In order to implement a billing strategy, wouldn’t it be beneficial to delve into the various forms of medical billing that are increasingly prevalent in the healthcare industry? Understanding physician and hospital billing is important before getting into the billing process.
Physician billing is also called professional billing while hospital billing is termed institutional billing. Hospital billing relates to all the charges that they make for services that were offered within the hospital while professional billing applies to bills for fees charged by specific doctors.
Let’s find out the differences between physician billing and hospital billing.
Getting to Know Your Physician Bills
Professional billing arises from services provided by an individual physician or a specialist in a certain discipline. These bills are usually broken down to account for individual services given within a visit or treatment regime. They include and are not limited to consultation services, physical examination, and any minimally invasive procedures that the physician might give to the patient.
Key Features of Physician Bills:
- Service Details: Physician bills indicate the specific services or procedures rendered, whether they are tests, consultations, or subsequent appointments. Each line item corresponds to a specific action or service.
- Billing Codes: These bills employ the Current Procedural Terminology (CPT) code system for the services delivered. Each medical code specifying a particular service or procedure contributes to the elimination of diverse billing practices among healthcare providers.
- Medical Forms: The CMS-1500 form is commonly used in the billing of physicians. This form concerns the submission of claims for services rendered by separate practitioners and is also necessary for insurance compensation. It includes details such as patient information, provider details, and itemized services.
- Separate Billing: The physicians mostly work independently or in a private practice away from the hospital setting. As a result, the physicians generate their bills separately from hospitals’ fees, showing only the costs of the services they provide.
- Insurance Reimbursement: Physician often sends their bills to the insurer for reimbursement and patients may receive an EOB from their insurance carrier informing them of how much of the bill the insurer is going to pay and how much they will have to pay.
Deciphering Hospital Bills
On the other hand, hospital charges include a wider scope of charges that go beyond the physicians’ fees and may include the use of hospital equipment as well as other related services. These bills can become more complicated because the hospital offers a wider range of services within its framework.
Key Features of Hospital Bills:
- Comprehensive Charges: Expenses for hospitalization may include the cost of room and board, nursing care, the utilization of medical equipment, prescription drugs, laboratory costs, and other incidental charges. This is in contrast to physicians’ bills and can make hospital bills even more extensive and less legible.
- Facility Fees: Besides the price per service, there may be hospital charges with facility charges included in the bill. These fees could be for the infrastructure—operating theaters, diagnostic equipment, and patients’ beds.
- Medical Forms: The UB-04 form (Uniform Bill 04) is a form used in billing by hospitals. The form caters to institutional providers and presents an extensive variety of services and facilities. It contains codes for facility charges, room type, and diagnostic services; therefore, it is more comprehensive than the present CMS 1500 used for physician billing.
- Billing Codes: Hospital bills are similar to physician bills in a way that both contain CPT codes for procedures and services. However, hospital bills may also cover Hospital Outpatient Prospective Payment System (OPPS) codes or the Diagnosis-Related Groups (DRGs) for inpatient days, making billing more cumbersome.
- Single Bill or Multiple Bills: Hospitals can present a combined bill for the whole treatment process, which is called an admit discharge summary, or several bills for different services and divisions. For instance, it is possible to invoice individually for work done in the emergency department, diagnostics, and pathology.
Comparing Physician and Hospital Bills
While both physician and hospital bills play a role in your overall medical expenses, they differ significantly in their composition and presentation:
Billing Structure:
The physician bills are simple and clearly broken down, thus only indicating what the doctor has done for the patient. Hospital charges are more detailed and encompass all conceivable services or materials used throughout your hospital encounter.
Billing Process:
Physician bills are normally processed and handled by the physicians or the billing department of the physician’s office whereas hospital bills are normally handled by the hospital’s billing section. This can therefore result in differences in billing activities and how the charges are passed on to patients.
Insurance Coverage:
Both types of bills are fully compliant with insurance coverage though the ways they undergo can differ. Usually, an insurance carrier has a different billing system concerning the physician fees and the charges that are by the hospital, this has an impact on the individual’s out-of-pocket expenses.
Financial Assistance:
Hospitals often have financial assistance programs and payment plans available for those who have difficulty paying their bills. Physicians may offer payment plans as well, but these options can vary widely depending on the practice.
Managing Medical Bills
The management of medical bills demands a more tenacious approach. Here are some tips to help you navigate and manage both physician and hospital bills:
Review Bills Carefully:
Patients should always scrutinize their bills to ensure that they receive the correct amount of money. Double-check that all the charges are proper and avoid situations where you are being charged for services not provided.
Understand Your Insurance Coverage:
Make yourself knowledgeable of your insurance policies to identify what services are payable under the policy and the payments you will be required to make. This depends on the insurance providing company; it is advisable to consult your insurance company to clarify any differences.
Keep Detailed Records:
Keep accurate records of all the medical expenses, both paid by insurance as well as personally. This can be very helpful in negotiating the prices and other problems that patients may have with their billing statements.
Seek Professional Help:
When it becomes too laborious, consider hiring a medical billing management services provider or a virtual medical assistant. These professionals can assist you in dealing with many charges and avoid paying excessively for services.
It is therefore important to have a solid grasp of the little-known distinctions between physician and hospital bills when it comes to managing costs. Being aware of these details and being prepared for them can help you avoid worrying too much about medical billing issues and being furious that you are charged more than you expect.
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