Difference Between Hospital Billing vs Professional Billing

If you are thinking of a career in the medical billing sector, then you must have a complete grasp of knowledge about the work nature of different types of healthcare providers.

Billing in medical healthcare is very different from other industries. Medical billing and coding companies have to deal with claims and other significant issues which may not arise in other professional billings.

Just like healthcare billing is different from other business billings similarly there is a difference between hospital billing vs professional billing. Let’s find out in detail.

What is the difference between hospital billing vs professional billing?

What is the difference between hospital billing vs professional billing

The medical coders and billers need to address these two kinds of bills in different ways, depending on the services they provide and the purpose that they serve.

Let’s have a look at hospital billing vs professional billing to find out the difference between them.

Hospital medical billing

Hospital medical billing mainly comprises compiling bills for the services provided to the in-patients and out-patients by the hospital or any healthcare practice. Hospital medical billing is also known as institutional billing.

The hospital billing also comprises other services provided by the hospital apart from the physician services such as medical supplies, laboratory tests, equipment, x-rays, or any kind of imaging services.

The billers and coders who compile hospital billers have to deal with different kinds of responsibilities as compared to the professional billers as most of the time the hospital billers have to compile the bill as well as collect it also.

Their job description includes compiling, charging, collecting, and billing to the in and outpatients.

Professional billing

Professional medical billing is a term that defines the medical procedures or services which are provided by healthcare individuals to physicians to the people who have medical coverage or medical insurance.

Professional medical billing is also called physician billing.

The medical office will professionally cover all the responsibilities of a medical organization such as the arrangement of consultancy, and patients’ appointments for visitation. Registration and verification of the patients, collection of the money, and various such services that revolve around billing in the medical sector.

Professional billing is termed as a very important procedure by the administration of any healthcare organization to channelize the monetary and medical series such as the meet and greet with the patients, their verification and further registration, appointment schedules, and most importantly the money process.

The major difference between hospital billing vs professional billing is that the hospital billing has a larger scope as compared to professional billing and it doesn’t deal with medical codes but only with the medical bill.

The hospital billing will cover all the services that are provided by the administration as well as the physicians while the patient was admitted to the hospital whether it was for a scheduled treatment or an out-patient in the emergency ward.

On the other hand, professional billing has limited services to provide. It is the service that is provided to physicians or a number of physicians that have all the charges against their provided procedures covered by any insurance company or the insurance panel.

Prospects of hospital billing and professional billing

Prospects of hospital billing and professional billing

As stated above, the medical coders and billers play one of the most important roles in the medical healthcare sector whether they are a part of hospital billing or professional billing. They have a great future in terms of career and they are sole professionals who have access to different prospects of these billings. Such as;

  • The billing staff has the access to all the confidential, sensitive health information of the patients and they need to protect it according to the security and privacy standards set by HIPAA.
  • It is very important for the medical billers to understand the value of verification of the benefits that involve the patient’s plan of medical coverage as well as where the claim will be made in order to avoid delays in the payment cycle.
  • Medical billers and coders have direct access to a huge amount of data regarding the insurance companies as well as previous records of any kind of medical claims.
  • Experienced medical billers or coders have a huge demand in the medical healthcare sector. The experienced medical billers will save the time, and money of the billing system because they can recognize and rectify any problem immediately and are less likely to make any mistake.

All of the above-mentioned medical services must be documented by the professional medical billing staff because these are then forwarded to the insurance panel or the insurance company.

Can hospital billing and professional billing increase the revenue?

Both hospital billing and professional billing staff perform their own distinctive tasks or jobs and they do not come in between the reimbursements of the revenue cycle or the distribution of the revenue.

But the fact remains that because of these professionals, the fraud and denial claims are significantly less as compared to the medical practices where there is no involvement of the billing staff.

It is one of the most important responsibilities of a professional biller to make sure that no treatment is unnoticed or unbilled or that no claims are left to be made later.

There can be any technical problems but the medical coding and billing staff must have complete knowledge about how to tackle a denial case or an insurance claim case.

 To avoid denials or claims issues, the majority of the hospitals and medical healthcare practices opt to outsource their billing tasks to thorough professionals.

Final thoughts

Hospital billing vs professional billing – both are important types of medical billing and coding. They both have their own sets of distinctive responsibilities and tasks to perform which might be similar in some way or other but the reality is that they are very different from each other.

But the prime goal of both these categories remains the same and that is to provide simplified invoices to both the physicians and the patients so that the billing process is smooth and the revenue generation cycle keeps on moving without any kind of hindrance or delay!