A Guide to Superbills
A Superbill is a document that outlines the care a patient has received and, if you have paid out-of-pocket, the information you need to get your money back from your health insurance. Here is a simple breakdown that explains Superbills and how Better uses them to process your claims.
When do I get a Superbill?
When you pay an out-of-network provider, for example, a psychiatrist, therapist or chiropractor, a basic receipt will not have the information is required by your insurer. That information appears on a Superbill, also referred to as a “coded bill”. It shows the care you received, how much you paid, and includes specific codes and information required by your insurance company. You will often need to request a Superbill from your provider.
An illustrated example–
(a) Contact Info
This is basic information, listing the provider’s name, their address and contact information so that the insurer can identify the doctor or other healthcare provider.
EIN stands for Employer Identification Number, also called a Federal Tax Identification Number and is issued by the IRS. It could be described as a social security number for businesses and identifies your healthcare provider. If your provider doesn’t have an EIN, they may use their social security number. That will work instead.
The National Provider Identifier is a 10-digit identification number supplied by the Centers for Medicare and Medicaid Services (CMS). It has been adopted as the standard provider identifier and most healthcare providers, individual therapists, doctors and entire hospitals are issued one, since it allows them to work within the insurance system. An NPI is optional. If you’re provider doesn’t have one, that’s okay.
(d) Appointment Date
A Superbill will show a date for each separate appointment. It can be for a single appointment or many appointments but requires a date for each individual appointment that is being billed for.
(e) Diagnosis Code
This code is a tool to classify symptoms, diseases, diagnoses, and all other patient interactions. This identifies to the insurer why you are receiving care. In some cases there will be multiple diagnosis codes if you’re being treated at the same time for a variety of medical issues. Every appointment will have a diagnosis code, even if you are not sick.
The coding process for diagnostic codes gets updated over time. The current version of International Statistical Classification of Diseases and Related Health Problems is known by the more convenient acronym: ICD10, but many providers are still using the old system: ICD09. If your coding is ICD09, your insurance will reject the claim.
Better checks this coding and corrects errors automatically.
(f) CPT Code
CPT stands for Current Procedural Terminology, a medical coding system, created by the American Medical Association (AMA) to define medical, surgical, and diagnostic procedures. There is a code for each procedure performed, specified by a 5-digit number. If this information is missing, the bill will be rejected by your health insurance.
Better can help you
90 percent of all medical bills are miscoded. When that happens you will either not get paid or you will not receive the full amount you are owed. If you have a problem, Better can help correct any billing issues, automating the process, taking the patient and the provider out-of-the-loop.
For more information check out the Better website.