Hot Topics: Superbills – Why Updating Is Critical to Coding, Billing, and Reimbursement

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I consider a superbill to be the life blood of a practice, as they are the check and balance process that tracks from the time the patient is seen by the provider to the time the information is generated into a claim form and submitted to a payer.

Over the years, whether a practice is on a paper chart or electronic medical record (EMR) system, I can’t tell you the number of times an encounter has been missed claims generation and then in an audit, I have gone back and found the visit via a superbill and have been able to have the provider go back and submit the claim* (as long as the timely filing guidelines were still open for the payer).

Key Components of a Superbill:

  • Practice Name
  • Practice Demographic Information
  • Provider name
  • Provider license number, NPI number, tax ID number
  • Provider electronic/ handwritten signature (stamped signatures are not acceptable)
  • Date of Service
  • ICD9 codes to reflect conditions treated
  • CPT4 codes to indicate services provided
  • Modifiers if necessary
  • Charges/Fees
  • Patient Name
  • Patient Social Security number
  • Patient Demographic Information
  • Patient Employer Information
  • Patient Insurance ID number
  • Assignment of Benefits on file indicated

What Puts the Super in Superbill?

A superbill contains the documented services and diagnoses that the provider indicates are the reasons why the patient was seen for an encounter. They are utilized in the majority of practices, even if the practice is on an EMR.  The information is translated into a claims form, which is then submitted to a payer for reimbursement. Superbills are also given to patients if the provider does not participate with that patient’s payer or if the patient has not assigned payment to that provider. The patient will take the superbill and submit it to their insurance plan for payment.

Failure to update codes on a superbill at least annually after the October releases by CMS and have at the ready for January 1st of each year, will lead to inaccurate coding and billing and ultimately reimbursement issues with payers. When the superbill is reviewed, it is important to remove deleted codes, update code revisions, and add any new codes to maintain compliance. It is important to also track the revision date so as not to use outdated superbills.

The following are some potential negative reimbursement issues which may result from outdated Superbills:

  • Payment denials
  • High number of time consuming appeals
  • Downcoding
  • Bundled codes
  • Audits due to outdated code submission
  • Decline in cash flow

Take a Proactice Approach to Annual Updates:

Part of being a coding and/or billing professional is the ability to take ownership of key practice issues and develop a proactive approach to keeping superbills updated annually. Discuss with your administrators and physicians to develop a team approach to annual updates. Sign up for CMS’ October release of coding updates and review payer specific reimbursement guidelines annually for any changes that might impact your practice. Familiarize yourself with CMS’ 1500 form and how to properly complete it.

For more information on superbills and downloadable tools visit the following sites.

Happy Coding!
Holly, follow Holly on twitter @hollycassano

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