Which form documents the services provided, charges, and amounts billed to a patient or payer in outpatient setting?

• A. ICD-10 codebook
• B. Notice of Privacy Practices
• C. Superbill
• D. CMS-1500 claim form

Answer: (D)

In outpatient billing, the document that captures what was done, the charges for those services, and the amounts billed to the patient or payer is the standard claim form used to seek payment. This form is designed to transmit professional services to insurance plans and government programs, listing each service with its CPT/HCPCS code, the date of service, place of service, diagnosis codes, and line-item charges, along with patient and payer information and provider identifiers. A superbill often serves as an internal record that supports this submission by detailing services rendered and the associated codes and charges, but the formal submission to payers is the CMS-1500 claim form. ICD-10 codebooks are for selecting diagnosis codes, not for the billing document itself, and the Notice of Privacy Practices is a HIPAA privacy notice, not a billing form.