Take a Closer Look at Your Superbill to Ensure Accurate Billing

Lisa Eramo August 21st, 2012

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Practices should take the time to review their superbills and any relevant coding/billing policies to look for deficiencies that could affect their bottom line.

Superbills aren’t necessarily supposed include every code a physician might report. The superbill is typically a one-page reference of the most common codes used in a particular practice.

Still, practices should take the time to review their superbills and any relevant coding/billing policies to look for deficiencies that could affect their bottom line, says Mandy Thompson, CPC, coding and compliance consultant at Kraft Healthcare Consulting in Nashville, TN. Thompson, who performs coding audits for physician practices nationwide, says superbills often include these common mistakes: 

Outdated codes

This is by far the most common mistake that practices make, says Thompson. Practices using outdated superbills run the risk of receiving countless denials due to extremely repetitious errors. At a minimum, practices should review the superbill annually when new codes take effect. New ICD-9-CM codes take effect October 1 every year. New CPT and HCPCS codes take effect each January. Practices should also monitor code changes every quarter when CMS releases its HCPCS Quarterly Updates.  

Lack of codes

Although the superbill can’t accommodate every code that a physician might report, Thompson says some practices inadvertently omit codes that truly should be included. Hypertension is a common example.

When this happens, physicians end up handwriting diagnoses at the top of the superbill in the hopes that coders will code them. However, handwriting is often problematic because it can be illegible and easily leads to incorrect coding and reimbursement. Also, if practices don’t hire certified coders or individuals who are thoroughly trained in coding who know how to look up diagnoses in a coding manual, these handwritten diagnoses may not even make it to the bill. Someone in the practice should monitor what physicians frequently handwrite and whether this information should ultimately be added as a permanent part of the superbill. 

Lack of specialty-specific information

Some superbills simply aren’t specific enough, says Thompson. Specialty practices should ensure that the superbill includes any relevant specialty-specific diagnosis and procedure codes in addition to chronic conditions, such as hypertension and diabetes. For example, dermatology practices should ensure that the superbill doesn’t simply provide one code for lesion removal. It should indicate that multiple codes are available and prompt physicians to document whether a lesion is benign or malignant as well as its size, location, and the number of lesions removed.  

The American Academy of Family Physicians (AAFP) published a superbill that practices can customize for their own use. One unique feature of this superbill is that it includes spaces for physicians to list up to four diagnoses, each of which they can assign a corresponding  number. The superbill also includes a column titled “Rank” next to each CPT code so physicians can link procedure codes with diagnosis codes. 

Revisit coding policies

From a policy standpoint, physician practices should ensure that coders always have an opportunity to review the medical record prior to coding—not only when they have significant questions about documentation, says Thompson. Unfortunately, this doesn’t always occur. Some practices require individuals performing the coding function to code straight from the superbill in the spirit of efficiency and multi-tasking. However, this is problematic for several reasons.  

Some physicians, for example, get distracted as patients ask questions, and then they forget to complete the entire document. For example, they may circle a procedure but no diagnosis. Immunizations are commonly omitted from the superbill even though physicians frequently render them during a patient’s visit, says Thompson.  

Practices that allow coding straight from the superbill also open themselves up for increased scrutiny of the E/M codes they report. Many physicians make costly mistakes when they under-report or over-report E/M codes simply because coders can’t review documentation to verify the specific level E/M assigned. Thompson says auditors don’t audit based on the superbill—they audit based on the record. 

Consider electronic superbills

Although many smaller practices still use a paper superbill, larger practices have likely transitioned to an electronic one, says Thompson. Not only do electronic superbills eliminate legibility challenges, but they also include a greater volume of codes. Coders also no longer need to guess which CPT code(s) a physician circled or debate whether a code appears to be partially circled. Some medical billing software solutions may allow physicians to securely email an electronic superbill to an internal or external biller. All of these advantages can potentially increase efficiency and reduce denials.  

Lisa A. Eramo is a freelance writer and editor specializing in medical coding, health information management, and other healthcare regulatory topics. Visit her website at http://lisaeramo.wordpress.com/. Lisa wrote recently for Getting Paid on Avoid These Mistakes When Appealing Denied Claims and Prevent Denials with More Accurate Medical Coding. Lisa has also written on Understanding RVUs: Ensure Accurate Reimbursement for the E/M Services You Provide.

You can learn more about streamlining your billing processes in our next informational webinar, Finish Strong: Make 2012 Your Most Profitable Year! with Karen Zupko on August 30. Register now.

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