Superbills allow health care providers to process and fulfill insurance claims quickly and accurately. But what is a superbill, and why is it an essential tool for medical billing purposes?
These forms contain the necessary information needed for insurance companies to properly authorize services, track visits, and determine benefits for patients.
Understanding what a superbill is and how it can improve your practice’s efficiency will help you keep up with payments due from different insurers while giving your team more time to focus on what really matters: providing quality medical care to your patients.
Key Takeaways
- Superbills are forms completed by a medical provider and sent to their insurance company or third-party provider to submit claims for services rendered.
- Superbills contain all the information an insurance companies need to process a healthcare claim quickly and easily, improving efficiency, accuracy, reducing paperwork costs, and streamlining the billing process.
- Superbills can be used whenever it’s necessary to submit a claim for payment from an insurance provider or third-party payer, including inpatient/outpatient visits, and out-of-network providers.
- The components of a superbill include CPT codes (procedure codes), ICD 10 codes (diagnosis codes), modifiers, and other relevant patient information such as name and address.
- Creating a superbill involves gathering required info like CPT/ diagnosis codes, creating templates, and entering patient data accurately into the form, followed by submitting proper service codes associated with practice-provided services.
Superbill Definition
A superbill is a form completed by a medical provider and sent to their insurance company or a third-party out-of-network provider to submit claims for services rendered. The document typically includes all the information required for the insurance company or third-party payer to review, process, and reimburse the fees associated with providing healthcare services for a given patient.
Superbills normally include patient information such as name, date of birth, current diagnosis codes, procedure codes (CPT), any applicable modifiers, and other relevant details such as taxes or discounts that were applied during visits. Because of all the sensitive information that superbills contain, all forms must adhere to HIPAA guidelines on privacy protection.
When it comes to providing therapy or psychiatry services, using superbills can be a much more efficient and convenient route compared to becoming an in-network provider. That being said, an insurer’s provider panel comes with great benefits — those who are insured are able to have access at lower costs, while those without the means of paying out-of-pocket will still be able to receive treatment.
What Are the Benefits of a Superbill?
Wondering what’s so super about superbills? Because superbills contain all the information an insurance company needs to process a healthcare claim quickly and easily, they offer numerous benefits for the medical practices that choose to use them. Improved efficiency, accuracy, and reduced paperwork are just a few key reasons more healthcare providers use superbill forms than ever before.
Improved Efficiency
Superbills make it easier to organize and submit claims, which can significantly streamline the billing process and save both time and labor. Because all of the required information is already included on a superbill form, insurance companies don’t need to wait for additional paperwork or ask questions in order to complete the claim settlement process.
This improved efficiency translates to quicker payment processing times and faster reimbursements for medical providers. It also means less time spent communicating back and forth with the insurance company.
Improved Accuracy
Another key benefit to using superbills is the improved accuracy of a pre-printed form. Reducing the number of times you have to manually enter information means less risk of typos and incorrect data.
Because all of the necessary information has already been entered and organized in a standard format, it’s also much easier for medical providers to make sure they’re making accurate claims submissions and getting paid what they deserve. The consistency provided by superbills ensures that insurance companies have an easier time processing each claim, without having to manually type or enter any patient data on their end, too.
Less Paperwork
One of the biggest advantages of using superbills is that there’s no need for manual paperwork. You can quickly and easily dispatch a digital version of the document from your practice management system or EMR/EHR, saving you time and money when it comes to printing out and copying documents.
This also leads to another benefit: reduced storage costs for physical medical records. Plus, because electronic versions are so much easier to modify than paper documents, updating a superbill after each visit is a quick and easy job.
When Can You Use a Superbill With an Insurance Company?
You can use superbills whenever it’s necessary to submit a claim for payment from an insurance provider or third-party payer. This includes any type of inpatient, outpatient, and office visit, as well as services rendered in other healthcare settings such as clinics, hospitals, and labs.
It’s also important to note that you should only use a superbill if you have already collected your patient’s financial information upfront, including co-payments, deductibles, and out-of-network deductibles. Otherwise, you’ll need to supplement the superbill form with other documents requesting additional proof of coverage or reimbursement authorization, before submitting the claim.
Can You Use Superbills for Medicaid Services and Out-of-Network Providers?
You don’t have to be in-network to take advantage of a superbill. Superbills can be used for both Medicaid services and out-of-network providers, assuming the patient’s plan offers out-of-network benefits. When submitting a claim via a superbill for Medicaid beneficiaries, all that is needed is the patient information, diagnosis and procedure codes, and any other additional modifiers.
If you’re an out-of-network provider, the superbill format will need to be supplemented with additional information, including the provider’s signature and contact information, patient verification, and other authorized documents, depending on the insurer. For example, if you’re an out-of-network therapist, you may need to provide a copy of your clinic’s policies and procedures when you submit a superbill.
