There are many dissimilarities in revenue generation and reimbursement procedures for both medical and physician billing. How to elevate revenues with hospital and physician billing? source: Medical billing for institutions is more complicated than physician billing. If adding the claims for skilled nurses, medical equipment, radiology, etc. Whereas, physician billing involves complex medical coding procedures. Hospital or institutional billing works only with the medical billing process and there’s no coding involved. The only thing that differentiates the two is the coding procedure. Where the process of billing is the same for professional and hospital billing. I in the 837-I refers to the configurations used for institutions. Here, UB-04 is the paper version and 837-I is the electronic form where there’s no difference between them. To submit the claims, hospitals use the claim form UB-04 or 837- I. In addition, in the hospital facility, the bills are claimed for the skilled nurses and the services provided by labs, medical supplies and equipment, radiology, and medical facilities, etc. Hospital billing, which is also called institutional billing is based on the claims of in-patient and out-patient services provided by healthcare organizations and hospitals. On the other hand, in a hospital facility, medical billing experts and a separate coding team is hired to cater the billing activities as a daily task. This translates to the fact that if you are a professional billing expert, you also need to understand the coding involved in medical billing procedures. It is also important to note that physician billing also involves medical billing that is based on complex medical coding. This is also because there are a few things that fall under in and out-patient policies defined by most insurance companies. This is why patient verification is necessary. Every healthcare insurance policy is different. However, both claims can only be billed only after the patient’s verification. The services that can be claimed under the physician billing everything about in-patients and out-patient services come under out-patient and in-patient services. This is because, in physician billing, some other managerial and administrative tasks are associated with greeting patients, registrations, check-in records, payment collection, and maintaining records. In comparison, an expert in professional medical billing has more responsibilities than an expert submitting claims for institutional or hospital billing. As mentioned, 837-P is the electronic version of the form CMS -1500 where ‘P’ stands for ‘professional’. Healthcare insurance companies like Medicare and Medicaid and some other companies only accept electronic submission of claims as a prerequisite of charging strategy. For CMS-15600 is the paper form of billing, while the 836 is the electronic form to submit claims where there’s no difference in both forms. Physicians use the physician billing forms CMS-1500 or 837-P to claim the bills. Physician billing, also known as professional billing is the process of submitting the claims for the procedures and medical services given by healthcare providers and physicians to get paid by the healthcare insurance. Hospital billing vs professional billing source: Let’s dig more into knowing the difference between these two billing procedures. Healthcare professionals involved in the billing sector have created these categories to better understand the billing procedures and to reduce the denials due to the complexity of the codes. Also, both billing services fall under medical billing procedures. In other terms, professional billing is also referred to as ‘Physician billing’ and ‘institute billing’ is known as hospital billing. This is because billing and submitting claims have different categories and you need to grasp the essential knowledge to figure out what types of claims should be submitted under hospital billing or professional billing. Prior to stepping into the healthcare billing world, you need to understand these two types and the difference between hospital billing vs professional billing clearly. If you are willing to move your career in a billing and finance field of a healthcare industry, it is essential to explore and have the information about all the medical billing types and strategies.
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