receipt.
2. Must be nice to have Direct Access!!! Our legislative session just began, so we will again be fighting hard for Direct Access in Texas. Since my patients don’t have direct access to my services, I don’t have experience in this realm. However, my input would be that if you let patients know ahead of time that they may need a referral in order to successfully submit self-claims, then the ball is in their court to find out from their insurance company and get the referral if needed.
We have been expected to take the time (and substantial cost) of getting paid/reimbursed for our services, pretty much forever. So those of us moving into the cash-based realm have patients who are now taking on that responsibility and taking the time to get reimbursement. If they run into problems (which insurance companies will often create), I try to help however I can, within reason. But when the insurance company doesn’t relent and finds new reasons to deny, I explain to the patient that “this is exactly why I got out of the insurance racket.” “Can you imagine fighting like this to get paid for the majority of the work you do?”
I really do appreciate your reply. However, admittedly this has opened up another can of question worms…ha.
1. I do charge differently for each patient. So, I could set each charge at the same amount to make it easy. But, where do I show that each charge is, for example $30? How do you have this set up to show that? My receipt just shows the pay amount and my WebPT super bill just shows the amount of charges i.e. 3 manual, 1 ther ex. What do you use to show the charge? Can I have a separate pre-made form for that?
2. Regarding the following- (ICD9 codes, Tax ID number, NPI number, location of service, etc). NPI number? How would I get that if I have only done cash-based? Did I miss getting that? Do I have it and not know it? Yikes.
The rest I have covered, but didn’t realize the tax ID has to be on my bill…Thanks for that!
Tracy
1) I would hope that WebPT allows you to place the “charge per unit” next to where you list the units of manual/therex/etc. These do need to be delineated on the bill to improve your patients’ chances of reimbursement (and decrease the time you’ll have to deal with insurance companies wanting more info from you. My receipts are simply created from a Word doc template… so it has 3 units Manual Therapy (CPT code) $30ea , total $90; and 1 unit Therex (CPT code) $30ea. TOTAL $120
2) You can get an NPI number here for free: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
Thanks for all the great information. I understand the need to switch from a visit fee to a CPT charge for the services provided in order to give the patient a chance for reimbursement. How do you manage the situation where your total visit charge and the number of units charged for that fee vary by visit…. let’s say patient pays $100 for the visit where 4 units are provided, which would be $25/unit compared to another appointment where $100 total charge for 5 units charged ($20/unit) is provided. If you provide a patient an invoice/receipt for multiple visits but the charge per unit changes each session based on the above math, does this make the insurance company less likely to move forward with reimbursement for the patient or could this lead to trouble because it looks like you are changing the fees for different visits/patients? If you keep the unit charge consistent, but the number of units charged varied, then it will lead to misreporting of total paid by visit.
Any help in the above matter would be greatly appreciated!
Do your best to keep it simple and consistent. Price all your units to be exactly the same cost and obviously all equal 15min/unit. If you end up spending more time and charge more unit, the patient should pay more for that session. If you want to charge more per unit of time for shorter sessions, you can use a “provider discount” to give all patients who choose longer sessions a standard discount from the total. For example, at my clinic we have hour sessions that cost $165 and half hour sessions that cost $110. All our 15minute CPT code units cost $55, but those who choose hour long sessions get a $55 dollar “full hour session discount” on the total. So basically, make sure you are not charging different amounts for different services, everything should cost the same and be based on 15 minute increments and any adjustments should be done via discounts. Does that help you? Feel free to follow-up.
Hi,
Why did you decide to a PLLC? My accountant suggested that I didn’t need it to open a cash based practice. Also do you need to have an NPI if you are not planning on taking Medicare? Are there any recommendations that you have if you are paying per patient inside of a pilates studio?
Thank you for any input!
I converted from an LLC to a PLLC because according to my attorney (who did not charge me or make money off of the conversion) said it offers better protection for companies offering “professionally licensed” services. I had also heard/read the same thing in my own research. This may not be the case in your state.
In order for your patients to file self-claims with their insurance, you will need an NPI (regardless of whether or not you’re a Medicare provider).
