• May


  • 1523

How Medical Billing Differs Depending on Your Setting

There are significant differences in the processing of medical claims across medical specialties and facilities. There are differences in medical billing between healthcare and other industries as well.

When it comes to medical billing, there are two different types of billing to consider:

  • Professional medical billing
  • Institutional medical billing

Learn more about these two very different types of medical billing.

Professional Medical Billing Services

Most tasks performed by the medical office are similar across all medical facility types, but medical billing is not. The medical office manages the administrative tasks for the practice including:

  • Greeting patients
  • Scheduling appointments
  • Checking patients in
  • Registering patients
  • Collecting payments
  • Medical billing
  • And more.

Professional medical billing is in charge of the billing of claims generated for work performed by physicians, suppliers and non-institutional providers for outpatient and inpatient services.

Professional charges are billed using a CMS-1500 form. Some claims are billed on paper, but Medicare, Medicaid and other insurance companies accept electronic claims as the preferred billing method.

Medical Practice Billing Duties

Private practice medical billers have different job duties than institutional medical billgers. They are often required to know both medical billing and coding. Many medical billing training programs teach medical billing and coding together. Medical billers may also be responsible for charge entry and collections from insurers and patients alike.

Institutional Medical Billing

Institutional medical billing is responsible for billing claims generated for work done by hospitals, skilled nursing facilities and other institutions for outpatient and inpatient services. These services can include:

Use of equipment and supplies

  • Laboratory services
  • Radiology services
  • And more.

Institutional bills are charged using a UB-04. The electronic version is known as the 837-I, with the I standing for institutional format.

Institutional Medical Billing Duties

In some cases, institutional medical billers have different responsibilities than private practice billers. Institutional medical billers are often responsible for billing or performing both billing and collections. Hospital coding is more complex than physician medical coding. Institutional claims are performed by medical coders.

Traits of Successful Medical Billers

Whether you end up working at a private practice or hospital, medical billers need to master five key areas to be successful:

  • Access to lots of information for each insurance company
  • Know how to avoid violating HIPAA privacy and security rules
  • Experience with the type of medical billing software used by the organization
  • How to bill claims in the correct order to avoid delayed payments
  • Accuracy of each part of the medical claim

Need help with medical billing for your medical office? Parasol Medical Billing can help. Contact us to schedule a walkthrough of our medical billing and coding services. Bill patients on time and accurately to earn more revenue and grow your practice.