What is a Superbill, and How Do They Work?

What is a Superbill?

Example of a Superbill

A Superbill is used by healthcare providers as a primary source of data for creating claims. These claims will eventually be submitted to payers for reimbursement.

Essentially, a Superbill is an itemized list of all services provided to a client. The Superbill will also contain additional information about the patient visit including practice information, CPT codes, ICD-10 codes, referring doctor and more. We’ll cover these components in the following sections.

Components of a Superbill

Provider Information

The provider information is straightforward. This section includes all of the relevant information regarding the practice when submitting a claim to insurance. This would include:

  • Provider first and last name
  • Provider NPI number*
  • Office location where the visit took place
  • Provider phone number
  • Provider email address
  • Provider signature
  • Referring provider name (if applicable)
  • Referring provider NPI number (if applicable)

*“A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).”

Patient Information

The patient information section includes all of the patient information needed to successfully submit an insurance claim for reimbursement. This would include:

  • Patient first and last name
  • Patient address
  • Patient phone number
  • Patient date of birth (DOB)
  • Patient insurance information

 

Visit Information

The information regarding the visit itself is a critical component of Superbills. Unlike a typical receipt or invoice, a Superbill needs to contain Procedure Codes (CPT), Diagnosis Codes (ICD-10), Modifiers, and additional pieces of data to avoid the denial of claims. This information includes

  • Date of visit
  • Procedure Codes and Description (CPT)**
  • Diagnosis Codes and Description (ICD-10)***
  • Modifiers****
  • Units or Minutes
  • Fees Charged

** Current Procedural Terminology (CPT) Codes describe the medical procedures that a provider performed on a patient. CPT codes are issued and maintained by the American Medical Association (AMA)

*** “ICD-10 is the 10th revision of the World Health Organization’s International Classification of Diseases (ICD) coding system. The ICD-10-CM (Clinical Modification) codes are used to capture diagnoses in all healthcare settings, while ICD-10-PCS (Procedure Coding System) codes are used to capture procedures only in inpatient settings.”

****  According to M-Scribe “A modifier is a code that provides the means by which the reporting physician can 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.”

Conclusion

Superbills aggregate the data from a patient visit needed to successfully submit an insurance claim. This includes provider information, patient information and visit information. Superbills are different from receipts/invoices because they provide additional information regarding the visit (diagnosis and procedure codes) that are needed to get a claim approved.

Sources:

  • https://www.carecloud.com/icd-10-and-your-practice/
  • http://www.who.int/classifications/icd/en/
  • https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/
  • https://www.m-scribe.com/blog/bid/191943/Medical-Billing-Intricacies-What-are-Modifier-Codes