What is a Superbill in Medical Billing

Definition of Superbill

In medical billing, a superbill is a detailed invoice or receipt outlining the services provided by a health care provider to its patient/client. This receipt also contains other information like appointment/visit information, CPT and ICD codes, patient information, and provider information.

However, it is important to note that the superbill should only outline the medical services mentioned in the patient’s insurance plan. It is because the insurance company will not pay for the services that fall outside the insurance plan. Moreover, generating the superbill and sending it for claims reimbursement does not guarantee that the insurance company will pay for the services provided to the patient. The payment of the services depends on various factors like correct procedure codes, and insurance plans, etc.

Understanding the Superbill

The superbill has a lot of information due to which is it called the ‘super’ bill. This information falls under various components of the superbill. The components of the superbill as are the following:

• Appointment/Visit Information
• Date of appointment or date of visit
• Referring physician
• Diagnosis (ICD-10 codes)—ICD codes must be included in the superbill otherwise the insurance payer may not cover the treatment.
• Procedures Performed (CPT codes)—along with diagnosis it is important to outline the procedures using correct CPT codes to make sure you are paid for the same.
• Modifiers used—it is important to use the correct modifier to “indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code.”
• Last date of visit
• Minutes or Units
• Fees Charged
• Patient Information
• Patient’s first and last name
• Address of the patient
• Date of birth
• Phone number
• Patient’s insurance
  • Social Security Number
  • Account TYPE
  • Co-payment
• Provider Information
• Provider’s first and last name
• Provider’s National Provider Identification (NPI) number*
• Address of the provider
• Phone number and email address
• Provider’s signature
• Referring provider’s name (if applicable)
• Referring provider’s NPI number (if applicable)

Role of Superbill in medical Billing

There are two major roles of superbill in medical billing:

• Reimbursement: The information provided in the superbill is important to create a claim. Without the complete information the insurance payer may reject the claim or even deny it. But with superbill the insurance payer gets an insight into the medical services received by the patient and is likely to pay for the services covered in the patient’s insurance plan.
• Patient’s Track Record: Since, the superbill contains the patient’s demographic details and medical information; it also functions as a document to keep track of the patient’s medical issues.

Generating the Superbill

Generating a superbill is a tiresome task since a lot of information is required to be documented. Also, the superbill should be free from any errors. Therefore, health care providers are now outsourcing medical billing services from good medical billing and collection companies. The medical billing company uses billing software to generate multiple superbill in no time.