Medical billing can be a complex and lengthy process in the healthcare network. Medical practices have suffered immense losses due to denied claims. 80% of claims get denied for different reasons, like missing codes, incomplete documentation, or mismatched patient details. A superbill helps fix that problem by keeping every piece of information.
So, what exactly is a superbill in medical billing, and how does it work?
In this guide, we will explain the entire concept of superbills, the importance of superbills for insurance reimbursement, and how healthcare providers and patients can use superbills and avoid common billing mistakes.
What is a Superbill?
A superbill is a detailed document that lists all the services provided by a healthcare provider during a patient visit, including diagnosis details and procedure codes. Superbills are typically completed and submitted each time a patient receives a treatment session with an out-of-network provider. At the end of the session, the patient pays the provider in cash for the treatment. Upon payment, the provider generates a superbill for the patient to submit to the insurance payer for reimbursement.
In some cases, the provider may also submit the superbill on behalf of the patient through electronic submission software, known as an e-superbill. An e-superbill creates a smoother patient experience with submitting claims. Regardless, the patient always pays the provider first, whether the provider or patient sends the superbill. Superbill submission is for patient reimbursement, whereas CMS 1500 forms are generally submitted to directly pay a provider.
It’s worth noting that superbills can also be called different names such as “encounter forms,” “charge slips,” “fee tickets,” or “Statement for Insurance Reimbursement.” Regardless of the title used to refer to the form, all forms of superbills documentation verify the treatment delivered so the patient can submit it to the insurance company.
How Does a Superbill Work in Medical Billing?
A super bill consists of all the essential information that enables the insurance company to move ahead with the processing of the claim without any errors. Below is its process:
- Diagnosis Codes (ICD-10): These codes indicate the diagnosis and condition of the patient.
- Procedure Codes (CPT/HCPCS): These codes show the services that were performed for the patient.
- Charges and Fees: The healthcare provider will indicate how much it has charged for a certain service or procedure.
The superbill is then given to the patient to submit to their insurance or sent to the insurance company directly by the provider if they are in-network. The insurance company then uses the information on the superbill to reimburse the provider for the medical services rendered.
Who Creates and Submits a Superbill for Medical Billing?
The creation and submission of a superbill usually involves the following parties:
- Healthcare Providers: The doctor/ practitioner who treats the patient creates the superbill. It verifies the diagnosis; the codes that are listed are relevant.
- Billing Department: In larger healthcare setups, the billing department is the one that submits the superbill to the designated insurance company. This again acts as a check in the codes used.
- Patients: If the provider is an out-of-network provider, the patient themselves submits the superbill to their insurance provider.
Types of Superbills in Medical Billing
Depending on the medical practice and the services offered, there are different types of superbills. Here’s a breakdown:
Standard Superbill
Standard superbills are common in many healthcare facilities. They have all the necessary information needed for basic medical services: diagnosis codes, procedure codes, and charges needed to prepare an invoice to submit to insurance for reimbursement.
Custom Superbill
A custom superbill is designed specifically for a particular healthcare practice. It might include unique codes and charges that are relevant to the provider’s specialty, making the process more structured and efficient.
Specialty Specific Superbill
Some medical fields require specialty-specific superbills that are custom to include codes and services specific to your specialty (i.e., dermatology, chiropractic, mental health). This helps in ensuring that procedures/diagnoses are captured correctly for billing.
Electronic Superbills (e-Superbill)
With health care technology expanding, many providers are using electronic superbills (e-superbills), which are superbills submitted directly via an EHR system, rather than printed on paper. This digital process improves efficiency, reduces paperwork, and supports better Healthcare RCM performance across practices.
3 Main Components of a Superbill
Component #1: Provider Information
The provider information section includes all relevant details about the healthcare provider that provided the services. This information identifies the practice responsible for the medical treatment and ensures the administrative billing process is performed accurately and completed by the appropriate provider. Provider information typically contains:
- Provider NPI number
- Office location
- Provider phone number and email
- Provider signature
- Referring provider name and NPI number (if known)
Caution: Errors and omissions in this section will affect claims processing and the payment of services rendered.