A Pilates studio sounds like a great spot for a cash PT practice! If I were you, I would offer monthly free seminars to the Pilates Studio trainers and clients on topics of interest to them (ex: Injury Prevention in Pilates, Burning Calories throughout the Day, Improving Joint Mobility and Health to Optimize your Pilates Sessions, etc). The clients (and instructors) will often approach you afterward to ask about different pains or limitations they’re dealing with and you can give them good advice or get them in for treatment as needed.
Thank you! Will get you some updated information on my practice next month when it “officially” launches.
What documentation do you use for cash based clients? Does this change because they are cash based? Did you raise rates based on your rent expenses? Thank you, the information provided here is priceless!
At the time of this writing, I’m extremely low tech and still use paper/pen for documentation. Documentation in a cash practice still of course must fulfill the requirements of your State Practice Act, and cover you legally if your documentation is ever needed in that arena, but you don’t have to be as detailed about many of the documentation components that can lead to insurance reimbursement denials (med necessity, ridiculously detailed goals, loads of objective measurements, etc).
Hi Jarod,
My new cash based practice has officially “launched”! I haven’t seen any patients yet but am working on the receipts and paperwork that will be given to patients. Would love any input you may have on the site: http://www.onenesspt.com
Do you use any dictation software or a program to maintain patient records? I’m considering a software program that you can dictate into your iphone and have the records mailed back to you (hipaa compliant).
Thanks,
Amisha
Huge Congrats on your cash based practice!! At the time of this writing, I’m still really low tech and just use pen/paper for documentation. I do have Dragon Dictate voice recognition on my computer but generally don’t have to use it much for dictation since my notes are on paper (I use it for progress notes). With that said, I’m certainly going to be on the hunt for a cash-based-specific EMR in the future (or develop one myself).
Hey guys thought this would be the best forum to share this info, I recently have had 2 patients be told by their insurance that they will not reimburse for CPT codes that do not contain modifiers. These were not Medicare people (for obvious reasons) one was Blue Cross, the other was Aetna. Just something for everyone to keep a lookout for.
Thanks so much Justin! Like I said in the Linked In forum, once you hear back from them and figure out what’s going on, please let us know here as well with a follow-up comment
Hi Justin, I just had this experience as well with United Healthcare- what modifier did you use?
Hi Jarod,
First and foremost, I want to thank you for being such a great resource as a I begin this journey to having my own cash-pay clinic. I opened my business bank account using my SSN, however I was wondering if it would be advisable to open one using my EIN instead? Re: superbill receipt, do I include my EIN number regardless of whether or not my SSN or EIN is associated with my account? Thanks Jarod.
Regards,
Joey Salgado
Hi Joey,
I would definitely recommend utilizing your EIN for your bank acct (keep everything personal completely separate from that acct). And as far as I’ve seen, insurance companies often will not reimburse for receipts that do not have your EIN
Jarod
Thank you for the response Jarod. I will speak with you soon and hope all is well! Hope to converse with you soon re: your book, as I hope to purchase it within the next day. Have a great night!
Regards,
Joey Salgado
Hi Jarod!
I am just starting a cash based solo practice and first of all want to thank you for sharing your wealth of knowledge. I just finalized my LLC (I understand there is no PLLC in Indiana). I want to make sure that my billing templates have all necessary information for the client to submit for reimbursement to their insurance company. I do have a few questions:
NPI – I am currently employed at an OP clinic and I have an NPI number associated with that location . Do I need to obtain a new one for my new practice or does the same number follow me regardless of where I work? Is it ok to use the same number in 2 different places?
Location code – my business address is my home address and I will be providing services in client homes. What would I use for location code?
I would like to keep things as simple as possible while at the same time supporting a client’s desire for insurance reimbursement if possible. I appreciate your feedback.
Thank you,
Annette
I believe the NPI number follows you, but I’m not sure if there would be an issue of billing via two different businesses at the same time. For that reason, I would definitely call them at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do to make sure this is not an issue.
Not sure what the home-based location code is, but I’m guessing would only take a phone call to a couple local third-party payers and they could tell you.
And … CONGRATULATIONS on starting your cash practice!!!!
