We have same issue as well and follow the exact same process of exporting/printing the superbills over to our outsourced biller. Our nurse starts off the note with vitals/weight info and then forwards it on to the physician. We only need to wait for the physician to sign off though so this sounds like only difference (you mention all three must finish to submit a single superbill?)
When our first started using AC, we would get behind if the notes were not signed off. But finishing the notes became an imperative to keep the revenue flowing. We chose not to use a separate out of system superbill as some have done. Thought it would be simpler to just keep it in AC.
Relying on AC superbill hasn't been perfect of course as certain busy times signoffs fall behind but it has worked out well enough to keep revenue flowing.
