What Is a Superbill in Medical Billing? A Complete Guide

As an American Citizen, after buying a healthcare policy from an insurance provider, you can choose between numerous in-network healthcare providers to get quality care. Visiting an in-network provider means the patient will pay part of the payment upfront, and the insurance provider will chip in with the rest.

However, the real problem begins when you don’t want services from an in-network doctor or physician and choose to visit an out-of-network provider. In such a scenario, you’ll have to deal with a superbill.

Confused? you’re not alone. Most patients may not have heard about this word or dealt with it before. Want to know what is a superbill and how it works? We’ve got you covered.

Today, we’ll explain things related to superbills, like their purpose, who issues and receives them, and other relevant details. Just stay put.

What Is a Superbill?

Simply saying, a superbill is not really a bill. It is more than that. A superbill provides additional information like CPT and primary diagnosis codes (DX). A superbill – also known as Encounter Form, Charge Slip or Fee Ticket – is a detailed document or invoice mentioning all services provided by the out-of-network healthcare provider to the patient.

It not only includes the services provided to avoid medical billing and coding errors but also contains:

• Healthcare provider details
• Practice location
• Patient Information
• Disease or ailment
• Service provided
• Time and date of treatment
• Codes billed for

Healthcare providers use these itemized lists or thorough invoices to create claims, helping insurance providers to track the services delivered. Clinicians don’t usually submit superbills and hand them over to the patients, who then claim reimbursements from their payor.

How Superbills Simplify Reimbursements?

Once a superbill is created, it is usually given to the patient. The document includes all vital information, like the diagnostic and procedural codes. Patients use it to get payment from their insurance payor network.

However, some healthcare providers, practices, or hospitals do submit superbills on patients’ behalf. They call it ‘Statement for Insurance Reimbursement’ and submit it electronically, referred to as e-superbill.

Whether the patients submit it by themselves or let the provider do it, the patient pays the doctor first, mostly in the form of cash. Simply saying, the purpose of superbill is to reimburse the patient, contrary to CMS 1500 forms where doctors are paid.

Patients, Avoid This Grave Mistake at All Costs

Most people who opt for out-of-network care often commit a serious mistake of underestimating their superbills. Before submission, they don’t know how much the insurance will pay them and think of it as a small amount. 

Some assume that their policy won’t cover their treatment expenses, or even if it does, they’ll receive a meager amount. However, we’ve seen patients getting almost full or healthy reimbursements against the services rendered and the amount they paid upfront to the medical specialist who was out of their insurance’s network.

The Need for Creating Superbills

In the US, a patient with a policy plan from a specific insurance company mostly visits a doctor enrolled with the same payor. This way, they’re limiting the complications. The process of claim reimbursement from the payor against the provision of healthcare becomes simple. However, the problem arises when a patient wants diagnosis and treatment from a specialist out of their network.

This is where a superbill simplifies everything and facilitates both parties. It lets the healthcare specialists provide compassionate care and still get paid without any restriction. Simply saying, whether they’re on an insurance network’s panel or not, they’ll still get paid – thanks to the superbill.

The medical specialist, prior to diagnosis and treatment will ask for direct payment from the patient. They’ll create a charge slip that allows the patient to seek compensation against the charges incurred during out-of-network checkups.

Significance of a Superbill

Consider your superbill as a key to unlock payment and benefits from your insurance. If you misplace or don’t submit them, you’re losing money on the table. According to a careful estimate, the total amount of funds surrendered or lost by patients annually on account of neglecting or mishandling superbills exceeds a whopping $50 billion.

For patients, it is better to thoroughly review the fine print of their policy plan. They can also visit the website to check out the terms and conditions regarding out-of-network services. Most insurance policies agree on a certain percentage through coinsurance. Once the patients complete their out-of-network deductibles, their benefits can reach up to 80% of what they’ve paid upfront.

Who Creates and Submits the Superbill?

The healthcare provider is the one who creates the superbill in a situation where they’ve rendered services to a patient having insurance from a company with which the healthcare provider is not enrolled.

They hand over the superbill containing detailed information about the services, patient-provider details, and precise codes to be submitted by the patient to their insurance against reimbursement. To make it convenient for patients and to enhance their experience, some doctors or hospitals submit superbills themselves.

Healthcare providers who can issue superbills

• Counselling specialists
• Clinical Social Workers
• Psychologists
• Psychiatrists
• Physiotherapists
• Speech therapists
• Massage Therapists
• Chiropractors
• Pain Management Clinics
• Dentists
• Occupational Therapists
• Dietitians
• Ophthalmologists and Optometrists
• Physicians and their assistants
• Pharmacists
• Nurse practitioners
• Acupuncturists

Basic Components of a Superbill

A superbill comprises all the necessary information, i.e., patient and provider info, encounter details, and basics like the place of service and fee for each service. We can divide the information or details mentioned on the superbill into three components. These are mentioned below.

