Physician vs. Hospital Billing: Understanding the Key Differences

Isn't it reasonable to investigate the various types of medical billing that soar in the healthcare industry before implementing a billing strategy? Before beginning the billing process, it is critical to understand the differences between physician billing and hospital billing. Before submitting a claim and following the steps required for the medical billing process, it is essential to determine whether the claim fits under hospital billing or physician billing.

To begin with, you should know that physician billing is termed "Professional Billing," whereas Hospital billing is "Institutional Billing.” However, these two are part of the overall healthcare billing process. Healthcare professionals in the healthcare industry distinguish between these two terms depending on their intention and the services involved in the billing process.

Let’s have a deep insight into what makes physician billing different from hospital billing:

Physician Billing

Medical billing is also referred to as professional billing or medical office billing. Physician billing is used for billing claims to receive reimbursement for medical services that physicians offer to insured patients. It can also be utilized to bill suppliers and non-institutional providers.

Physician billing services include both in-patient and out-patient procedures. However, only after insurance verification is services billed under the in-patient and out-patient services domains. This is due to the fact that only certain in-patient and out-patient services may be billed for claims under the patient's insurance policy or insurance agreement.

This type of billing is essential for regulating various administrative tasks associated with medical practice, such as greeting patients, scheduling appointments, check-in in and registration, and collecting payment, among other things.

It should be noted that physician billing can also include coding. This means that, in some cases, the medical biller is trained in both medical billing and coding. However, some hospitals chose to have medical billers and coders trained in billing and coding.

• Forms Used

CMS-1500 or 837-P is the physician billing form used to bill claims. The only difference between these forms is that the CMS-1500 is a paper version, and the 837-P is an electronic version. In some cases, Medicare, Medicaid, and other insurance companies will only accept electronic claims as a necessary charging strategy. The CMS-1500 electronic version is the 837-P claim form, and the "P" stands for professional configuration.

When compared to institutional or hospital billing, an expert physician billing service may sometimes have multiple responsibilities.

• Benefits

This billing has a few advantages, such as the ability to directly negotiate the price with the doctor, or the doctor can contact your insurer to offer you the best possible treatment if you have health insurance.

Hospital Billing

Hospital billing, or institutional billing, is used to bill claims for in-patient and out-patient services offered by a hospital or medical institution. Under this billing type, skilled nurses' services are also billed for claims. Furthermore, hospital billing is used to bill claims for medical facilities such as medical equipment and supplies, laboratory services, and radiology, among others.

It should be noted that hospital billing only deals with the billing process, not medical coding. As a result, institutional billers are only trained in billing and collections.

Unlike physician billing, hospital billing is only in charge of billing and collections. Hospital medical billing services are more complicated than physician billing services.

• Forms Used

The claim form UB-04 or 837-I is used for hospital billing. The paper version is the UB-04, while the electronic version is the 837-I form. The letter "I" represents the institutional configuration.

• Benefits

The advantage of the hospital billing services is that you can quickly pay your medical bills through your insurance. For starters, you cannot negotiate the price with hospital staff, and you must wait longer to have your bill paid off through the hospital.

Enhance your Revenue by Outsourcing!

Regarding revenue generation, hospital billing and physician billing are distinct. Nonetheless, these billing measures are essential in preventing the revenue cycle from being disrupted by a calamitous event such as denied claims or extortion. The biller ensures that no declaration or service is left unbilled. However, an inexperienced biller will likely make a mistake while performing hospital billing or physician billing due to the complexities of both administrative duties.

As a result, many hospitals and physicians opt for hospital billing or physician billing outsourcing. 24/7 Medical Billing Services is one such company that offers the best medical billing service. We are known for offering dependable and cost-effective revenue cycle management services. In fact, our team can handle your billing and coding services effectively, whether it is hospital or professional billing. So, what are you waiting for? Contact our team of professionals to begin with your healthcare billing operations.

See also: How Can Medical Billing Outsourcing Impact Your Revenue In 2023?