What is a Superbill in Medical Billing?

A superbill is not really a bill at all. It’s a highly detailed receipt for each patient encounter, itemizing the services that were provided by a physician, therapist or other health professional. 

Sometimes going by less-than-super names like charge slip or encounter form, superbills contain all the vital information required for the patient to be reimbursed by their insurance provider, like the diagnostic and procedural codes that explain precisely what care the patient received. Insurance companies typically use superbills to reimburse patients, rather than providers, for services.

A superbill for insurance purposes is crucial for patient reimbursement. Let’s say that, as a patient, you see a health care provider who’s in your insurance’s network. Depending on your plan’s benefits, you might have to pay a co-pay at the time of the service. To cover the rest of the bill, the provider submits a claim to your insurance company. As the payer, they reimburse your healthcare provider directly without you having to take any further action. 

But what about instances where you need health services from a physician, therapist, diagnostic center or other provider who’s outside of your plan’s network? In this case, you may have to pay out of pocket, then file an out-of-network claim with your insurance provider. This is where the superbill gives you the detailed documentation you need to be reimbursed accurately.

Superbills are typically provided to patients by healthcare providers who are outside of the patient’s insurance network, so the patient will pay for the treatment themselves. If the patient has out-of-network benefits, think of the superbill as the key that unlocks them. The patient can submit a superbill to their insurance plan after they’ve received treatment and be reimbursed for a portion of the total cost. 

How much of the total amount of the bill can you be reimbursed for? The answer will vary by plan, which typically have out-of-network restrictions like benefit limits, allowed amounts, out-of-network deductibles and out of pocket maximums. 

These restrictions, which will vary widely among insurance plans, are a good reason why all consumers should familiarize themselves with their health plan prior to starting any treatment and be aware that prior authorization may be needed to access some out-of-network services.

The next important part of our “what is a superbill” discussion is the information that goes into one. Superbills include specific information from 3 areas: provider information, patient information and visit information.
 

This section of the superbill includes all the information related to the practice and the specific provider. This includes the provider’s first and last name, their unique 10-digit National Provider Identifier (NPI) number, the office location where the patient encounter took place, the provider’s phone number and email address, their signature and the referring physician’s name and NPI number, if necessary.
 

Super bill information about the patient includes their first and last name, date of birth, address, phone number and insurance information.
 

This component of the superbill includes highly detailed, information that summarizes the visit itself. To be used for insurance reimbursement, it needs to contain the date of the visit, any applicable fees and the medical codes that describe the diagnoses and procedures involved. These will appear as CPT procedure codes and ICD-10 diagnosis codes, along with any applicable code modifiers.

CPT, or current procedural terminology codes are 5-digit numerical codes used to track and bill medical, surgical and diagnostic services, and determine how much to pay providers. The American Medical Association (AMA) develops the codes and updates the coding system as changes occur in the healthcare delivery field. 

ICD-10 codes consist of up to 7 characters and classify diseases, injuries and procedures. A single 7-digit code can indicate the patient’s condition, its cause and what part or parts of the body it’s affecting.

Any healthcare provider, such as a physician’s office or clinic can issue a superbill, but they’re typically used by providers that do not accept health insurance. 

Examples of providers who routinely issue superbills include:
 

You can take the first steps toward your medical billing and coding career with our online Undergraduate Certificate in Medical Billing and Coding programs.

Built to meet the needs of today’s digitally driven health information technology field, these 100% online programs provide you with hands-on experience with industry-standard software systems, practice working with simulated patient records and preparation for industry-relevant certification exams built right into the curriculum. 

Students enrolled in our Medical Billing and Coding Certificate programs will also learn how to navigate both inpatient and outpatient settings, providing them with the skills they need to thrive in either environment. 

Our Undergraduate Certificate in Medical Billing and Coding program includes material addressed in the CPC® certification exam, which focuses on outpatient coding, by taking a Coding Practicum and Review (CPC Exam) course. DeVry students who earn an 85% or higher in this course can earn a voucher for the CPC exam. The voucher code is valid for 60 days. 

Students enrolled in our Medical Billing and Coding – Health Information Coding (HIC) Undergraduate Certificate program will be able to prepare for the inpatient-focused CCS® exam with a CCS Review (CCS Exam) course. DeVry students who earn an 85% or higher in the course can earn a voucher for the CCS exam. The voucher code is valid for 60 days. Eligible students will also receive a complimentary AHIMA Student Membership. 

DeVry University has the highest number of graduates from a Medical Billing and Coding Certificate program for the last 5 years, according to IPEDS.¹