Whether you want to do your own billing or use a vendor, the Academy has information to help you get started. Learn the basics of billing with our RDN's Complete Guide to Credentialing and Billing: The Private Payer Market. Learn when and how to use a CMS1500 form or a superbill.
RDN's Complete Guide to Credentialing and Billing: The Private Payer Market
Use this comprehensive billing guide, developed by registered dietitian nutritionists, to learn about private insurance credentialing, submitting claims, using correct procedure and diagnosis codes and much more.
Claim Form (CMS-1500) and Instructions
The CMS-1500 claim form answers the needs of many health insurers. It is the basic form used in the Medicare program for claims from physicians, other providers and suppliers, except for ambulance services. It has also been adopted by the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and has received the approval of the American Medical Association (AMA) Council on Medical Services.
The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of some Medicaid State Agencies. Please contact your Medicaid State Agency for more details.
- Sample 02/12 1500 Claim Form (National Uniform Claim Committee, accessed February 2017)
- National Uniform Claim Committee 1500 Health Insurance Claim Form Reference Instruction Manual, July 2016
- Instructions — Chapter 26 of the Medicare Claims Processing Manual
Providers who bill electronically should consult the Centers for Medicare and Medicaid Services (CMS) website for Electronic Data Interchange (EDI) information. The material includes facts about Medicare EDI, advantages to using Medicare EDI, news and updates in Medicare EDI, descriptions of Medicare EDI formats and EDI formats to download.
- Electronic Billing and EDI Transactions (CMS website)
Ordering CMS-1500 Claim Forms
The form specifications require red drop out ink in order to facilitate the use of image processing technology such as Image Character Recognition (ICR), facsimile transmission and image storage. It is available in various formats (e.g., single copy, duplicate, etc.). The CMS-1500 claim form may be purchased from local printers or through the following organizations:
U.S. Government Printing Office
Superintendent of Documents
Washington, DC 20402
Pricing Desk: 202/512-1800 or 866/512-1800
American Medical Association (AMA)
PO Box 930876
Atlanta, GA 31193-0876
Credit Card Orders: Call 800/621-8335
(American Express, Visa and Master Card accepted.)
Billing: Vendors and Services
Factors to Consider When Selecting a Professional Billing Service
Below are some examples of companies and organizations provide medical billing products, education and other resources. This list is not an Academy endorsement for any specific company, organization, billing software, service or agency.
Centers for Medicare & Medicaid Services (CMS)
As part of the Health Insurance Portability and Accountability Act (HIPAA), CMS offers program updates and publication notices through the Electronic Data Interchange (EDI) electronic mailing list. Free Medicare Electronic Media Claim (EMC) software is also available from your Medicare Administrative Contractor.
Medical Association of Billers (MAB)
MAB supports billing and coding centers, provider offices, insurance carriers and hospitals. This group offers education and training in ICD-10, ICD-10-CM, CPT Codes, HCPCS National Level II Coding and Reimbursement Trends. The MAB website includes detailed procedural and diagnostic coding information.
American Medical Billing Association (AMBA)
AMBA provides networking and some advocacy for small and home based professional medical billers. Their website features software packages and a list of vendors with AMBA's Medical Billing Certification.
Medical Billing Network
The Medical Billing Network is a trade association and school for both small and large independent medical billers. They offer several electronic medical billing software products on their website.
Medical Billing Consultants & Collections, Inc. (MBCC)
MBCC is both a billing service and a medical software dealer. They offer office automation services, practice management, software training, seminars and physician practice management classes. Access additional information online.