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 the services you have provided your client. Clients can submit these to their insurance companies to (potentially) get reimbursed for your services.
A CMS 1500 is an insurance claim form for non-institutionalized healthcare providers (such as private practice dietitians). If you come from a clinical background, a CMS 1500 is like a UB-04. You fill out this form each time you wish to submit an insurance claim.
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 company. You use a superbill when you’re not an in-network 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. 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 a LOT of information to collect. Especially with the CMS 1500 form.
Healthie makes 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! Breeze right through insurance with Healthie.