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Medical billing has a lot of terms that the general public is not aware of. However, it is important for healthcare providers to understand all the complex terms and be updated about any changes. Superbill is one such term in medical billing about which we are going to learn in today’s blog.
Superbill in medical billing refers to the document that provides an extensive invoice of the services provided by a healthcare provider to their patient. These superbills are created and submitted for every treatment session conducted by an out-of-network provider. Once the doctor provides the required treatment, the cash is collected from the patient.
In exchange, the doctor generates a superbill which the patient can present to the insurance payor and get reimbursed for their out-of-pocket expenses.
Some healthcare providers even submit superbills on the patient’s behalf to create a better patient experience. They use a portal for electronic submission also known as e-superbill. Either way, the patient pays the doctor first. Superbills are created so that the patient can get reimbursed unlike CMS 1500 form that pays the doctor directly.
Superbills also go by different names like encounter forms, charge slips, fee tickets, or statement of insurance reimbursement.
Who Is Responsible for Creating & Submitting a Superbill?
Only the doctor can create or generate a superbill. It is then handed over to the patient who submits it to the insurance company and get paid back. This is all a hectic procedure which is why it is advised to get professional medical reimbursement services for healthcare providers.
Nowadays, some doctors also submit superbills themselves so that the patient has an easier time. If the provider is not able to submit it due to any reasons, the patient can do it too.
How Does Superbill in Medical Billing Work?
Generally, when a patient visits a doctor that is not a part of the insurer circle, the patient will have to pay the doctor from his/her own pocket for the treatment rendered. The doctor then creates a superbill that includes a list of all the services rendered along with their costs. The patient can then use this bill to file an out-of-network claim with their insurance company. The patient will not get a complete reimbursement because the doctor was out of the insurance network.
The insurance company reviews the claim and decides the amount they will reimburse. If the patient is not satisfied with the reimbursement, the patient can revise and re-submit the claim.
What Is the Need for Superbill Creation?
Superbills allow medical practitioners to offer their expertise without being constrained by any sort of limitations of being in the insurance network. With a superbill, the provider can collect the full payment directly from the patient. After that the patient can seek reimbursement from their insurance provider by submitting the superbill. There could be various reasons for superbills. Let's take a look at them.
When the doctor is not approved within the payer network
In this scenario the patient goes to a doctor that is not listed with the insurance company as an approved provider.
When the Doctor is not yet credentialed
In this case, if the doctor is waiting to get approved, he must be paid somehow. In this scenario, the providers rely on superbills as a payment method while they wait for credentialing from the insurance company. This helps them continue their services to ensure that they receive payment for their expertise until they are officially recognized by the insurance provider.
When The Doctor Does Not Want to Be on the Insurance Panel
A lot of head doctors and therapists do not want to join the insurance network. This happens because the application process takes a very long time with loads of paperwork and interviews. It is much easier for the healthcare provider to simply charge the patient directly. They let the patient get reimbursed on their own time.
Different Types of Superbill in Medical Billing
Medical superbills are of two types; however, the creation process is the same for both. The change is made when the superbill has to be handed to the payer for reimbursement. Let's take a look at both the types.
Client-Submitted Superbills
Client-submitted superbills are the ones in which the provider hands over a copy of the superbill to the patient. The patient can then take the initiative to contact the insurance provider and submit the claim to get reimbursed for their out-of-pocket expense.
Clinician-Submitted Superbills
Clinician submitted superbills are the ones where the provider takes charge and submits the superbill to the insurance company on patient’s behalf. The therapist acts as the intermediary that helps streamline the reimbursement process for the patient.
Components of Superbill
A superbill has all the details of the patient-provider encounter like the date, fees of each service, diagnostic codes, etc. It is a crucial piece of billing information which showcases the important components mentioned below.
Component 1: This is the provider information section that holds all the relevant information about the practice involved in providing the service or treatment.
Component 2: This section includes complete patient relevant information needs to successfully generate claims and call reimbursement for the patient.
Component 3: This section contains the visit information and is comparatively tricky. It requires immense precision to create accurate bills.
How Outsourcing Can Help Your Business?
While medical billing is full of complexities, outsourcing it to professionals is always the best approach for any healthcare practice. Professional medial reimbursement services can do wonders for your organization in every sense possible. Unify Healthcare Services is one such organization that manages the billing and coding for various small and big scale medical providers.
Unify Healthcare Services has a team of professional billers and coders who are well-versed in all the elements of medical billing. We can handle the billing responsibilities of all types of healthcare providers. Finding us is very easy. Simply go to Google and search “Medical billing company Massachusetts”. You will find us in the top results. That's how good we actually are.
Our experts make sure that you get reimbursed for every single service you offered to a patient. We take extra measures to ensure that you are compliant with all the guidelines so that your organization never faces an audit or any kind of legal trouble. We believe that a free mind provides the best patient care. This is why we take all the administrative burden off your shoulders and let you focus only on your core specialty.
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