UNDERSTANDING THE DIFFERENCES IN BILLING SERVICES AND METHODS TO BOOST REVENUE

 There are 2 types of billing - physician billing and hospital billing. Although these terms look similar there is a very typical difference between them. It is essential to understand the difference so that the revenue flow is smooth. 

Physician billing services refer to the process of claims for doctors or physicians. This is the reimbursement of their professional fees for any service they render. The health insurance companies pay the physician for this. Physician billing is sometimes referred to as professional billing services for this reason. 

Whereas hospital billing refers to the bills related to in-patient and out-patient claims. The insurance companies settles this to the institutes directly.

The physician billing services for hospitals involve claims for both the physician and the hospital. When this process happens without any problems, then the revenue flow is smooth. This even ensures an increase in overall revenue generation. 

PHYSICIAN BILLING 

This refers solely to the bills that are directly related to the practitioner. Even though this sounds like private billing, this is very much related to the hospital. If the service of the provider is not settled on time, the hospital will not be able to pay the physician on time. 

The physician claims are mostly made on CMS-1500 or 837-P. CMS-1500 is in physical form on paper, whereas 837-P is electronic. The ‘P’ denotes that the form is for physician billing. Both these forms are the same. The only difference is that one is physical while the other is electronic. 

Verification of the bills is essential, so as to identify the in-network providers. This is because of the conditions laid down by the insurance companies. There is a difference between in-patient and out-patient billings. It is essential to bill them separately. 

HOSPITAL BILLING 

This bill includes the services of skilled nurses as well. Along with the services of the laboratories, consumable services or devices, equipment, etc. The hospital claims are mostly made on the form UB-04 or 837-I form. The first one is the paper one while 837-I is the electronic version. The ’I’ denotes that the form is for institution billing. 

The billing process is further split up into 3 categories - 

• Closed billing - This billing process does not allow transfers. There is no scope for collaborations with other medical practisioners and institutes. An example of this is EMR - Electronic Medical Record. 

• Open billing - There are transfers in this process. There is a need for communication and efficient collaboration. An example of this is EHR - Electronic Health Record.

 

• Isolated billing - This is a very rare method of billing. This process is getting outdated. An example of this is PHR - Personal Health Record. This process is mostly for the patients to have a knowledge about thier health. The institutes cannot use them officially. 

THE PROCESS

The primary difference between physician billing and institution billing is the codes. The institution billing process deals with only the billing process. The physician billing process includes the exact codes for the claims settlement. Therefore the physician billing process is a bit lengthy process in comparison to the institution billing process. 

Physician billing includes an in-network billing process. This ensures that the patients who have insurance coverage do not need to undergo the lengthy settlement process. However, hospital billing depends on the reimbursement process. The type of insurance coverage does not affect the process. 

A medical billing company understands the difference between these bills. It is essential to properly process these bills to ensure that the flow of revenue is smooth. This ensures minimum denials and timely settlements. 

The physician billing process puts enormous stress on the hospital staff. Mistakes arising in the bills can lead to delays. Ensuring that the codes and the bills are without mistakes becomes the prime responsibility of the physician. 

Outsourcing these bills makes the process convenient. The physicians and the hospital staff can focus on quality care. The  billing companies complete the settlement process. 

CONCLUSION

Although physician billing and hospital billing are different, both these together play an important part in revenue generation. It is essential to ensure that the bills settlements are  on time. It is also equally important to ensure protection of confidential data as per the guidelines of HIPAA privacy. 

The physician billing services for hospitals are efficiently provided by billing companies. This ensures there are no problems in settling the bills. Timely settlement of claims helps in improving the overall revenue generation of the institute. The billing companies also lower the burden on the hospital staff in settling the bills.