What Is A CMS 1500 & Superbill for Insurance?
Learn the difference between a superbill vs CMS 1500 form. Find out what a superbill for insurance is and how to use them in your health practice.
Whether you are just starting to take insurance at your nutrition private practice, or are interested in learning more, you may find yourself wondering what the difference is between two insurance forms — a Superbill vs CMS 1500s. Both forms can be submitted to insurance companies for possible reimbursement towards nutrition services, however how they are utilized are very different.
In this article, we’ll break down:
- What are Superbills and CMS 1500s claims
- When to submit these insurance claim forms
- Superbill vs CMS 1500s: which to use in your practice
What are Superbills and CMS 1500s?
A Superbill is essentially a receipt of wellness services that can be provided to clients which insurance companies recognize. Clients can submit these to their insurance beneficiary for (potential) reimbursement for services. You’ll use a superbill if your practice does not accept insurance, or you are not in-network with your client’s insurance plan — but your client would like to still try to use their insurance benefits. Clients pay you out-of-pocket for your services, and insurance will reimburse the client directly if their benefits cover.
Below is an example of a Superbill generated through Healthie, an EHR and billing platform designed for dietitians and nutrition professionals.
A CMS 1500 is a health insurance claim form for non-institutionalized healthcare providers (such as private practice dietitians). It is essentially a receipt of service that wellness providers submit to insurance companies to then receive reimbursement. You fill out this form each time you wish to submit an insurance claim, and you will only submit CMS 1500 claims to insurance companies that you are an in-network provider with.
Below is an example of a CMS 1500 claim form. When submitted by mail, CMS 1500 forms must always be a red-ink printed version, which you can obtain in office supply stores (like Office Depot or Staples). However, most wellness providers (and insurance payers) have transitioned to electronic claim submissions for faster and more efficient claims processing.
How are Superbills and CMS 1500s different?
The short version:
You use a CMS 1500 form when you are an in-network provider with an insurance provider. You use a Superbill when you are out of network with an insurance provider.
With a superbill, you still accept out-of-pocket payments for your services, but your client can receive reimbursement for their bill by submitting their superbill to their insurance company.
We sometimes call superbills the “Junior Varsity” version of offering insurance benefits to your clients. Providing a superbill will give your clients a chance to receive a reimbursement through their insurance company. You can submit a Superbill for multiple client sessions (ie. if you offer service packages in your nutrition practice) however every single individual client appointment must be listed out in an itemized format. Some providers choose to provide clients with a Superbill after each session or at the end of a time-period (ie. end of the package or end of each month). As a provider, it’s best to discuss with the client how they would prefer to receive their Superbills.
Superbill vs CMS 1500: Which to Use in Your Practice?
In nutritional care, Superbills and CMS 1500s are both ways to decrease client expenses on nutritional services. Superbills can be a way to ease into insurance billing, but providing CMS 1500s will require the nutrition practice to become and insurance-based practice. Deciding whether to become insurance-based or remain self-pay is an important consideration when building a nutrition private practice.
Ultimately, it is the client who will be responsible for submitting the Superbill and following up with their insurance company on the status of their reimbursement — they will also receive the reimbursement directly, so providers should always have clients pay for the services at time of service. Nutritionists and dietitians alike can create Superbills, whether they accept insurance or not. It’s simply a matter of generating the form and giving to clients to then submit to their insurance company. For out-of-network (or non-insurance) nutrition practices, providing Superbills can be a great way to help clients leverage their insurance and decrease out-of-pocket expenses for nutrition services.
CMS 1500s on the other hand are solely the providers responsibility to create and submit the insurance claim. In order to accept insurance in their practice, dietitians must first become in-network providers with specific insurance payees. Becoming an in-network provider can be a time consuming process, taking several months to become credentialed. However, accepting insurance is one way to gain client referrals, grow a practice and offer affordable nutritional care. A client does not pay for their service (other than copays) and the provider will receive reimbursement directly from the insurance payee. If a claim is denied by the insurance company, nutrition providers can revise and resubmit the claim, or the patient will be responsible for paying the their session as described in the practice financial agreement terms.
When navigating insurance forms, it’s always best to be upfront with clients regarding expectations, policies and payment terms.
Pro Tip: Whether you’re creating a Superbill or CMS 1500 form, there is specific information to collect in order to be processed by an insurance payer.
Healthie makes completing insurance forms easy. Collect the need-to-know details right with an intake form. Fill out your CMS 1500 form or Superbill once, and it will save to auto-fill the information that client for the next time. To learn more, start your free trial today.
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