Medical billing is a complex process, and those applying for positions in medical billing companies must understand the various types of healthcare service providers. One of the most significant distinctions is between professional and institutional billing. Both have different purposes and encompass various services in the billing process. In this article, we will explore the differences between professional and institutional billing and how they can be used to increase revenue.
Understanding Professional Medical Billing
Professional billing, also known as physician/provider billing, submits claims for medical services or treatments provided by the provider to the insurance of the patients or the patients themselves. It is an essential procedure that governs many administrative duties related to medical practices, such as scheduling appointments, greeting patients, verification and registration, and payment processing. Professional billing is limited to services provided by a physician or multiple physicians.
Capabilities of Professional Billing
Medical billers in professional billing must understand critical areas to file medical claims effectively. This includes access to large amounts of data for each insurance company, sensitive and confidential client health information, HIPAA privacy and security standards, and benefits verification. A good understanding of the billing system saves time, reduces mistakes, and eliminates problems.
Types of Medical Billing Claims for Professional Billing
The CMS-1500 form is used for professional billing, and the 837-P is the electronic counterpart of the form. It is used to file medical claims for services provided by physicians or healthcare professionals.
Understanding Institutional Medical Billing
Institutional billing, also known as hospital or facility billing, submits claims for in-patient and out-patient services performed by hospitals or healthcare organizations. It accounts for services provided by professional nurses, laboratory tests, medical supplies, equipment, imaging, and other medical services. Most institutional billers are responsible for billing or do both billing and collections.
Capabilities of Institutional Billing
Institutional billers play a crucial role in collecting information and charges related to the facility during a patient’s stay, whether in-patient or out-patient (i.e. ER visits). They must have a good understanding of the difference between facility billing and provider billing, including medical coding, to ensure that all treatments are billed properly, and nothing is missed.
Types of Medical Billing Claims for Institutional Billing
The UB-04 form is used for institutional billing, and the 837-I is the electronic counterpart of the form. It is used to file medical claims for services provided by hospitals or healthcare organizations.
Increasing Revenue with Professional and Institutional Billing
Both physician and hospital billing are distinct in revenue distributions or rising revenue reimbursements. However, their processes play a significant role in preventing denials and fraudulent actions. One of the primary responsibilities of a hospital biller is to complete collections and control the billing process. Outsourcing professional billing and institutional billing services can help avoid mistakes in billing and increase revenue. To achieve this, billers and coders must have a good understanding of the entire billing process, including medical coding, and work together to ensure no claims or treatments go unbilled or unnoticed.
In conclusion, medical billers must understand the differences between professional and institutional billing to provide effective billing services. Professional billing is limited to services provided by physicians or healthcare professionals, while institutional billing covers all charges related to interventions and administrative charges during a patient’s stay in a hospital or outpatient emergency department. To increase revenue, billers and coders must have a good understanding of the billing process, including medical coding, and work together to ensure no claims or treatments go unbilled or unnoticed.