Superbills don’t affect rates or whether you’ll get paid for your services. Typically, providers ask clients for payment immediately after a session. If the provider is out of network, they can give the person a superbill after paying. The client can then use the superbill to attempt to receive money back from the insurance company — but only if their plan offers out-of-network benefits for the applicable services.
The Components of a Superbill
The components of a superbill can vary depending on the type of practice and services you’re providing. Generally speaking, however, most forms will have some key information in common, such as CPT codes, ICD-10 codes (diagnosis codes), modifiers, diagnoses, and other relevant patient information.
CPT Codes
CPT stands for Current Procedural Terminology. These are numerical code sets that classify specific types of medical services for billing purposes, including identifying and treating medical procedures and illnesses. Each type of service performed has its own unique CPT code number — this is what an insurance company uses to identify which activities were performed by a provider during a visit or procedure.
ICD-10 Codes
ICD-10 stands for International Classification of Diseases Tenth Revision. This system is used to standardize diagnosis codes across healthcare organizations worldwide for reporting purposes. The ICD-10 includes thousands of identifiable diseases and health conditions, with each one assigned its own distinct letter-and-number combination code.
Modifiers
Modifiers are two-character numbers appended onto CPTs to indicate certain details about how procedures were provided or billed out during an office visit or procedure. They provide additional context so that insurance companies understand which deductibles and coinsurance amounts to apply to which services.
Diagnoses
Diagnoses are coded descriptions of the condition or health problem for which a patient is seeking medical treatment. Diagnosis codes, typically found in the ICD-10 system, tell an insurance company which services provided were deemed medically necessary by the provider.
Other Patient Information
Superbills also typically include other relevant patient-specific information, including their name and address, phone number, and any discounts or taxes applied to the totals during a visit. Depending on your practice’s requirements, additional information can be included as well.
How to Create a Superbill
Creating a superbill follows the same steps as creating any other form. You’ll need to gather all the necessary information required by each insurance company you work with, create a customized template, enter patient information into the document accurately and efficiently, then submit the proper codes associated with the services your practice provided.
Gather Necessary Information
The first step to creating a superbill is gathering all the relevant information you’ll need. This typically includes CPT and diagnosis codes, patient personal data (name, date of birth, etc.), any coinsurance or discounts that were applied during the visit, and other applicable modifiers.
Create a Template
Once you know what information will need to be included on your healthcare practice’s superbill, the next step is to create a template for your superbill forms. You’ll need to add fields for each of the required elements, such as name, diagnosis code, etc., and then design it with enough space that you can fill in patient information accurately without having entries spilling over onto additional pages or lines.
Enter Patient Information
Once you have your superbill template ready, it’s time to start entering patient information. All the details for each visit need to be included, including their personal data, financial information, and any discounts or taxes associated with services rendered.
Enter CPT and Diagnosis Codes
Next, you’ll need to enter codes into the form. This includes both CPT and diagnosis codes, depending on the services provided during each patient visit. As with any medical claim form, it’s very important to make sure every service code is correct before you submit a superbill. Incorrect diagnostic codes could lead to delayed or denied claims, which can impact your revenue significantly.
Even though using a superbill means you won’t have to enter this data as often, it’s still best practice for any medical provider to familiarize themselves with current coding standards. This will help ensure your team gets the right info in the right place, every time.
Include Your NPI and EIN
Even if you do not accept insurance, obtaining a National Provider Identifier (NPI) number is still beneficial. This 10-digit ID number is provided by the Centers for Medicare and Medicaid Services (CMS). Any healthcare provider who electronically bills government or private health insurers must use an assigned NPI in order to follow HIPAA regulations.
Though clinicians that bill by mail may be exempt from being considered “covered entities,” they might still need their own unique NPI should any insurer require one; making having an NPI worthwhile regardless of your status as a covered entity.
As an independent practice, it is essential that you also possess and use an employer identification number (EIN). You should use your EIN instead of your Social Security number when submitting an insurance claim to insurance companies and filling out paperwork like superbills.
If you still don’t have an EIN, obtaining one from the IRS doesn’t cost a thing. In case you’ve misplaced yours or cannot find it, contact their Business and Specialty Tax Line for help.
Final Thoughts
Superbills are important in any health care practice. Now that we’ve answered the question, “What is a superbill?” you know they help speed up the claims processing process, improve the accuracy of your patient information, and reduce storage costs for physical medical records.
If a provider doesn’t accept your insurance, your insurance may not cover medical bills. There is a way to circumnavigate this — submitting a superbill. Creating a superbill involves some work up front in gathering the relevant information and creating a template that works for your medical practice. Once you start using them, however, superbills will help your practice save costs on billing while ensuring you’re getting paid what you deserve at the same time.