Once you have verified the patient’s benefits, you can provide therapy. Don’t forget to collect the co-pay, coinsurance, or deductible amounts at the date of service. After the session, write up a claim on a CMS 1500 claim form (more info from ASHA here). If you are submitting claims manually, you will fill out the paper version of the form by hand. To do this, you will need the following information:
Date/s of service
ICD-10 (diagnosis) codes
CPT (procedure codes) and any modifiers
Place of service and rendering provider with your NPI
Billing provider (this will be the same if you provided the services and own the private practice)
The patient’s address, insurance information, and date of birth
You can save a lot of time by doing this digitally. If you use an EMR like Fusion, then the software will auto-populate the form for you from your session notes.
2. Submitting claims.
After you fill out the CMS-1500 form, you will submit it to the clearinghouse that is required by the insurance company. Some companies require you to submit claims electronically, while others allow both paper and electronic claims. If you send in a paper claim, know that it will take longer to be reimbursed.
Make sure you submit the claim within the Timely Filing requirements, which can vary by insurance company! Many companies allow 365 days from the date of service, but some only allow 90. For more info on timely filing limits in this great blog post:
Now that you’ve submitted the claim, you wait. In most cases, you will receive your ERA directly to your EMR, or to an account on the insurance company’s provider portal if you do not use an EMR. This can take anywhere from a few days to a few weeks (or, in some cases with Medicare or Medicaid, a month or two). If you have to fix anything, then you fix it on the CMS form. Add the correct Resubmission Code in box 22- 7 to replace a claim, or 8 to void the original claim, then resubmit it through the method required by the insurance company.
4. Get paid.
Once the claim is accepted, you will be paid by the insurance company, either through an EFT directly into the account you specify or through a paper check. Make sure to deposit it into your business account to avoid tax issues down the road.
ASHA has an FAQ session just for SLP reimbursement, which you can find here. It answers questions about where to find ICD-10 and CPT codes; the difference between a superbill and a CMS-1500 form; and how to write up your session notes.
If you want support for your billing, Fusion Web Clinic offers a free In-House Billing kit that includes a Verification Questionnaire to use when calling insurance companies, along with a Billing & Collections Checklist and 7 Tips to Help with Billing & Collections handout. To get this resource, check out their resource library.
If this billing process sounds too complicated, Fusion also offers Assisted Billing as an add-on feature to their EMR. Let their professionals handle the claims process while you spend your time doing what you love--providing speech therapy!
Need help with billing? Let us take care of your claims.
Spend less time on billing with Fusion's claims management service. Schedule a call to find out if Assisted Billing is a good fit for your practice.
About the Author:
Jill Shook, MS, CCC-SLP owns a private practice in Pittsburgh, PA. She created a course for SLPs starting out in private practice, which is available through Northern Speech Services, and blogs about resources for SLPs in private practice at Private Practice SLP. Email her at firstname.lastname@example.org
In-House Billing Kit
We've put together some resources to help you bring billing in-house. This In-House Billing Kit includes:
A Verification Questionnaire to use when calling payers to verify coverage
A 50% off coupon for our billing course, The Essentials of Insurance Billing for Therapy
A Billing & Collections Checklist to guide you as you interact with caregivers
A Payment Policy Generator to help you set expectations for caregivers
7 Tips to Help with Billing & Collections handout
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