Superbill

A superbill is the visit written down in billing terms. It carries the patient’s details, the rendering provider’s NPI, the date and place of service, the diagnosis codes, the procedure codes with units and any modifiers, and the charge for each line. In a paper practice it is a checklist the clinician ticks; in an EHR it is the encounter the clinician closes. Either way, it is the source document charge entry works from, and the thing an auditor asks for when a claim is questioned.

It also has a second life. Cash-pay practices and out-of-network therapists hand the superbill to the patient, who sends it to their own insurer for reimbursement. For that to work the form needs everything the insurer’s claim form would: the provider’s NPI and tax ID, the diagnosis pointer for each procedure, and the amount the patient paid. A superbill missing any of these comes back to the practice as a phone call.

The mistake is treating the superbill as complete because the clinician signed it. Procedures done in the room but not on the pick list, supplies, injections and time-based codes are the lines most often left off, and a claim can only bill what the superbill says. Reconcile closed encounters against the schedule every day, and compare what was documented against what was coded before the charges post.