Difference between Hospital Billing and Physician Billing

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Hospital billing and physician billing are both considered medical billing functions, but they are different. Understanding the difference between hospital billing and physician billing allows your team to submit clean medical claims and reduce the chances of rejections. It also helps you recognize what to expect from your billing team based on where you are performing services. 

The primary difference involves the purpose of the bill and the services performed during the billing process. Each process requires filling out different forms and may cover different services. 

What is Hospital Billing? 

Hospital billing primarily refers to the billing process for services in a hospital or other medical facility. Along with hospitals, this type of billing also applies to services at skilled nursing facilities and other inpatient and outpatient agencies. Hospital billing typically includes inpatient and outpatient care, diagnostic tests, and procedures. Because of the nature of hospital services, these bills are often complex involving multiple departments, services, and caregivers. 

Professionals in hospital billing are only involved in billing and collections. They are also required to handle coding since medical coding in the hospital setting is more complicated than in a physician setting.

What is Physician Billing? 

Physician billing is also called professional billing. It involves the billing process that allows physicians and other healthcare providers to be paid for their services outside of a hospital setting. Professionals tasked with physician billing may also handle other administrative tasks such as appointment scheduling and check-ins. Because of these diverse responsibilities, medical billing specialists in the professional setting may not have as much time to devote to billing and collection services. 

A physician or specialized healthcare practice may choose to outsource this function to free up their administrative team for other responsibilities. Whether they are working for a third party or in-house, those who process medical bills in a professional setting are also responsible for patient verifications and medical coding. These tasks are necessary for filling out claim forms and being reimbursed for services. 

What is the Difference Between Hospital Billing and Physician Billing? 

The main difference between hospital billing and physician billing involves the setting in which a patient receives care. Since a hospital is more complex and often involves a variety of services rendered in one visit, these bills include facility fees and itemized fees for various services. Hospital billing uses a UB-04 claim form which lists codes for tests and procedures as well as facility fees and other fees. 

Physician billing utilizes a CMS-1500 form and requires medical billers to be familiar with a specific set of codes for specific services and procedures. Because physician billing is often handled by a third party, these medical billing specialists need to be familiar with HIPAA rules and compliance required to protect sensitive patient data. 

How to Improve Revenue With Hospital Billing and Physician Billing

Whether you’re managing billing and claims services in a hospital setting or in a clinic or other physician setting, you can improve your revenue cycles by making your processes more efficient. In the hospital setting, your billing team is likely only handling billing. In a professional setting, your billing team may be juggling multiple tasks that take their focus away from billing. 

In either setting, it’s important to submit a clean claim form to reduce errors and increase your chances of being paid faster. Using medical billing software developed by medical billing specialists can save your team time by automating parts of the billing process. Software can scrub claims and identify errors so your team can fix them before submitting. 

You can also use analytics reports to assess your current revenue cycles and set key performance indicators for improving them.  After analyzing a series of submitted claims, you may notice that certain services or procedures are getting denied consistently. In this case, you could check to make sure your team is coding these services correctly and verifying patient coverage before submitting a claim, for example. 

Simplify Physician Billing Processes With PUREDI

PUREDI offers medical billing services for hospitalists, physicians, and other healthcare professionals. We offer 100% cloud-based intelligent software and revenue management services to help you collect faster and improve your cash flow. Our team has over two decades of medical billing and practice management services, so we understand the nuances of physician billing and hospital billing. 

Let us help you take your practice to the next level with medical billing, revenue management, and consulting services that combine industry knowledge with cutting-edge technology. Schedule a demo to learn more.

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