Physician and Hospital Billing-What’s the Difference?

Physician billing, which is also termed 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. In this blog, we will take a quick look at both physician and hospital billing.

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 many times. Nevertheless, when we emphasize 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.

Difference Between Physician and Hospital Billing:

Physician 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 white in color and the letters are printed in red ink. Moreover, the CMS-1500 form is used by suppliers and doctors for case charging.

There are still some cases that are charged on paper while Medicaid, Medicare, and most 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.

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Hospital Billing

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, which 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 being in charge of billing.

As hospital coding is extremely complex than ASC coding, this could be one of the reasons why coding of institutional cases is carried out 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 revenue cycle management.

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MBC’s team of Medical Billing Experts works closely with healthcare providers to ensure that all medical services are accurately coded and billed. To know more about our billing and coding services, email us at: or call us at 888-357-3226.