Well, to employ a billing strategy, isn’t it fair to explore the types of medical billing that soars
in healthcare industry? Physician billing and hospital billing are the two types to be clearly
understood before stepping into the billing process. Prior to claim submission, and following the
steps required for medical billing process, it’s very important to figure out if that claim falls
under physician billing or hospital billing.
In other words, physician billing is termed as “Professional Billing” and Hospital billing as
“Institutional Billing”. However these two come under over all medical billing process. The
healthcare professionals involved in the healthcare industry had differentiated between these two
terms based on their purpose and the services involved in the billing process.
Let’s find out the purpose of both physician billing and hospital billing to highlight the key
difference between them.
What is Physician Billing Services?
The purpose of physician billing which is also known as professional billing is to bill the claims
to get paid for the medical services or procedures rendered by the physicians or healthcare
providers to patients with healthcare insurance.
The physician billing form used for billing the claims is CMS-1500 or 837-P. Apart from billing form
the CMS-1500 being a paper version and the 837-P an electronic version, there is no difference in
these forms.
There are cases where Medicaid, Medicare, and other insurance companies accept only electronic
claims as the necessary charging strategy. The 837-P claim form is an electronic version of CMS-1500
and “P” stands for professional configuration. An expert physician billing service at times can have
multiple responsibilities compared to institutional or hospital billing.
Physician billing is a significant process that regulates numerous administrative tasks associated
with medical practices like scheduling appointments, greeting patients, check-in and registration,
and payment collections.
The services billed under physician billing include both in-patient and out-patient and fall under
the domains of in-patient and out-patient services that can be billed only after patient
verification.
Verification is essential because, very selective in-patient and out-patient services will be billed
according to the insurance policies of the patient.
Please note that physician billing includes the complete medical billing process that involves
medical coding too.
It means that medical billers have to be trained for both billing and coding processes. However
healthcare professionals’ office and hospitals are employed with medical billing and coding teams to
perform everyday billing activities.
What is Hospital Billing Services?
The purpose of hospital billing is to bill the claims for in-patient and out-patient services
provided by hospitals or healthcare organizations. Hospital billing is also termed as institutional
billing based on the same reason.
Additionally, hospital billing also bills for the services rendered by skilled nurses. It also bill
claims for medical facilities such as laboratory services, medical equipment and supplies, and
radiology, etc.
Hospital billing uses the claim form UB-04 or 837-I form. The UB-04 is the paper version and 837-I
form remains as electronic version. “I” stands for the institutional configuration.
The only difference for physician billing and hospital billing is that, hospital or institutional
billing deals only with medical billing process and not with medical coding. Whereas physician
billing includes medical coding.
The appointed medical biller for hospitals only performs duties of billing and collections. Compared
to physician billing, hospital billing is much complicated.
Related: 4 Things To Check Before Outsourcing Hospital Billing Services
How to boost revenue with Physician billing and Hospital Billing?
When it comes to revenue payments or increasing revenue reimbursements, both physician and hospital
billing stay dissimilar. Yet, their processes play a huge role in preventing denials and fraudulent
deeds.
It becomes physician biller’s first priority to check that no claims or services go unbilled or
missed. But the staff must be aware of billing and coding errors while filing the claims. Errors are
caused due to various reasons and one of them might be technical errors too.
Most of the hospitals and healthcare providers choose outsourcing physician billing and hospital
billing services as best option to avoid errors and payment loss.
Hospital billing will have special tasks unlike that of physician billing. One of the major
functions of institutional or hospital billers are the accomplishment of collections and in charge
of billing.
Hospital coding is considered to be extremely complex than physician coding and is another reason
for which institutional cases are carried only by coding experts.
Different types of Medical Billing Systems:
There are three types of medical billing systems in healthcare industry. They are :
Closed
Open and
Isolated
Closed:
A closed medical billing system does not allow transfers. In medical billing terms, it represents
that a closed system must only focus on one single practice and the foremost example for closed
medical billing system is EMR- Electronic Medical Record. They don’t encourage collaboration with
other healthcare professionals and healthcare facilities.
Open:
An open system allows the transfers across healthcare professionals, practices, facilities, etc. And
an example of an open medical billing system is using EHR, or electronic health record. EHR is
highly collaborative and enables everyone to be under privacy to the patient’s healthcare. An open
medical billing system represents necessity to communicate and collaborate efficiently.
Isolated:
An Isolated medical billing system is no more used in the healthcare industry. It’s completely
removed from healthcare organizations, hospitals and healthcare facilities. PHR, or Personal Health
Record, is used in isolated medical billing system and the patients hold all their healthcare
records and are allowed manage them. These records are entirely different and shouldn’t replace EMR
or EHR as it’s simply to help patients manage their health information. As PHR can’t legally replace
official healthcare records, isolated medical billing systems aren’t commonly used.
Both physician and hospital billing staff has the access to private, confidential patient health
information and must know the ways to avoid violating HIPAA privacy and security rules.
Hope you got the information on Physician billing and Hospital billing. For latest updates on
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