Physicians services billing is the billing of claims for work or services performed by a physician or other healthcare professional, including inpatient and outpatient services. Physician billing differs from hospital physician billing when the physicians are independent contractors rather than employees of a facility or hospital. In these cases, the cost of service is dependent on the individual practice and billed separately from hospital fees or serviced.
While similar to medical billing in many ways, there are some nuances related to coding and forms that are specific to physician medical billing services and physician billing services for hospitals. Physician billing is tied to cases where procedures are performed by physicians and other non-institutional suppliers for both outpatient and inpatient services. These services use a CMS-1500 form for charging, which is white in color with letters in red ink. While some cases are charged on paper, most insurance companies, as well as Medicaid and Medicare accept electronic claims. In these cases, the 837-P (an electronic version of CMS-1500) is used. The P in the form name stands for professional configuration. Those with expertise in physician billing often have an increased workload compared to those in more standard medical or hospital billing roles.
Hospital billing covers work done by speciality hospitals, organizations, and medical offices for both outpatient and inpatient services. This differs from physician billing because it includes various other usages, like services from radiology and the laboratory or other equipment. These types of cases are billed by suppliers using the UB-04 form with red-ink on white paper. The electronic version of the UB-04 is the 837-I, where the I stands for institutional configuration. Given the sheer amount of service combinations, hospital or institutional billers often deal with very complicated coding. These complex coding configurations often require professional and expert billers to step in and bill for greater reimbursement, resulting in increased profit for the institution.
Regardless of whether or not the physician works in-house or is an independent contractor out of a private practice, it’s imperative that physician services billing is carried out by a knowledgeable and reputable team that understands and can manage complex billing and coding.