Specialty billing · Hospital & Facility
Two payment systems, one claim form, no room for a generalist.
Hospital billing services from 247 Medical Billing Services get every inpatient DRG, outpatient APC, captured charge, and aged facility balance paid to its true value across Medicare, Medicaid, and managed care. Acute-care, critical-access, and specialty facilities get a dedicated account manager, a free 360° reporting dashboard, HIPAA and SOC 2 Type II security, and certified facility coders — running your revenue cycle since 2005.
A hospital does not bill the way a physician practice does, and the difference is structural, not procedural. Both claims ride on one institutional form built from revenue codes, condition codes, occurrence codes, and value codes a professional biller never touches.
Assigned under IPPS from principal diagnosis, procedures, and CC/MCC capture. The single lever that moves that payment is documentation — whether the coder can support a complication or major complication from the record.
Paid as a lump sum, no matter what you charged
Paid under OPPS through ambulatory payment classifications, where services are packaged, status indicators decide what pays separately, and comprehensive APCs bundle whole encounters.
Paid line by line, with packaging logic
Four-digit revenue codes plus condition, occurrence, value, and span codes. A clean, fully coded claim with the discharge status and value codes payers require to adjudicate.
Inpatient versus observation, the two-midnight benchmark, and Condition Code 44 for status change before discharge — so short stays aren't billed inpatient and pulled by RAC or QIO review.
Time-based observation under revenue code 0762 with HCPCS G0378/G0379 and the 8-hour composite-APC threshold, documented and billed correctly.
Present-on-admission indicators assigned to every diagnosis so genuine comorbidities are paid and true HACs are handled correctly, not guessed.
| Where money is won or lost | What it is | What we manage |
|---|---|---|
| Inpatient DRG payment | The MS-DRG assigned under IPPS from principal diagnosis, procedures, and CC/MCC capture, billed on the UB-04 (837I) | Coding to the highest supported specificity, CC/MCC capture reconciled to the record, and DRG validation so the stay is paid to its true weight |
| Outpatient APC payment | OPPS payment by ambulatory payment classification, with status indicators, packaging, and comprehensive APCs | Correct revenue-code-to-HCPCS pairing, units, and packaging so separately payable services aren't bundled away or over-reported |
| Revenue codes & the claim record | Four-digit revenue codes (e.g., 0450 ER, 0762 observation, 036x OR) plus condition, occurrence, value, and span codes | A clean, fully coded UB-04 with the discharge status, value codes, and occurrence data payers require to adjudicate |
| Status & the two-midnight rule | Inpatient vs. observation, the two-midnight benchmark, and Condition Code 44 for status change before discharge | Status set to the documented expectation and the rule, so short stays aren't billed inpatient and pulled by RAC or QIO review |
| Observation services | Time-based observation under rev code 0762 with HCPCS G0378/G0379 and the 8-hour composite-APC threshold | Observation hours documented and billed correctly so the encounter pays as observation instead of being denied or downgraded |
| Charge capture & the chargemaster | The CDM mapping of each service to a revenue code, HCPCS, and rate across every department | Charge reconciliation and CDM review so delivered services are actually captured, correctly coded, and priced to current rules |
| POA & hospital-acquired conditions | Present-on-admission indicators and the HAC payment provision on Medicare inpatient claims | POA assigned to every diagnosis so genuine comorbidities are paid and true HACs are handled correctly, not guessed |
Facility billing carries a cluster of structural traps found together nowhere else. A vendor that treats an institutional claim as a bigger office visit will miss all of them.
A stay that clinically warranted a higher-weighted DRG but was coded from a thin note is simply underpaid, permanently. The single lever is documentation.
Miss a value code or a discharge status and the claim doesn't underpay — it doesn't process. A team that codes outpatient facility claims like professional claims loses the packaging logic entirely.
The two-midnight rule and the inpatient-versus-outpatient call decide which payment system the entire stay falls under, and getting it wrong is the single most-audited event in the hospital.
The leak that generates nothing
The chargemaster is where revenue silently disappears. If a service is delivered but never charged, or the CDM line maps to the wrong code or an outdated rate, the money is gone before billing ever sees it. Charge-capture leakage doesn't generate a denial — it generates nothing, which is why it goes unnoticed for years.
