Physician Billing vs. Hospital Billing: Understanding the Key Differences

 

Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.

 

With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, it's based on the pricier reimbursement model, where the hospital charges the patient's insurance plan for the services required and received.

 

Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.

 

To highlight the key differences between physician and hospital billing, let's find out how they are used in both cases.

 

Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
• Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments.
To make sure that the organization's overall financial and operational goals are met, people who work in Medical Billing need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical office's billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly.
The organization's ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
• Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
• All outpatient and inpatient services will be billed based on the patient's insurance policy, so it's important to check.
• It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both Billing procedures. Healthcare professionals' offices and hospitals employ Medical Billing teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. ZK Medical Billing makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like ZK Medical Billing, you can focus on the doctor's practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

• The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
• A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
• An institution's configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
• A physician's billing is similar to a hospital's billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
• The hospital's appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.

 

Billing for Physicians and Hospitals: how to increase revenue?

• Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
• Keeping track of unbilled and unmissed claims and services becomes the physician biller's priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
• Outsourcing healthcare Billing services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
• The hospital billing process is quite different from physician billing. A hospital or institution's billing function includes collection and billing.
• As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
 
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.