Thank you so much for this information. I just graduated from PT school and have a 10 year background in massage therapy. My plan is to work part time for a orthopedic clinic, and build my own practice.
Thank you,
AnnaKate Moore, PT
LMT, Certified Rolfer
You are most welcome! Be careful if building a practice on the side that would compete with your current employment.
Hi Jarod-
I came across your site in a google search – very happy I did, lots of great information!
I am a pediatric OT – I’ve always worked in inpatient rehab or acute care settings. Over the years I have picked up a few private pay clients for short therapy stints in their home – all cash based. I’ve kept brief notes for the obvious legal reasons. My newest client ran out of insurance visits so she transitioned from clinic based services to home (found me through the recommendation grapevine). Once the new year starts, she would like to submit to her insurance for reimbursement – to date, none of my clients have attempted insurance reimbursement because they didn’t want the hassle. So this is new for me! I already have an LLC, business bank account, and EIN (my business-oriented dad made me set up an LLC many years ago!). I also have an NPI that is associated with the hospital where I am a part-time employee.
Based on what I have read in your posts, it’s seems like I just need to provide an invoice/receipt to the client and they can submit to insurance? I will have to change my flat treatment rate to a fee based on CPT code units. I am also assuming the the insurance company will dictate a time line for re-evaluations? Do you typically have to provide your treatment notes regularly for the client to submit to the insurance company? If that’s the case, my treatment notes will need to be more detailed to meet the insurance needs.
On another topic – what type of liability insurance do you recommend carrying for someone who is seeing private patients “on the side” and not technically operating a private clinic? I know many therapists do not carry private liability insurance for this and some who pay for significant coverage. This has been a debate with fellow OTs/PTs over the years, would love to get your opinion!
Thank you,
Jenna
So so sorry for he delayed reply!! I lost your comment in the shuffle and just saw that I missed it.
I have only had to submit Treatment notes to insurance companies a few times, so it is not very common but does happen. As long as you follow the recommendations of this post, most insurance companies will be able to process the self claims sent in by your patients. I’m not sure about the re-evaluations… I’ve never had a denial based on re-evaluations not being completed on a certain timeline.
You definitely need to have professional liability insurance for your LLC, and I would also get a general liability rider (usually very cheap) since you are seeing patients in their homes.
I know this is years following this comment, but this is the exact situation I am in. My pediatric clients have moved to cash pay and due to the new year, want to attempt to get reimbursed by their insurance. I currently am not a business entity because I only have a few number of clients, (but please let me know if that is recommended at this point), and because of that, I also do not have an EIN or tax ID to include on the invoices. Do you anticipate that this will be a problem with reimbursement? If so, is there a way to get this ID without becoming an (P)LLC. And I am hesitant to do so because I would like to continue to move forward with my clients, but have absolutely no idea how to go about becoming a legal entity.
Hi Michelle I am in your same situation now! Did you end up becoming an LLC?
Hi Liz,
Thanks so much for sharing! I’m doing the part time at an ortho clinic and part time private version at the moment.
Do you mind sharing how you keep your schedule manageable for you? Do you give yourself time between clients? How many people do you normally see in a day?
Thanks,
Dina
Thank you for this website. It has been very helpful. I am working part time for a great private practice. However, I am starting to treat patients in my off days as a cash business. I have a treatment table and room set up in my home. I have not yet tried to send in an invoice for out of network reimbursement. I have one patient requesting an invoice. Will it be problematic that I am treating from my home and not an established outpatient “clinic”.
Thanks,
Shawna
I don’t know that it will be a problem for reimbursement from the Ins companies, because I’ve never had any of them check or confirm my location. HOWEVER, if you haven’t already, you need to check your state practice act and make sure it’s okay to operate out of your home, and ou may have to “register” your home as a facility with the the State Board before treating patients (legally).
Hi Jarod,
Just finished podcast 27 – thank you for all of the hard work you put into these podcasts. On the topic of Office Code 11 for Location of Service, what do therapists put on the receipt when they are traveling to the patient at either their home or workplace?
Thanks,
Sven
Not sure Sven, but that one should be easy to find with a quick Google search. Thanks for the kind words on the podcast! Glad you’re enjoying it!