Present-on-admission indicators cut payment directly too. Coded carelessly, they turn earned reimbursement into a write-off by treating a condition as a hospital-acquired complication Medicare won't pay to treat.
NO DENIALCharge-capture leakage produces no denial to flag itNO ALERTNothing appears on a denial reportFOR YEARSUntil someone goes lookingHolding every one of these variables in check, on every inpatient and outpatient claim, is the whole job of professional hospital billing services — and it's the job we're built around.
Everything it takes to move a facility encounter from admission to a paid claim, run by one certified team instead of split across vendors:
Coverage, plan, inpatient authorisation, and observation notification confirmed up front, and the hospital and its billing providers kept enrolled and revalidated across payers.
Certified coders who assign MS-DRGs with full CC/MCC capture on the inpatient side and code outpatient encounters to the correct APCs, revenue codes, and units, with POA indicators applied to every diagnosis.
ICD-10-CM/PCS and HCPCS coding held to the highest supported specificity, with clinical-documentation queries where the note won't carry the code.
Every denial and every DRG downgrade appealed on the medical record — medical-necessity, status, and coding challenges alike — inside each payer's clock.
Old balances pursued across Medicare, Medicaid, managed care, and self-pay, with underpayments checked against the DRG and the payer contract rather than accepted at face value.
Charge capture, chargemaster oversight, claim submission, remittance posting, and reporting run start to finish, with a live dashboard on every claim and every dollar.
Prefer to keep hospital billing and coding services under one roof? That's exactly the model — certified coders and billers on the same team, working from the same record, instead of handing charts back and forth between companies.
Facility revenue cycle is one of the few functions where an outside specialist consistently beats an in-house team — not because the in-house staff is weaker, but because the expertise a hospital needs is deep, constantly moving, and expensive to keep on the payroll.
IPPS weights, the OPPS addendum, the two-midnight guidance, NCCI edits, and payer-specific status rules all change on their own calendars, and a single coder out on leave can back up a week of DRGs.
When you outsource to a team that lives in these rules every day, you stop carrying that risk on a handful of desks and stop watching earned reimbursement walk out on the days you're short-staffed. You get certified facility coders, DRG validation, chargemaster review, and audit defence as a running service instead of a hiring project.
Facilities that move their revenue cycle to us typically see:
A 98% client-retention rate, because those numbers hold month after month rather than fading after go-live.
Revenue review
A certified facility specialist reviews your DRG downgrades, charge-capture leakage, and aged facility A/R — and puts a dollar figure on what they are actually costing.
A facility billing specialist will reach out within one business day.
A facility billing specialist will reach out within one business day.
Bringing us on isn't hiring a general biller who happens to accept UB-04 claims. It's hiring a hospital billing services company that already knows where facility revenue leaks:
Inpatient stays are coded to the highest supported specificity with CC/MCC and POA captured from the record, and each DRG is validated before submission — so admissions are paid to their true weight instead of downgraded on a thin note.
Packaging, status indicators, and APC logic are handled the way facility claims actually pay, so separately payable services collect and bundled ones aren't double-billed into a denial.
We reconcile charges against services and review the chargemaster so revenue that never made it onto a claim gets captured, coded, and priced correctly instead of vanishing.
The two-midnight rule, observation, and Condition Code 44 are applied before the claim goes out, keeping short stays and observation off the RAC and QIO takeback list.
A named account manager owns your account and a live 360° dashboard shows every claim, denial, and dollar — with no long-term lock-in holding you there.
