Getting into the profession of medical billing, calls for a good insight of various types of health care service providers. The difference between Medical billing practices at healthcare and other professions is both clear and complex. Experienced medical billing minds often throw knowledge on the important differences between institutional and professional billing.
The cv professional services and institutional billing services divide is the understanding of even their objectives as well as the service scale in which services are to be included in the whole billing cycle.
Let us now articulate the essence of both professional and institutional billing and understand the differences.
Professional medical billing is basically making claims for medical treatments or procedures that have been performed by a physician or an allied healthcare professional on a patient who has insurance coverage. Therefore, this is usually called physician billing. A myriad of administrative chores is carried out concerning a medical office for a medical practice, such as seeing patients, making appointments, verifying and registering insurance, financial transactions, and many other ancillary services including medical billing.
This type of billing remains a critical process that governs several operational aspects of every medical practice, such as scheduling appointments, receiving patients, verifying and registering insurances, and processing payments. Documentation is scrutinized at a very fine line because specific inpatient and outpatient procedures require special billing with the insurance of the patient.
Institutional Medical Billing Defined
Institutional billing is the generation of appropriate receipts for inpatient and outpatient services furnished by the hospitals or health provision institutions. It is frequently referred to as hospital billing.
Institutional billing also includes professional nurse services and may process claims for other types of medical services, including laboratory diagnostics as well as medical supplies, equipment, and imaging modalities. Responsibilities within institutional billing practitioners may differ from their counterparts in professional billing, as most institutional billers are confined to billing functions, while others carry out both billing and collection duties. The three collection, charging, and billing make the basis for defined institutional billing responsibilities.The cardinal distinction between professional and institutional billing resides in the scope of services: When professional billing is done regarding specific services rendered by the respective individual or group of physicians, institutional billing addresses all charges concerning medical interventions and administrative expenses throughout an inpatient or outpatient emergency visit. Revantage Healthcare: Professional and Institutional Billing Partners
Revantage Healthcare provides full-fledged medical billing services to meet professional and institutional needs. Our expertise ensures error-free claims submissions and prompt recoveries while eliminating unnecessary administrative processes so that health care providers can get involved in optimum patient care.
Skills in Professional and Institutional Billing
Medical billers are important components in the healthcare machinery, regardless of whether they belong to professional billing or institutional billing. Thus, it is essential for any biller to have the required knowledge as follows:-
- Data Management: Healthcare providers have access to many different datasets for each insurance entity to process medical claims effectively.
- Confidentiality Adherence: Billing personnel have access to sensitive, confidential patient health information and must know HIPAA privacy and security mandates.
- Skill with the System: The skill of familiarity with billing systems saves time, reduces errors, and avoids complications.
- Benefits Verification: To understand what benefits verification really entails is knowing how to accurately bill a claim and its nuances with coverage the patient’s insurance plan provides by ensuring an understanding of what is inside their coverage.
Types of Medical Billing Claims: Professional and Institutional
A wealth of claims typologies is engendered across the healthcare billing environment. Here are two salient categories that can be associated with professional and institutional billing:
- CMS-1500 for Professional Billing
Professional billing is claimed by the use of CMS-1500; this was made possible by its electronic version, called the 837-P, which has the letter “P” denoting the professional schema.
- UB-04 for Institutional Billing
The form for institutional billing is the UB-04 form. Claims built with the electronic version of this instrument, namely the 837-I, have the letter “I” showing that the claim is set in an institutional framework.
Thus, physician billing and hospital billing are separate but overlapping approaches to revenue allocation and boosting reimbursement streams. Both methods, however, are critical in forestalling denial of claims and misleading practices. It is the responsibility of the biller to see that all treatments are accounted for in the comprehensive billing of all claims. An important part of vigilance is against medical billing and coding error in the claims submission stage because errors could result from either clerical or technological.
To avoid billing discrepancies, many hospitals and healthcare providers choose to outsource their professional and institutional billing functions. The primary responsibility of an institutional biller involves collections and the billing process’s management. Due to the increased complexity of hospital coding versus that of independent physicians, institutional matters are handed solely to expert coding professionals. It is essential to have billers and coders with complete knowledge of the whole process to increase revenue.
Why Choose Revantage Healthcare
Having been in the medical billing business for over 20 years, we offer:
- Expert Medical Billing: Complying with strict rules while assuring correctness of medical billing enables quicker payments without hassles.
- 360° Support for Your Practice: From digital marketing to IT, we offer a full suite of services that work together to support your practice at every level.
- Real-time information: Clear, actionable messages on the financial health of your practice will empower you to make decisions with great ease.
- More Time for What Matters: We will worry about the finer points so that you can focus on what you are meant to do: caring for your patients.
For further information or a free assessment, please visit our website or call us at (925) 217-8110.
