Medical billing services are a vital part of the healthcare industry. It is important for both the physicians and the patients to know what services they availed themselves and the charges against them. This is exactly where the superbill comes into the picture. Now you might wonder what is a super bill?
Well to keep it simple, a superbill is an extended and detailed version of the medical services which are availed by the patient.
Let’s have a detailed look at what is a super bill and how it is compiled?
What is a super bill?
As defined above, a superbill is said to be a detailed and extended version of the invoices generated to the patients against the medical services which were availed by him. Usually, therapists use superbill in order to generate the invoice especially when the said therapist is not on the list of insurance companies’ panel supporting the said patient.
The superbill is mostly submitted to the insurance company directly and the insurance company is supposed to have all the detailed information in order to file a claim of payment.
Basics of superbill
It is not necessary to give a superbill to the client, it is only required when it is specifically asked. The superbills are compiled for the insurance companies.
The bill has detailed information and is specific about the medical services provided to the patient. Superbill also has detailed information about the diagnosis of the patient’s ailment.
It has been observed that superbill is compiled separately for separate treatments.
A superbill contained all the medical codes issued by the international statistical classification of diseases (ICD-10). It is mandatory to update the superbill according to the codes of the medical services rendered by the client.
The superbill must have the exact specific code for each diagnosis and service, if this is not the case and a superbill is presented without the codes or the correct codes then it will be rejected immediately, this will delay the payment.
It is important for the insurance companies to have a superbill to make the claim and it is time-consuming to create a superbill that can be submitted to the insurer by the client or the therapist.
Therapists are the ones who use superbill but they have extremely busy schedules and they might go for the clients who have insurance or can directly pay for the services in cash.
This might affect the chances of some clients getting the services from a renowned therapist because superbill takes time to be compiled and also requires an expert to do the job. Therefore, a therapist ponders before opting for a client that will end a superbill later on because this will be both time and money-consuming.
Why do therapists opt for superbills?
A lot of therapists opt for clients who will need superbills later on because it is also a good thing to get listed on a panel of insurance companies. This will also lead them to be paid directly for their therapeutic services. Getting listed on the panel means that the services will be readily accessible to clients who cannot afford the medical services of the therapist on their own.
However, once the therapist has joined the panel, the process might be longer than assumed previously. Especially as they will need to apply for the individual panels themselves or to make a decision on which insurance company will be the best to get acquainted with.
A superbill also allows the patient to accept insurance from a private provider if the client is not on any panel’s list. This is a very supportive option for all those therapists who:
- Are still waiting for an acceptance from the insurance panel
- Do not have any intention of joining any insurance panel
- Or want to join any other insurance panel
- Are willing to accept payments from small and lesser-known insurance companies but do not have the resources to join the big names of the insurance world.
How does a superbill work?
Superbill is a traditional way of invoicing distinctive medical bills to the insurance company or the client. This is mainly because the insurance company has to pay the client and not the therapist even if the bill is submitted by the therapist.
Once a superbill is handed over to the insurance company, it is assumed that the bill has been paid by the client and now the reimbursement needs to be done by the insurance company.
A lot of therapists who draft the superbills on a regular basis are of the opinion that the bills should be submitted to the client directly at the end of the session and the client proceeds it further to the insurance company for the claim. This is to make sure that the therapists get their payment time and the client will, later on, receive the reimbursement from the insurer after submitting the superbill according to their own reimbursement schedule.
This is a good practice as it secures the relationship between the therapist and the patient and protects them from any kind of surprises in terms of finances and lagging bill payments.
Superbill format
A general superbill will have:
- Relevant information about the client, that is the name, DOB, address, phone number, and all the information needed by the insurance company.
- Information about the practice of the therapist. It will have the name and the contact details of the therapist along with his address which the insurer can visit for verification
- The identification of the referrer, the person who referred the client to the insurance company. All the information of the reference provider such as the address, name, contact details, etc.
- ICD code is mandatory as not all insurers cover the specific treatments therefore the ICD-10 codes must be used for the medical services provided by the therapist.
- Must include the CPT code. A CPT code is a current procedural terminology (CPT) code that has a list of American medical association codes that will help the insurer identify the particular procedures used for the treatment of the ailment.
Final thought
Superbill is a challenging bill that is time-consuming and also requires time from the therapist to compile it and later on submit it to different insurance companies’ panels. Even though superbill empowers the client and makes it easier for them to receive reimbursements from the insurers, this is a highly technical kind of medical billing and has the minutest details of the services provided, therefore, must be compiled by an expert only.