Wiki Billing insurance from a superbill

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mabrown1994

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I am working for a medical billing service. We code & bill for an ASC. We read every word on every OP report & code the procedures & diagnosis in this way.

In the past we have occasionaly had to call the physician office to ask for documentation to justify medical necessity. Recently, on two separate occasions, at two seperate offices, we've called to ask if they could provide us with documentation & we've basically been told that they bill from a superbill & they cannot give us a copy. We've learned that the "coders" aren't really coders, they are just entering data.

My manager & another woman I work with are questioning the use of superbills.

Is it legal to bill insurance from a superbill?
 
I don't work in the physician's office. I don't know if it is signed ...

The thing is, I didn't go to school specifically for billing & coding. I went to school for MAA. So I feel like maybe I'm missing something ... In class we were taught how to use ICD-9 & CPT more or less, in the event that we may at some point have to look up a procedure or diagnosis. I personally am not surprised to learn about the use of superbills, because that's more or less what I was prepared for in school when working in a physicain office. So I was just curious about the appropriateness of it.
 
It really makes no difference if it is signed or unsigned. A superbill or encounter form is not considered a piece of the patient's medical record and , therefore, cannot be utilized to substantiate a service occurred. This is Medical Records 101, so to speak.
 
Superbill/Encounter form is a tool to input data only and will not be utilized in an audit. They can be audited to ensure the information is being entered as provided but there is no justification from this for the medical record
 
mabrown1994 said:
I am working for a medical billing service. We code & bill for an ASC. We read every word on every OP report & code the procedures & diagnosis in this way.

In the past we have occasionaly had to call the physician office to ask for documentation to justify medical necessity. Recently, on two separate occasions, at two seperate offices, we've called to ask if they could provide us with documentation & we've basically been told that they bill from a superbill & they cannot give us a copy. We've learned that the "coders" aren't really coders, they are just entering data.

My manager & another woman I work with are questioning the use of superbills.

Is it legal to bill insurance from a superbill?
Click to expand...

Just to clarify. The superbill is a tool used in most practices for the doctor to communicate with the billing staff what happened in the visit. I have been a coder for over 25 years, but I did not "code" every visit. I did code many of the surgeries and procedures, but office visits were coded by the physicians. I would audit a random selection of the visit notes each quarter to be sure that E/M levels were appropriate and diagnosis codes were accurate. For physicians who coded their own procedures, I would check the documentation to be sure the codes were correct. Busy physician offices are generally short-staffed so many staff have to wear multiple hats...coders are billers and do data entry work too.

The information from the superbill is data entered into the system to make billing to the insurances happen. I would enter that data, update patient demographics, and I could verify what was being billed fit with the reason for the visit. My title was Coder/Biller (and whatever else needed to get done).

I would call again ask for the physician's documentation of the visit, not his billing sheet. If they respond again that they just use a superbill for documentation, ask to speak to a supervisor, or the doctor. If they are using a superbill as documentation, then you can share with them that this is not acceptable in an audit and could result in money being sent back to the insurance companies.

This could be a good teaching situation!
 
Great points about the superbill not being "part of the medical record". As an auditor when I request records I request all pt medical and financial records when I audit a practice.
The OIG will request the exact same thing when they request records.
So find out if it is signed. If the physician of record has not provided at least the minimal signature you cannot and should not bill from it.
 
Lots of good info here. I work with a very large physician group. We use superbills or charge tickets as billing sheets. They do not support and are not designed to support charges. They are merely a communication tool to the patient financial services staff from the provider on the services that they wish to bill for. It does not have to be signed by the provider as it is not part of the legal record. When we audit we always go back to the patient record for documentation.
 
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