Aaron Lebauer had a link on his consulting website:
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html
Looks like ’12’ for in-home and ’18’ for at the patient’s place of employment.
Thanks for the continued information that has helped me grow my cash based business. I am now starting to provide receipts for my patients to send in for reimbursement. I was curious that if you do a package discount (say 10% off with 8 sessions) do you include this in the superbill for the insurance to see? Or do you just say what you normally charge for services? I created one superbill with a separate item titled ‘discount for package of 8’ but wasn’t sure if this was necessary. I search in your comments so hopefully I’m not duplicating a question!!
SO pumped to hear about your cash practice success!
Unfortunately, for a receipt to be processed as a self-claim, it must have the dates of service … so you can’t give them a receipt for the entire purchase (at the time of the purchase) that they’ll be able to send in as a claim. I know you’re not doign that but I wanted to include it here for the sake of clarity.
So each time they get a discounted session because they bought a package, you provide them with the receipt for that day and use “pre-pay discount” or “provider discount” or whatever you want to call it, and deduct the 10% off the subtotal that way.
Hi Jarod, I am an SLP and I have a question about the super bill provided to the client. I do not have a private practice. However, I work for a special school that provides outclient therapy as cash based or “tuition” based program. The fees are the same for each month of therapy irregardless of the number of therapy sessions. However, I know the superbill has to reflect the rate for each session. If the number of sessions varies from month to month obviously. Therefore, some months result in the client having paid less than what the per session fee would be and other months would be more. Do you have any suggestions on the best way to handle this?
Also, is it required that the client pay for the service prior to obtaining the superbill?
Thanks!
That’s a really tough one, but I can answer the last question: yes, providing a receipt to be sent in as a self claims can only happen after payment has been made, b/c those receipts have to have a date of service in order to be processed (and you wouldn’t supply a receipt when nothing was received)
Hi Jarod,
I am a PT currently working in an outpatient clinic. I have an individual NPI number through my current employer. When I look up my NPI # it has my information (name/license #) and theirs (provider mailing address and practice location). I am in the process of starting my own cash-based practice, but my current employer does not yet know this (nor do I want them to at this point). I’ve done some research on NPI #s and it appears that since I have an individual # that will stay my number even if other things change. Do you know if this is true? Can I use my current number on my super bill? Or do I need apply for a second one (if that’s even a thing)?
Thanks in advance for your help!
Since you are starting your own practice, you might consider getting a Type 2 NPI number. But this is more in the realm of compliance expert information… if I were you, I would reach out to Nancy Beckley (https://nancybeckley.com/) and she will give you all the information you need.
Hi Jarod,
thank you for all of the great info. I am starting a cash-based practice, but have also applied for a few insurance contracts to see what rate I get. In the meantime I am cash. Question about superbills: I have an individual type 1 NPI, and I also have a type 2 NPI for my LLC. Which one do I put on the superbill for out of network reimbursement?
The Type 2
Type 2 NPI
Jarod,
Thank you so much for all the great information! I was thinking about the number of units and was curious about something. It sounds like you consistently bill out 4 units, but in 1 hour you could easily get 5. Would it be more beneficial for the patient to bill out 5? Wouldn’t they get more reimbursement?
Hi, this is Chris, Jarod’s assistant. Here is Jarod’s response to your question:
“We simply bill based on 15 minutes per unit. I know going over 8, you can get in 5 but we keep it a little more simple this way since we also offer 30-minute sessions”
Let us know if you have any other questions. Thanks!
Hi Jared,
I reached out to a couple of colleague and searched the web, but was unable to find clear guidance regarding proper formatting for creating a discount on an invoice. I know you are the expert on this matter, and would appreciate your thoughts.
On rare occasions there may be a time where I will give a client a small discount as a professional curtesy or under certain financial circumstances. I want the invoice to reflect the amount they paid, and also want my invoices to remain consistent with unit pricing so it is uniform if clients are submitting on their own to same insurance carriers (my practice is out of network). I was thinking to write on the invoice 3 units=x as usual and then under that write professional discount=Y and then on the bottom write Total X-Y=Z which is the paid balance. Is that the ethically correct way it should be done, or do you have another recommendation?
Thank you,
Rebecca