graphic of superbill in medical billing

What Is a Superbill?

A superbill is used to outline services offered, rendered, and pricing. It can be used in conjunction with a patient receipt to submit to the insurance carrier, confirming the patient has paid for out-of-network services. A superbill may also be referred to as an invoice.

When a healthcare provider renders medical service to a patient, the provider must submit the information regarding the services to the patient’s insurance company. Many providers allow medical billing specialists or medical billing companies to submit the claim information to the insurance company, on their behalf. Providers may also ask the patient to submit the claim details to their insurance, for the insurance company to reimburse the patient for services. 

superbill icon

The insurance company’s claim adjuster requires specific service details to properly reimburse the provider. The itemization of the services is transferred to a document known as a superbill. 

Submitting a superbill is especially common when the provider is out-of-network because it helps speed up the reimbursement process – and is often easier than joining an insurance panel. 

How Does a Superbill Work?

A superbill is an itemization of the details of the services, which will allow the claims adjuster to decide whether a claim is reimbursable. The superbill is generated by the provider and is translated by the medical billing submitter. The medical billing submitter will extract the details of the service and this information into either a CMS-1500 or UB-04 claim form. The claims may be sent to the insurance company via mail or electronically.

Components of a Superbill

The superbill contains various demographic and service information.

The patient’s information includes:

  1. Patient first and last name
  2. Patient address
  3. Patient phone number
  4. Patient date of birth
  5. Insurance type
  6. Insurance name
  7. Insurance ID number

The provider’s information includes:

  1. Billing provider’s information and phone number
  2. Billing provider’s NPI number
  3. Referring provider information and phone number
  4. Referring provider’s NPI number (if applicable)
  5. Rendering provider information and phone number
  6. Rendering provider’s NPI number

The service information includes:

  1. Date of Service
  2. Place of service
  3. Diagnosis codes (ICD-10)
  4. Common Procedure Terminology (CPT) codes/ Healthcare Common Procedure Coding System (HCPCS) codes
  5. Modifiers (if applicable)
  6. Units or minutes
  7. Charges

What Is a Superbill for Therapy?

Therapists and psychologists often use superbills in lieu of becoming an in-network provider. This is especially common in specialized fields. For these providers, creating a superbill is often easier and quicker than joining an insurance panel – and becoming an in-network provider. The superbill enables the out-of-network provider to collect payments, ideally up-front, just as if the provider was in-network.

How to Streamline Your Billing Process

Superbills allow out-of-network providers to receive reimbursements faster by receiving upfront payments from customers. But the practice of printing a superbill is being replaced by smarter, more advanced systems. To further streamline the billing process, healthcare providers should consider adopting a medical billing platform

Gentem’s medical billing and revenue cycle management platform replaces the manual process. No more hard copies needed. All data is stored electronically and billed electronically. Real-time eligibility verification enables providers to send invoices via text message – whether the patient is in-network or out-of-network. 

Schedule a quick demo to see how Gentem can help you.

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