Many clinics will submit an insurance claim or create a CMS-1500 for their patients when they are out of network with the insurance company. In this scenario, your patient is self pay (they are paying you) but you are creating the claim form for the patient and then either giving the patient the CMS-1500 to mail in, or submitting the initial claim electronically on behalf of the patient. You are then expecting the insurance company to submit payment to the patient.
How to do this in Therabill
Before we go over the procedure of how to do this in Therabill, we will first give the concept of what you are doing. First, you need to indicate on the claim form that you are not accepting the assignment. This is to indicate to the insurance company that they should send payment to the insured. Second, in Therabill, you want to initially create the session/charge as 'open to insurance', this will allow you to create the insurance claim. However, as soon as you create the claim in Therabill, you want Therabill to 'close the session' (remember, close session means that the patient owes the balance due on the charge). For more information on what a closed session means, please see: What does Closed Session mean?
- You will need to add the insurance information into Therabill for the client. This is done by adding an insurance card. When adding the insurance card, make sure you select Accept Assignment as No. For more information on accept assignment, please see: Accept Assignment.
- Do not mark the client as "self pay" (above the insurance cards on the add / edit client form). Remember, you are going to be creating an insurance claim.
- When adding a session/charge for the patient, on the add session form, choose the Initially Bill To option as Insurance. This will send it to the bill insurance area where you can create the claim for the patient.
- When you create the claim, because you have Accept Assignment set to No, Therabill will automatically close the session for you when you create the claim. Remember, closed sessions mean that the patient owes the balance due, which is correct because you are now expecting payment from the patient and not insurance.