Physician billing, which is also termed as Ambulatory Surgical Center (ASC) billing or professional billing is the billing of claims for services, which were offered or performed by healthcare professionals or a physician that also includes inpatient and outpatient services.
Majorly, these claims are billed electronically as the 837-P form. Institutional billing deals with claims for procedures or work executed by institutions like nursing facilities, inpatient and outpatient centers, and hospitals. Moreover, these claims need the 837-I electronic version or the UB-04 paper form. Institutional or hospital billing is basically more complicated and needs separate billers as well as coders.
As far as physician billing is concerned, the role of billers and coders is merged in many of the times. Nevertheless, when we emphasize on medical billing and coding, one should specifically understand that physician billing services and hospital billing agencies are of a similar craft, it varies with coding undertakings and their names.
Let us understand the difference between physician billing and hospital billing:
Professional billing or Physician billing is responsible for the billing of cases for procedures performed by physicians, suppliers, and other non-institutional suppliers for outpatient as well as inpatient administrations. On a CMS-1500 form, professional charges were charged. The form is of white color and letters are printed by red ink. Moreover, the CMS-1500 form used by suppliers and doctors for case charging.
There are still some cases that are charged on paper while Medicaid, Medicare, and most of the insurance companies accept electronic claims, as the necessary charging strategy. The 837-P is an electronic version of CMS-1500. The P stands for professional configuration. An expert physician billing services sometimes have numerous job responsibilities as compared to institutional or hospital billers. Keep in mind that professional billers are sometimes needed to know billing as well as coding methods. If you research, you will notice that several medical billing training programs provide combined medical billing and coding.
Hospital billing or institutional charging is in charge of cases formed for work done by specialty nursing offices, hospitals, and several organizations for outpatient and inpatient administrations. Furthermore, it includes the usage of equipment and supplies, radiology services, laboratory services, and various charges. On UB-04 institutional charges were billed. UB-04 is a standard case form red-ink on the white paper used by institutional suppliers for case filing. The 837-I is an electronic version of the UB-04, I stands for the institutional configuration.
At times hospital billing facilities have special tasks as compared to professional billers. Some of the major functions of institutional billers are the accomplishment of collection and charging and in charge of billing. As hospital coding is extremely complex than ASC coding, this could be one of the reasons for why coding of institutional cases is carried only by coders. Therefore, it is understood that hospital and physician billing needs expert billers and coders for greater reimbursement and increased profit. In addition to this, it could impact positively on revenue cycle management.