What is the Difference between Hospital and Physician Billing

In layman’s term, both hospital billing and physician billing, fall under the umbrella of medical billing. However, the professionals involved in the healthcare industry tend to differentiate between these two terms based on their purpose and the services involved in the billing process.

The following is the definition and purpose of both these terms to highlight the key difference between them.

Hospital Billing

The term hospital billing is also called institutional billing because it is used to bill claims for the in-patient and out-patient services provided by a hospital or a medical institution. The services provided by skilled nurses are also billed for claims under this type of billing. In addition to this, the hospital billing is also used to bill claims for the medical facilities such as laboratory services, medical equipment and supplies, and radiology, etc. These services are billed using the UB-04 form or 837-I form. The UB-04 is the paper version whereas the 837-I form is the electronic version.

It is important to note that hospital billing only deals with the billing process and not medical coding. Therefore, institutional biller is only trained in billing and collections only.

Unlike physician billing, hospital billing is responsible for billing and collections only. As compared to physician billing, hospital billing is more complicated.

Physician Billing

Physician billing is also called medical office billing or professional billing. The purpose of physician billing is to bill the claims to get reimbursement for the medical services provided by physicians to insured patients. It is also used to bill suppliers and non-institutional providers for their services.

The billing form used to bill claims is CMS-1500 or 837-P. There is no difference in these forms except that the CMS-1500 is the paper version whereas the 837-P is an electronic version of the same.

This type of billing is an important process to regulate various administrative tasks that are associated with medical practice such as scheduling appointments, greeting patients; check-in and registration, and collecting payment, etc. The services billed under physician billing include on both in-patient and out-patient services. However, the services falling under the domains of in-patient and out-patient services are billed only after insurance verification. It is because only selective in-patient and out-patient services may be billed for claims as per the insurance policy or insurance agreement of the patient.

It is important to note that physician billing may also include coding. This means in a few cases the medical biller is trained to perform both medical billing and coding. However, sometimes hospitals prefer to have both medical billers and coders who are trained to perform billing and coding respectively.

Boosting Revenue with Hospital and Physician Billing

Hospital billing and physician billing are quite different when it comes to ways of boosting revenue. But both of these billing processes play a huge role in preventing the revenue cycle from any unfavorable event like denied claims or fraud. The trained biller ensures that no claim or service goes unbilled. But an untrained biller is likely to make an error while performing hospital or physician billing due to the technicalities involved in both of these administrative tasks. Therefore many hospitals are outsourcing hospital and physician billing services from medical billing and collection companies.