Medical billing is a highly regulated profession that requires specific training, skills and experience. As such, it’s important to understand the different types of healthcare service providers. If you are applying for a position in a medical billing company, you must understand the various types of healthcare service providers. There is a clear distinction between billing in healthcare versus billing in other professions. Most experienced medical billers will tell you significant differences between institutional and professional billing.

Healthcare professionals in the industry distinguish professional and institutional billing by understanding their purpose and the services they encompass in the billing process. While both types of billing provide a mechanism for collecting payment from patients, they differ in where they collect that payment

What is Professional Medical Billing?

Professional billing is one of the most important aspects of medical practice. This job gives a physician or other health care provider the opportunity to provide and bill for medical services required by patients with medical coverage, insurance, or other means. In addition to these administrative tasks, physicians also have the responsibility for being knowledgeable about the rules that apply to professional billing.

Medical Billing is a necessary procedure that is set up by a medical practice to live up to their responsibility as an entity that has been hired to provide care for their patients. This process of billings must be done with precision, accuracy and punctuality, so as to reduce all costs in the long run.

What is Institutional Medical Billing?

Hospital billing is the process of charging claims for in-patient and out-patient services performed by hospitals or healthcare organizations. Hospitalization is a type of institutional billing because it’s performed in a hospital that can bill insurance companies and other third party payers.

In addition, hospital billing is responsible for the services provided by professional registered nurses. It also bills claims for medical services such as laboratory tests, medical supplies, equipment, imaging, etc. Institutional billers are occasionally assigned responsibility that is not the same as professional billers. Most institutional billers are just in charge of billing or do both billing and collection of claims. The achievement of collecting, charging and billing are critical tasks that most institutional billers perform on a regular basis as they receive payment from employers and patients/payers.

If a patient is admitted to the hospital, any charges incurred would be billed as professional billing. However, if a patient is discharged from the hospital, charges related to his or her stay in the emergency department will be charged as institutional charges and can only be paid by the facility itself.

Capabilities of Professional Billing and Institutional Billing

Medical billers play a vital role in the healthcare industry, whether in professional or institutional billing. All billers must understand critical areas such as Medicare reimbursement codes, coding and coding rules, claims and coding processes, claim disposition policy and manual handling of insurance carriers.

• Providers can better predict and process claims that result from their medical work. They gain access to large amounts of data for each insurance company and can reduce the cost of premiums.
• Medical billing staff must be aware of HIPAA privacy and security standards and have knowledge of technology, including the ability to interact with electronic record systems.
• As an experience with the billing system gives you the knowledge to save time and not making mistakes while billing patients. The automated process of billing can also be very helpful in eliminating problems.
• It is important that you understand the importance of benefits verification and take steps to avoid payment delays. We have created a comprehensive resource that provides a brief overview to billing restrictions, eligibility and more.

Types of Medical Billing Claims for Institutional and Professional Billing

Medical billing experts are involved in the process of medical claims submission to insurance companies. There are different types of healthcare claims. Now we discuss two types of medical billing claims one is for professional billing and the other one is for institutional billing

1. CMS-1500 For Professional Billing

The CMS 1500, which is the professional configuration of the CMS form is used for professional professional billing. The 837-P, which is the electronic counterpart of the CMS 1500 form, is used in professional billing. The letter “P” refers to professional configuration.

2. UB-04 For Institutional Billing

The UB-04 form is used for institutional billing by the facility. The 837-I is used for electronic claims in institutional billing by the facility. The letter “I” represents the institutional configuration.

How might professional billing and institutional billing be used to increase revenue?

The physician and hospital billing systems play a significant role in preventing denials and fraudulent actions. The billers need to ensure that no claims or treatments go unbilled or unnoticed. However, while filing the claims, the billers must be wary of medical billing and coding problems. Problems can occur to a variety of causes, including clerical and technological errors.

Billing is a very important portion of healthcare. Not only does it relate to the overall profitability and efficiency of any healthcare provider, but also has a direct effect on how patients are treated. Hospital coding is supposed to be far more sophisticated than independent physician coding, thus institutional matters are handled only by coding professionals. It is important to have billers and coders that understand the entire process thoroughly. Only then, can revenue increase