Component #2: Patient Information
The patient information section contains critical and identifying information to ensure that the claim is accurately associated with the appropriate individual. This information is also used to confirm insurance coverage as the claim proceeds through adjudication for reimbursement. The primary components of the patient information area may include:
- Patient’s First and Last Name
- Patient’s Address and Phone Number
- Patient’s Date of Birth (DOB)
- Patient’s Insurance Information
Component #3: Visit Information
The visit information section is likely the most functionally significant part of a superbill, as it lists the detailed medical encounter. The accuracy of this component is critical to avoid billing errors and claim denials that may come at a financial cost to the provider and patient. In the visit information components, it is important to accurately list the following details:
- Date of Visit
- Procedure Codes and Descriptions (CPT)
- Diagnosis Codes and Descriptions (ICD-10)
- Modifiers
- Units or Minutes
- Fees Charged
Since visit information is often very detailed and has complicated elements, it is important to manage this part of the superbill cautiously. Medical coding companies, which follow the coding guidelines for ICD-10 and CPT codes, are frequently provided for this purpose to ensure codes are correct and compliant. Doing so decreases the risk of errors and denials of claims.
Step-by-Step Guide to Create a Superbill
- Patient Information: Enter the patient’s basic information, such as name, date of birth, and insurance company.
- Diagnosis Codes: Apply the appropriate ICD-10 codes based on the diagnosis of the conditions during the visit.
- Procedure Codes: Refer to the CPT or HCPCS codes based on what was completed.
- Add Charges: Add the cost of each service completed at that visit.
- Review: Verify everything is correct and complete so that there will be no hold on the claim processing.
Having a superbill template, you can easily complete your superbill and concentrate on what’s not filled.
Pros & Cons of a Superbill in Medical Billing
Superbills provide numerous advantages, but they may also present problems. Below is a brief overview of the benefits and challenges:
| Pros | Cons |
| Simplifies the Process: Superbills help with insurance claims submission by including all the information a health insurance company requires in a single document. | Complicated for Patients: For out-of-network services, patients may find it challenging to understand how to use a superbill to submit a claim. |
| Minimizes Mistakes: By standardizing the data needed for a claim, superbills minimize the risk of missing information or coding mistakes or errors. | Administrative Costs: The administrative time to generate superbills can be time-consuming, especially for large practices. |
| Quicker Payments: When insurance claims submission includes accurate and succinct information, it allows health insurance companies to process the claims faster. | Coding Errors: Errors in the coding may cause a claim to be denied and can cause a delay for payment. |
Superbill vs Invoice: What’s the Difference?
Superbill: To request reimbursement from insurance companies, it also includes diagnosis and procedure codes required for claim processing.
Invoice: A bill issued to the patient for services rendered, showing the total cost of treatment or products, typically without any coding for insurance submission.
Use Superbills to Improve Accuracy for Faster Reimbursement
A superbill in medical billing is a critical document for healthcare providers and patients. They are used to organize the claims process, ensure accurate billing, and speed up insurance reimbursement.
By using a customized superbill, or electronic superbill, healthcare providers can effectively strengthen their practice’s operational efficiency and decrease the chances of billing errors that could cost heavy monetary losses. Working with medical billing services can further streamline this process and improve reimbursement rates.
FAQs
How do I create a superbill?
When creating a superbill, the main things you will want to do are gather the patient information, the diagnosis and procedure code, the charges, and make sure the information is all correct.
Does a Superbill need to be signed?
There are no requirements (other than office policy) to require a physician’s signature, so the primary function of a superbill is to allow the provider to communicate to the office staff what services were provided and why they were necessary (and, by extension, the office staff to communicate to the payer).
Are there different types of superbills?
Yes, there are standard superbills, custom superbills, specialty-focused superbills, and electronic superbills, each serving its own purposes based on the needs of the practice.
Does a Superbill need to be signed?
There are no requirements (other than office policy) to require a signature from the billing physician, so really the primary purpose of a superbill is to simply allow the provider to communicate to the office staff what services they provided to the patient, and why they were necessary (and in turn that allows the office staff to communicate to the payer).
