Understanding the Differences Between Physician and Hospital Billing

Medical billing is a very tedious task and can prevent you from focusing on your practice. It is a huge field and has multiple genres of billing. As a result, it is likely for people to get confused between different genres of the field. Hospital billing and physician billing are two such domains that confuse people a lot. But not anymore. In this blog, we will discuss what physician and hospital billing are and how they are different from each other.

What is Physician Billing

Physician billing, also known as professional billing, is the process of recording all the procedures and treatments that the patient has taken. Physician billing plays an important role in the reimbursement process as it helps in maintaining the revenue cycle management of the organization.

Physician billing regulates numerous administrative tasks associated with the practice like scheduling appointments, check-in & registration, and collection of payment. The physician billing service could be billed for both in-patients and out-patients. However, this can be done only after proper patient verification. Verification is vital because not all the services will fall under the claim. Only the services that are covered by the insurance policy of the patient can be filed and sent for claim. All this makes it a hectic process, which is why it is advised to hire Physician Billing Experts by outsourcing it to medical billing companies.

Physician billing covers the complete medical billing procedure that includes coding too. It means that the medical billing specialist needs to be profound in both billing as well as coding processes. It is advised to always have a dedicated team that can handle the billing and coding processes for the healthcare organization.

The form used for physician billing is CMS-1500 or 837-P (electronic version of CMS-1500).

What is Hospital Billing

Hospital billing or Institutional charging is the billing of all the work done by specialty nursing offices, hospitals, and several organizations for both outpatient and inpatient administrations. Apart from that, it includes maintaining a record of all the machinery used in the treatment. It includes all the radiology services, laboratory services, equipment, supplies, and multiple other charges. Overall, every factor should be accounted for during hospital billing. 

Hospital billing is done on the UB-04 form. It is a standard case hard copy form and red ink is used on white paper by institutional suppliers. Whereas 837-I is the electronic version of the same.

Sometimes hospital billing facilities have special tasks in comparison with physician billers. The major function of an institutional biller is to collect the right amount and manage any flaw or discrepancy in the documentation.

As hospital billing is a very complex task, most organizations have separate coders for hospital billing.

Now that we know what hospital billing and physician billing are, let’s take a look into what are the common errors that can occur while completing the billing process.

Common errors in Billing

Incorrect billing:

This is the most common mistake that is very easy to make. Improper coding or billing leads to claim denials which in turn reduces the revenue cycle of the organization. Sometimes it is just the codes and sometimes the patient is charged for incorrect services.

Duplicate Medical Billing:

This mistake will cost the organization its reputation. It occurs when a hospital bills the same patient twice or more for the same procedures. It can also happen that the organization sends the same report to two different patients. This practice can lead you into trouble as the insurance company might come and audit your workplace. This will not be a pleasant experience for you as well as your patient.

Unbundling:

This mistake might happen when groups of procedures are billed under separate codes. Sometimes it also happens that a single treatment is mentioned under the code of a bundled treatment. These mistakes are very common and can happen to anyone.

Upcoding:

Upcoding occurs when the treatment is inflated from moderate to a more serious condition or the patient is billed for a service that is not covered by their insurance.

Under coding:

Under-coding occurs when a healthcare provider fails to capture all the services or simply bills the patient for a less expensive procedure.

These are some of the common mistakes that should be avoided to maintain a proper revenue cycle. Often it is advised to seek help from professionals in the field. You can hire Medical Billing Specialist and Medical Coders who have profound experience of the field.  

However, it is always advisable that you should prefer to go for the services of a medical billing company.

Perks of Outsourcing Your Medical Billing

Medical Billing is a job that requires time, efficiency and precision. However, maintaining proper documentation along with your practice could be a very tiresome task. Outsourcing your medical billing procedure will take the burden off your shoulders. There are multiple other perks that you get when you opt for a medical billing company.   

• Trained Experts: Medical Billing companies have experts who are trained to efficiently manage the documentation process so that no paperwork is left. They will make sure that you get the maximum reimbursement within the provided time limit.
• Reduced Errors:When you hire an organization for your medical billing procedure, it becomes their duty to complete the paperwork with a hundred percent efficiency. You will be assured that all the claims made on your behalf are reimbursed.
• Saves Money: Once you outsource the medical billing procedure it means that you have to spend zero amount on training and infrastructure. It also means that you do not have to worry about updating yourself about the latest changes in guidelines and policies.
• Increased revenue: Medical Billing Specialists are trained to efficiently manage large amounts of data. They follow a very systematic process. They have access to advanced technologies that help in maintaining a proper revenue cycle.
• Improved patient satisfaction:When you and your staff do not have to worry about the billing, it takes a huge load off your shoulders. Your staff will have more time to attend to the patient and you will have more time to devote to your practice.

These are the benefits of outsourcing your medical billing. However, if you want to do the medical billing yourself, you should know what needs to be done if you ever find an error.

What to do when you find an error

Sometimes we do not check the documentation and file a claim with errors. In such a case the claim will be denied. However, sometimes the error might be from the insurance provider’s side. In both cases, it is advised that you should take the necessary actions.

• Contact your Billing Team: Ask your billing team about the errors and ask for an explanation. Your billing team has the responsibility for ensuring that your claims get reimbursed. You can do the same if you opt for a medical billing company. You are eligible to ask questions as denial of claims will impact your business and mental peace. Ask the team to remove any wrong information or double charge from the claim. Always advise your team to double-check the paperwork before submitting it for claims.
• Contact the Insurance Company: If there are no errors on the medical billing expert’s side, you can contact the insurance company and ask them to do a review. It is not necessary that error can happen only on the billing part, sometimes even insurance companies are at fault. Do ask for a review and if possible, ask for a federal or state review. In such a case you are eligible to ask for assistance from the insurance company too and they are liable to help you.
• You Can Seek Help from a Medical Bill Advocate: Medical billing is a complicated job. There are multiple scopes of error. Disputes could be raised about any minor mismanagement. In such a case it is advised to hire an advocacy group that specializes in medical bills. They will take up on your concern and can negotiate with the provider on your behalf. An expert advocate will make sure that you get the perfect reimbursement.

These are the key points that one can remember if they do not get proper reimbursement. It is always fine to ask questions because it will lead you to the actual cause of denial. This will decrease the tendency to repeat the mistakes. However, it is always advised that you should hire a professional medical billing company that will take care of all this hassle for you.

How Unify Healthcare Services Can Help

Now that we have discussed how billing can be a hectic task and what are the perks of outsourcing it, let’s understand who the best medical coders are.

Unify Healthcare Services is a well-known and established medical billing company. They have helped multiple organizations as well as individual practitioners in maintaining their revenue cycle management. They provide the best A/R management that will help in creating a regular revenue cycle.

Unify Healthcare Services is your one-stop solution for all your medical billing needs. They are always ready to assist you and if you face any problems, they will always be on your side.