Medical Billing Forum
Billing => Facility Billing => : Angie August 29, 2011, 05:54:54 PM
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I do the insurance work for a small residential treatment center for adolescents (mental health). When the insurance denies the facility due to the patient does not meet necessity I have parent's asking for a super bill of the therapy sessions so they can submit it to their insurance and try to seek reimbursement for those services; which are included in the daily rate. (we are out of network with the insurance.) I know of some other facilities that provide this on UB04 when requested. Is this OK to do or is it considered unbundling of services and not OK? It is the parents (insured) that would be getting reimbursed, not the facility and it is coded with residential treatment codes on the UB04.
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As long as you are indicating that the patient was in a residential treatment center then you can provide the parents with the superbill. The insurance may not allow for the facility, but they may allow the therapy separately.
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Would we need to show the Room and Board charge plus the therapy sessions itemized on the superbill?
Say the daily rate is $300 a day and the patient has 5 therapy sessions a week which is included in that $300 a day. The parents of the patient are only wanting a claim for just the therapy sessions face to face on the claim (coded as residential treatment 90818) ; can we do that? or do we need to break out the room and board charge as well and show that on the claim if they are only trying to get the insurance to reimburse them for the therapy sessions only. We are not contracted with the insurance company and services have been paid for. :-\
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If you are providing them with a superbill I would include all services.