A generalist learns institutional billing on your claims. We show up already fluent in it:
Most facility losses trace back to the same handful of failure points. We close each one at the front end, before it becomes a denial, a downgrade, or a recoupment:
Short inpatient stay billed without meeting the two-midnight benchmark
RAC/QIO status denial and full inpatient takeback
We set status to the documented expectation and the rule, and use Condition Code 44 to correct status before discharge
DRG coded without capturing a documented CC/MCC
Silent underpayment on every affected admission
We reconcile CC/MCC and POA to the record and query the provider where the note falls short, then validate the DRG before billing
Missing or wrong value/occurrence code or discharge status on the UB-04
Claim rejection or return to provider (RTP)
We assemble the full institutional code set so the claim adjudicates on the first pass
Outpatient service unbundled against OPPS packaging, or a packaged item over-reported
APC denial, NCCI edit, and overpayment exposure
We apply OPPS packaging, status indicators, and NCCI/PTP edits so units and separately payable services are correct
Service delivered but never charged, or CDM line mapped to a stale code or rate
Pure charge-capture leakage — revenue lost with no denial to flag it
We reconcile charges to services and review the chargemaster so delivered care is captured and priced to current rules
Complication coded without a present-on-admission indicator
Hospital-acquired-condition nonpayment and audit exposure
We assign POA to every diagnosis so true comorbidities are paid and genuine HACs are handled correctly
Every one of these is preventable before submission — or recoverable on appeal — rather than written off after the fact. Request a revenue review and we'll show you which of them is hitting your remits right now.
The rules shift with the setting and the entity billing the claim, and we bill each one to the detail it demands:
Full inpatient IPPS and outpatient OPPS billing on the UB-04.
What decides the moneyDRG accuracy, charge capture and status decisions
Cost-based facilities with their own payment methodology.
What decides the moneyCorrect revenue coding protecting a thin margin
Specialty prospective payment systems (IRF, IPF, LTCH) with distinct assessment and coding rules we bill to their own rulebooks.
What decides the moneyEach system's own assessment and coding rules
Clinics, infusion, imaging, and observation units billed under OPPS. See also our ER facility and professional billing and ASC surgical-case billing.
What decides the moneyPackaging and status logic those claims require
Multi-facility organisations that want inpatient, outpatient, coding, and A/R under one accountable team instead of a patchwork. For post-acute placements, see our skilled nursing facility billing.
What decides the moneyOne accountable team instead of a patchwork
Changing billers shouldn't mean a gap in cash flow, and with us it doesn't.
We work inside your existing HIS, patient-accounting, and EHR systems, so nobody has to relearn a platform.
A chargemaster and code-set review runs in parallel while your claims keep going out the door, and a named account manager leads the transition from day one.
Most facilities are fully live within a few weeks.
The denial drop and the faster A/R show up in the first cycles, not a quarter later.
Collect the full value of every admission and every outpatient encounter — that is what medical billing for hospitals is supposed to do.
247MBS runs your facility as one connected revenue engine: charge capture feeds coding, coding drives the DRG or the APC, and posting and follow-up close the loop against the payer contract rather than the expected allowable — so earned reimbursement stops leaking between departments and vendors. The result is measurable: a first-pass clean-claim rate near 99%, days in A/R under 25, and up to 40% fewer denials, cycle after cycle. Request a revenue review
The right provider proves itself against your own historical remits — not on a sales call — and that is the bar we clear before you ever sign.
What outsourcing looks like with us
Outsource hospital billing to 247MBS and you gain a specialist department, not a black box — deep facility expertise running as a service instead of a hiring project you can never fully staff.
This ends the risk of a single coder's leave backing up a week of admissions, because the rules that move on their own calendars — IPPS weights, the OPPS addendum, two-midnight guidance, NCCI edits — are ours to track, not yours.
Stop watching earned reimbursement walk out or call +1 888-502-0537.
RULESIPPS, OPPS, two-midnight and NCCI tracked by usDASHBOARDEvery claim, denial and dollar without you askingCOVERNo single coder's leave backs up a week of admissionsWhere we bill
Billing rules, payer requirements and program structures vary by state. Explore our state pages for the programs, payers and billing considerations that matter in each market.
Each state page covers that state's own payer programs, authorities and rules, and the denials we prevent there.
Whether you run an acute-care hospital, a critical-access facility, a specialty or rehab hospital, or a multi-site health system, our hospital billing services protect every DRG, every outpatient APC, every captured charge, and every dollar of aged A/R. Outsource hospital billing services to a team that treats DRG accuracy, OPPS packaging, the two-midnight rule, charge capture, and RAC audit defence as routine — and put the revenue you're leaving on the table back where it belongs.
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