Revenue Cycle Management Blog | GroupOne Health Source

Will ICD-10 Cause the Extinction of Paper Superbills?

Written by Kaitlyn Houseman | August 26, 2015

Paper superbills have been as much a part of many medical practices as stethoscopes and blood pressure cuffs over the past few decades. And despite increasing prevalence of electronic health records (EHRs), more than half of physician practices today still use paper superbills. That's because they're flexible and powerful and do their job well.

The paper superbill lets clinicians capture procedure and diagnosis information efficiently, and can be designed to closely support the specific needs of a practice - or even a specific physician within a practice. Once clinicians get used to using them, they can complete paper superbills very quickly, which is essential considering the many demands on their time. Moreover, paper superbills contain information necessary for the billing department to submit claims promptly. But significant changes are expected with the ICD-10 transition deadline of October 1.

What Happens When You "Translate" an ICD-9 Superbill to ICD-10?

ICD-10 is made up of 68,000 codes while ICD-9 is made up of 15,000 codes. ICD-10 codes are longer and much more detailed than its corresponding ICD-9 code. On a standard sized paper form, unless you use a tiny font, a printed superbill with ICD-10 codes will be longer - sometimes significantly longer - than the same superbill with ICD-9 codes.

A study by Government Health IT had some representative practices convert some ICD-9 superbills to ICD-10. One hospital's two-page ICD-9 superbill turned into a 48-page superbill when ICD-10 codes were used. Another provider discovered that their two-page ICD-9 superbill turned into a nine-page superbill under ICD-10, which is still significant, particularly for a high-volume facility. For this reason alone, many practices are questioning whether to discontinue paper superbills altogether starting in October.

Other Reasons October 1 Could Mark the End of the Paper Superbill

Practices that want to continue using paper superbills with ICD-10 will have to develop techniques to capture patient encounter information from clinicians for the billing team. But they'll have to develop ways to provide this extra information without staffing up or slowing providers down if they want to maintain their current cash flow pace. That means they have to determine who will provide this extra information, and at what point in the workflow they do so. Without providing the necessary level of detail, billing staff won't be able to assign specific enough ICD-10 codes, which could result in their spending a decent chunk of time each day answering follow-up questions for payers who need more coding detail.

Advantages of Electronic Superbills

Electronic superbills created with EHR systems can flatten the learning curve and help keep the revenue cycle on track. For one thing, electronic superbills cut down on simple human error compared to manually completed forms, and this results in more accurate coding. Accurate coding plus EHRs to create electronic superbills could ultimately mean more money for a practice.

Outstanding EHR solutions offer templates and superbills that let clinicians, coders, and billing staff document services efficiently. And when a practice automates charge capture with its EHR system, the result is more accurate and complete coding, because the EHR can be made to suggest codes automatically based on the physician's progress notes. This can cut down on undercharging due to confusion about codes on superbills.


The paper superbill served its purpose admirably, but with the change from ICD-9 to ICD-10, paper superbills will become impractical for many providers. Fortunately, good EHR solutions exist with built-in tools for quick, accurate coding, and generation of electronic superbills that let practices enjoy the benefits of ICD-10 without the excessive slowdowns that would result from continuing with paper.

The advent of ICD-10 may spell the end of paper superbills, but better, more accurate, and more efficient electronic superbills are expected to replace them. The key to great electronic superbills is great EHR software that can be tailored to the needs of individual practices. At GroupOne Health Source, we're experts in optimizing the revenue cycle through outstanding EHR systems. We invite you to schedule a personalized RCM demo with us so we can show you exactly how we can help your practice overcome the challenges of ICD-10.