What is the difference between hospital and physician billing?

What is the difference between hospital and physician billing?

Medical billing separates these two terms depending upon the services and motivation with the  billing. Physician billing, also known as professional billing, performs both billing and coding,  whereas hospital billing or institutional billing performs billing & collections and no coding. 

Hospital Billing 

Hospital billing is in charge of the billing of claims produced for work performed by skilled nursing  facilities, hospitals, and several organizations for outpatient and inpatient administrations. It also  includes equipment and supplies, radiology and laboratory services, and other additional charges. 

Applicable Forms 

On UB-04, hospital billings get billed. It is a standard case form with the red ink on white paper  claim form used by institutional suppliers for guarantee billing. The electronic rendition of the  UB-04 is called the 837-I, where the I represents the institutional format. 

Duties Performed 

  • The hospital or institutional billers have unexpected tasks as compared to professional billers. 
  • They are responsible for billing and sometimes the accomplishment of collection. 
  • Hospital coding is much more mind-boggling than ASC coding, and that is why the coding  of institutional claims is carried out only by coders. 

Physician Billing 

Also known as the Ambulatory Surgical Center (ASC) Billing, for the services performed by the  physician for the inpatient and outpatient. All the tasks get offered at the same medical facility, like  welcoming patients, scheduling appointments, registration and enlisting, administrative tasks,  collecting cash, and other assignments such as medical billing. 

Physician billing is responsible for the billing claims produced for work done by suppliers,  physicians, and other non-institutional providers. Many times the role of billers and coders gets  merged. 

Applicable Forms 

On a CMS-1500 form, physician billing gets charged. The CMS form is the red-ink-on-white-paper  claim form used by suppliers and providers for case charging. 

While some claims get charged on paper, Medicare, Medicaid, and most other insurers acknowledge electronic claims as to the primary billing method. The electronic version of CMS-1500 is known as the 837-P, where P represents the professional or physician format. 

Duties Performed 

  • Physician billers often have different job responsibilities than hospital billers. 
  • Physician billers are needed to know both billing and coding. 
  • Most medical billing training programs provide combined medical billing and coding  programs. 
  • Most practices necessitate that medical billers have coding certification. 
  • They could be responsible for the payments and charge entry from patients and their  insurers.

Boosting Revenue

Irrespective of hospital and physician billing, medical billers are vital to submitting claims  efficiently and boosting the revenue cycle management. 
The medical billing staff have access to a bunch of data for each insurance company and have  accessibility to patients' confidential and private health information and therefore need to know how  to follow HIPAA regulations for clean claims. 

Experienced billers guarantee that no service goes unbilled, and understanding the coordination of  benefits will help boost revenue and avoid making blunders while performing hospital and  physician billing.

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