Understanding the Superbill for Insurance: What Providers and Patients Need to Know

It’s no secret that healthcare services are largely paid for through insurance claims — but what’s the best way to receive reimbursement if you aren’t in the network for the patients you serve? Or, taking things a step further, what if you don’t want to work with insurance providers at all? At face value, patients are responsible for paying their bills in full if they don’t have compatible insurance. But that being said, in many cases, patients can still receive partial or even full reimbursement for the services you provide with a little help from superbills. But what exactly is a superbill, and how can providers quickly create them?

In this blog post, we’ll discuss the fundamentals of creating customized superbills as well as best practices when submitting them, ultimately ensuring all parties are equipped with the information required in order to tackle the process successfully.

How Superbills Help Providers and Patients Receive Reimbursement

Superbills offer both providers and their patients many advantages, including increased access to medical care and potential cost savings. Even though it’s common for providers to accept insurance, it’s unlikely that every provider will accept every form of insurance their patients use. And in many cases, providers won’t accept insurance at all. The responsibility to pay an out-of-network provider falls fully on the patient, and that can create substantial lags in receiving payment.

By providing line-by-line bills, patients can submit accurate claims on their own for insurance reimbursements and track individual expenses like deductibles. Superbills are easy to generate using information captured within EHR and PM software solutions. When patients are more confident they will receive reimbursement, they’re more inclined to pay providers promptly.

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Essential Components of a Superbill

A superbill contains crucial details such as patient demographics, date of service, and diagnosis and procedure codes describing a patient’s visit. Superbills are meant to be succinct, and most importantly, highly accurate representations of services rendered during a patient encounter.

Patient and Provider Details

Precise data regarding both patients and providers on a superbill must be included so it’s easy for insurance companies to evaluate if they can offer compensation for medical services. An Employer Identification Number (EIN) should always appear on a superbill as well as the provider’s full legal name and National Provider Identifier. In addition, the patient’s full name and date of birth should be prominent on a superbill.

Diagnosis and Procedure Codes

ICD-10 and CPT codes make up the bulk of a superbill. ICD-10 codes assign a numerical value for every diagnosis a provider addresses during a patient encounter, while CPT codes are affiliated with treatments provided to the patient. These codes are universally recognized and understood by providers and insurance companies alike, forming a common language so services can be appropriately billed for. When creating a superbill for a patient encounter, always provide a complete list of all relevant diagnosis and procedure codes.

Fees and Charges

Healthcare providers are required to accurately reflect the charges for services rendered when listing them on a superbill. Each practice or independent provider sets their own rates for different services, and those rates aren’t always consistent. A superbill should indicate the total amount each service costs so insurance payors can evaluate how much compensation can be offered to patients. Fees listed in a superbill should specifically correspond with each individual instance.

How to Create Your Own Superbill Template

By using templates, providers can quickly and easily generate superbills following patient encounters. If you don’t already have a superbill template, that’s okay — we’ll walk you through how to create one that serves your practice well. In a lot of cases, your practice management or billing software will have a template already made that you can customize to your liking.

1.) Identify Common Encounters and Procedures

Depending on your specialty, you may find that you have certain appointment types that happen on a daily or even hourly basis. Once you’ve determined what encounters are most common at your practice, you can make a list of superbill templates to create.

2.) Set Up a Template within Your Practice Management or Billing System

Once you’ve identified what templates you’d like to build, it’s time to create the framework. Most billing systems will have a report you can easily adapt to function as a superbill template. Your template should have smart fields that automatically fill in provider and patient information with the ability to quickly swap out info when you need a new superbill. Your superbill should also have a section for codes describing the encounter and associated fees.

3.) Assign Encounter and Diagnosis Codes

While no two situations are exactly the same, you may be able to get a jump start on plugging in codes based on historical data. You can also designate approximately how much treatments will cost based on ICD-10 and CPT codes — the goal here is to get as much down in your system as you can so all you need to do is change out provider and patient information.

4.) Benchmark PM Makes Superbills Easy

If your current tech stack doesn’t make it easy for you to generate superbills, it may be time to consider making a switch. Benchmark PM’s built-in billing platform is fitted with a variety of built-in reports that are pre-formatted for fast, accurate data entry. Plus, when you connect Benchmark PM with Benchmark EHR, you can use automatic ICD-10 and CPT code recommendations so generating your superbill template requires little mental effort.

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Submitting and Tracking Superbills

If you’re a patient and you’ve just received a superbill, you may be wondering what to expect from here. It depends on your insurance company, but typically, you should start by submitting your claim online. Next, your insurance provider will review the superbill, and if the services received fall within the scope of your insurance plan, you’ll receive reimbursement via mailed check or direct deposit. Insurance companies typically take at least a few days and as long as a few weeks to process claims for out-of-network services.

Benchmark PM, Benchmark EHR, and Benchmark RCM Work Together to Improve Your Billing Processes

By leveraging superbills, providers can offer another potential payment option to patients — and in return, receive more compensation for services provided. With Benchmark PM, you can analyze your practice’s performance and pinpoint common appointment types. From there, Benchmark EHR helps you identify the right codes to assign. And finally, Benchmark RCM services can handle as many aspects of billing as you want so you can improve cash flow without increasing your workload.

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