What is a Superbill?
A superbill is a detailed, itemized receipt given to patients/clients by a healthcare provider when:
A superbill may be used by clients for Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), tax purposes, or to try to obtain reimbursement from their health plan. The superbill is different than a CMS 1500 form, which providers use to submit claims to payers (private or government health insurance) for services provided.
In-network providers vs Out-of-network providers
An in-network provider is one who is credentialed with a payer and has entered into an agreement that includes a fee schedule for the services they provide. Payment rates for the MNT CPT® and other codes that reflect the services an RDN is approved to provide are negotiated and included in provider agreements. Out-of-network providers differ in that they have not entered a contract with a payer (e.g., insurance companies and other entities). There are benefits to becoming credentialed, such as known payment rates and a referral base. Learn more about private insurance credentialing.
Superbill Considerations
If you are an out-of-network provider who does not submit out-of-network claims to a payer, you may be able to help your patients access out-of-network benefits and minimize their out-of-pocket expenses for the services you provide by issuing a superbill for your services. It is possible that patients/clients may have benefits for MNT with an out-of-network provider under their individual insurance policy, although the coverage details may be different for services received out-of-network. When a superbill is used, patients/clients pay for services upfront, the provider issues a superbill to the patient, and the patient could submit the superbill to their insurance along with a request for repayment or allocation towards a deductible. The superbill shifts responsibility to the patient for contacting the insurance provider.
A superbill does not guarantee an insurance provider will reimburse the patient for the services provided. The ability of a health plan member to obtain reimbursement from a health plan is dependent on individual member benefits and coverage, as well as health plan policies regarding member reimbursement. Medicare beneficiaries are unable to submit superbills for MNT provided by an out-of-network provider. RDNs should inform Medicare beneficiaries that MNT is covered for diabetes, kidney disease and 3 years following a kidney transplant if they see an RDN Medicare provider. Medicare MNT coverage and resources.
Components of a Superbill
A superbill is more than just a receipt or a standard invoice. It is the main source of information a payer (insurance, funds, programs) will use to create a healthcare claim, which will be used to determine reimbursement. Insurance companies require specific information be included in a superbill. (Note: The Internal Revenue Service may have additional documentation requirements for health care expenses for HSA, FSA, and other tax-favored health plans.)
At a minimum, a superbill should include the following:
