As a private practice owner who has chosen to operate out-of-network (OON) with insurance companies, one of the most important billing decisions you’ll face is whether to submit claims to insurers on behalf of your patients or provide them with a superbill for self-submission. If you decide to submit the claim yourself, you have two options: accept assignment or not accept assignment. Accepting assignment means the insurer pays you directly for the portion they cover, and the patient pays only their cost-sharing amount (copay or coinsurance). However, keep in mind that insurers aren’t required to honor assignment and may still send the payment to the patient. If you choose not to accept assignment, the patient pays your full rate upfront, and the insurer reimburses them directly for the covered portion—this is common with PPO plans but may not apply to Medicare Advantage or TRICARE plans. Alternatively, if you don’t want to submit any claims at all, you can either give the patient a superbill or simply charge your cash rate and provide no documentation for reimbursement. A superbill is an itemized receipt that includes essential details like diagnosis codes (ICD-10), service codes (CPT), charges, provider and therapist information, and patient identifiers. This allows the patient to seek reimbursement directly from their insurance carrier.
¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at www.physicaltherapynow/franchise¨
