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Hospital Billing vs Physician Billing

Hospital Billing vs Physician Billing

What Do You Need To Know About Hospital And Physician billing?

Medical billing is essential in the healthcare sector because it ensures payment to health facilities, doctors, and other providers. Physician and hospital billing are two most common types of medical billing in the healthcare industry. Professionals in the healthcare industry distinguish between these two terms by focusing on their goals and the services involved in the billing process.

This post will discuss the differences between physician billing and hospital billing, as well as the features that contribute to understanding these two types of healthcare claims.

Physician Billing 

Physician billing is also known as professional billing. It is responsible for billing claims created by physicians, providers, and other non-institutional providers for outpatient and inpatient services. Physician billing is used for billing claims to receive reimbursement for medical services provided by physicians to insured patients.

CMS-1500 or 837-P billing forms are used to bill claims. The only difference between these forms is that the CMS-1500 is a paper version, whereas the 837-P is an electronic version. The CMS-1500 is a red-ink-on-white-paper claim form, whereas CMS-1500 electronic adaptation is known as the 837-P, with the P showing the professional or physician format. 

Physician billing regulates many administrative duties involved in medical practices, such as scheduling appointments, greeting patients, check-in, registration, and payment processing. Physician billing services include inpatient and outpatient services that can only be billed after insurance verification. Insurance verification is essential because selective inpatient and outpatient services are billed under the patient’s insurance policies.

Physician billing encompasses the entire medical billing process, including medical coding. It follows that medical billers must be trained in both billing and coding procedures to perform regular billing.

Hospital Billing 

The term hospital billing is also known as Institutional billing. It is responsible for the billing of claims for inpatient and outpatient services performed by hospitals or skilled nursing facilities. A hospital billing system also charges medical claims for laboratory services, equipment, radiography, supplies, and medical facilities.

The UB-04 or 837-I form is used for billing these services. UB-04 is the red ink on the white paper claim form used by hospital providers for guarantee billing. The 837-I is the electronic version of the UB-04, with the I signifying the institutional configuration. Hospital billing only deals with the billing procedure and collections. Hospital coding is far more complex than physician coding, and coders only code institutional claims.

Significance Of Medical Billers

Medical billers play an important role in billing to reduce denials an improve reimbursement. Significance of medical billers is as follows:

  • Medical billers have access to a lot of information for each insurance company to handle medical claims.
  • Medical billers examine patient bills for consistency and reliability and assembling any missing details.
  • They follow unpaid claims within the essential billing cycle timespan.
  • Medical billers have the problem-solving ability to investigate discrepancies, denials, appeals, and collections.
  • Medical billers must be aware of HIPAA privacy and security standards.
  • They have experience in using billing software to save time and reduce errors.
  • Medical billers know how to bill claims in the correct order to avoid payment delays.

Outsource Physician And Hospital Billing Services To Us 

Hospitals and other health care providers choose to outsource physician billing and hospital billing services to avoid errors and revenue loss. We offer comprehensive and customized physician and hospital billing services to help you accurately manage your practice. We also assist you in efficiently submitting medical bills, managing AR, and improving collections to obtain payer reimbursements. We provide professional hospital billing services to help hospitals reduce billing errors and achieve their full potential. We are a HIPAA-compliant medical billing firm that provides technology-driven medical billing solutions. We can significantly enhance your medical billing process by saving time and money by providing reliable medical billing services.

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