Patient Information

The first component of the superbill is adding all patient details required by the insurer to accept and reimburse payments successfully. The inclusion of the following information falls under patient information.

• Patient’s full name and address
• Contact details like phone number
• Date of birth in the correct format
• Patient insurance information

Provider Information

Another significant component containing straightforward but relevant information regarding the healthcare provider involved in the encounter with the patient. The provider information includes:

• Practice or provider’s full name
• Practice or provider address
• A 10-digit NPI number allotted by the Government
• Place of service
• Contact information (phone and email)
• Provider signature
• Name of the referring provider (if applicable)
• NPI number of referring provider (if applicable)

The insurance company, before reimbursing the patient, confirms that the service is provided by a legitimate healthcare provider.

Encounter (visit) Information

The third and most important component for generating a superbill is including complete visit information. Contrary to invoices or billing statements, a superbill must have procedural codes (CPT), diagnosis codes (ICD-10), relevant modifiers, and other relevant data to ensure claims don’t face denials.

Here’s what’s included in the visit information

• Date of visit
• Procedural Codes and description (CPT)
• Diagnosis Codes and description (ICD-10)
• Relevant modifiers
• Times spent during service
• Fees charged against every service

Invoice Vs. Superbill Vs. Statement

To enlighten you more about the information included and building blocks of a superbill, let’s take you through a brief tour explaining invoice Vs. Superbill Vs. statement.

A Step-By-Step Guide for Providers to Create a Superbill

To make superbill creation easy, there are many software available in the market. EMR solutions also help to generate superbills for patients. The best part for healthcare providers is that they can create their own template of a superbill. Let’s take you through the necessary steps to generate superbills.

Enter Diagnosis Code (DX)

Enter the correct diagnosis code for the treatment of the service delivered. This way, you’re ensuring accuracy, which leads to claim acceptance and reduced denials.

Include Place of Service (POS) Code

The inclusion of this code in the superbill indicates the location where the service was delivered. It could be an independent clinic, a hospital, or a patient’s home.

Fill All Required Fields

Specialists need to manually add some basic information for new patients. On the contrary, for returning patients, the software automatically fills the information in the fields.

Enter practice details

Don’t forget to add practice or details about yourself. Include your or your practice name, complete contact details, NPI number, and full address.

Add ICD-10 and CPT codes

Use the correct ICD-10 or diagnosis code to show the health concerns or diagnosis. The usage of the CPT code will show the procedure performed to address or treat the issue.

Other Relevant Information

Include all the treatments or services provided, units, fee per unit, and how much the patient has paid against these services, i.e., full or partial.

Billing Information

Mention the amount the patient has paid up front and the mode of payment. The payor will later reimburse this payment upon submitting the superbill.

Relevant Modifier Codes

Correct modifier codes ensure that the claim is accepted and approved without any objection. They provide extra details regarding the services to the insurance company.

How to Submit a Superbill?

After the checkup from an OON medical specialist, and once you have the encounter form with you, submitting it to your insurer to get compensation isn’t difficult and time-consuming. You have multiple options to send it to your insurance company.

You can use the email route or submit it via their online portal. However, before submission, confirm which method is preferred by your insurance provider. However, before opting for an OON doctor or physician for a checkup or treatment, it is important to follow these instructions for swift returns.

• Visit your insurer’s website to go through the fine print regarding OON payments and benefits.
• Be aware of the specific process instructed by the insurer to submit the claim. Most insurance companies have unique requirements which must be fulfilled for easy reimbursement.
• Before submitting the superbill, double-check it for errors and ensure the information provided is correct. For accurate coding, you can get online help. These considerations will save you from the hassle of denials.

I-Med Claims Can Help You with Superbills, Medical Billing, and Credentialing

I-Med Claims is an all-inclusive medical billing company working to streamline revenue cycle management and accelerate reimbursements for healthcare providers in all 50 states. With over 24 years of experience under our belt, we can simplify hectic processes, reduce denials, help patients seek correct reimbursement against OON checkups. I-Med Claims enables medical specialists and their staff to help patients develop and maintain good health.

We have a team of highly experienced CPC, CPB, and AHIMA-certified medical billers and credentialing specialists who’re well-versed in enrollment matters. They’ll take all technical aspects upon themselves, like communication with the payor and complex documentation, to enroll you in a strong network.

Last but not least, we’re a HIPAA-compliant medical billing services provider managing everything from billing and eligibility verification to denial management and unfreezing aged receivables. Get in touch with our RCM maestros to experience continuous and enhanced cash flow.