Hospital vs. Physician Billing: Key Differences and the Role of Medical Billers

Medical billing is vital in the healthcare industry since it helps ensure the payment of health facilities, physicians, hospitals, and other healthcare providers. Hospital and physician billing are the two most frequent kinds of medical billing used in the health sector. Healthcare professionals discern between the two types of billing by focusing on their objectives and the specific services they provide in the billing process.

Hospital Billing

Hospitalist billing, or institutional billing, is responsible for the payment of claims for outpatient and inpatient services provided by hospitals or skilled nursing centers. The hospital billing system accounts for medical claims related to equipment, laboratory services, radiography, equipment, supplies, and medical facilities.

The UB-04 form, also known as 837-I, is used to bill these services. It is printed in red ink on the white claim form that hospital providers use to guarantee their billing. The 837-I form is the digital version of the UB-04 form, with the I representing the institution’s configuration. 

Hospital billing focuses on the billing process and collections. Hospital coding is much more complicated than coding for physicians, and codes are only used to code claims for institutional use.

Physician Billing

Physician billing can also be referred to as professional billing. It is accountable for the billing of claims made by physicians and other non-institutional service providers for inpatient and outpatient services. Physician billing is utilized for making claims for reimbursement for medical services rendered by doctors to insured patients.

The CMS-1500 or the 837-P forms for billing are used to invoice claims. One difference between the two versions is that CMS-1500 has a printed version, while the 837-P can be used as an electronic variant. The CMS-1500 is a red-ink-on-white-paper claim form, whereas the CMS-1500 electronic adaptation is known as the 837-P, with the P showing the professional or physician format.

Physician billing oversees a variety of administrative tasks that are part of medical practices, like scheduling appointments and greeting patients, checking-in registration, check-in, and processing payments. Physicians offer inpatient and outpatient services that may only be paid after verification of insurance. Verification of insurance is crucial since only certain outpatient and inpatient services are charged according to the patient’s insurance policies.

Physician billing covers the entire medical billing process, which includes medical Coding. This means that medical billers need to be educated in the billing and coding processes for regular billing.

Significance Of Medical Billers

Medical billers play an essential part in the billing process to decrease denied claims and increase reimbursement. Medical billers are important as below:

• Medical billers are able to access many details for every insurance company that handles medical claims.

• Medical billers scrutinize the bills of patients for consistency and reliability before the missing information is compiled.

• They are followed by unpaid claims within the required period of time for billing.

• Medical billers have the ability to analyze disputes, appeals, denials, and collections.

• Medical billers need to understand HIPAA security and privacy requirements.

• They have experience making use of billing software to cut time and cut down on the chance of errors.

• Medical billers are trained to bill claims in proper order to avoid payment delay.

Conclusion

Understanding the distinctions between hospital billing and physician billing is vital for accurate claims processing and reimbursement within healthcare facilities. Physician billing primarily covers services provided by physicians and non-institution providers; hospital billing handles claims related to facilities, equipment, and inpatient services at medical institutions. Medical billing requires specific coding standards and claim submission processes that entail billing specialists to help reduce errors, avoid denials, and optimize revenue cycles.