Monday, January 30, 2023

Different types of medical billing

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Types of medical billing


There are different types of medical billing in the healthcare sector. Before choosing to join this sector, you should have a strong knowledge of all of them. In previous articles, we have discussed more medical billing. Let’s start with a quick introduction to this process if you’re new to the profession or this topic, medical billing.

Medical billing and coding process

Billing and coding are two distinct processes, but both are required in order to receive payment for medical services.

Medical coding is the process of collecting relevant information from the medical record and clinical paperwork, whereas medical billing is the process of using such codes to produce insurance claims and invoices for patients. Preparing claims is the point at which medical billing and coding come together to form the foundation of the healthcare accounting process. The procedure begins with patient registration and continues when the practitioner gets complete payment for all treatments rendered to patients.

The medical billing and coding process can range somewhere from a few days to many months, based on the complexity of the services provided, the handling of any claim rejections, and how organizations collect a patient’s payment responsibility.

Ensuring that service providers understand the basic principles of medical billing and coding may assist providers and other professionals in operating efficiently

accounting activities and recovering all eligible payments for the delivery of comprehensive services.

What are the different types of medical billing?

If you’re considering a career in medical billing, it’s critical to know the nature of the employment at various sorts of organizations. There is a considerable variation in billing between healthcare and other professions, and most medical billers are considering that there are major variances in the processing of medical claims across different specialties and facility types.

In this article, I am going to discuss different types of medical billing. There are two different types of medical billing in the healthcare sector, those are professional billing and institutional billing.

 1. Professional billing

Professional billing is also called physician billing or medical office billing. Professional billing is the form of medical billing that is utilized in the practices of medical professionals. Professional billing specialists are frequently necessary to understand both billing and the coding system.

A medical office conducts administrative activities for medical practices. Such as contacting patients, arranging appointments, check-in and registering money collection, and a variety of other services such as medical invoicing.

Professional billing is in charge of billing claims produced by doctors, suppliers, and other non-institutional vendors for clinical and non – clinical treatments.

Professional billing services contain both in-patient and out-patient procedures. However, procedures in the in-patient and out-patient sectors are invoiced only after insurance verification. This is due to the fact that only certain in-patient and out-patient procedures may be invoiced for claims under the patient’s insurance coverage or insurance agreement.

It should be noted that professional billing might include containing coding. This means that in some instances, the medical biller is engaged to do both medical billing and coding. Furthermore, some organizations prefer to employ both medical billers and coders who are educated in billing and coding.

There is more important information about professional billing can be found below.

  • CMS-1500 Forms are used for professional billing.
  • Although Medicare, Medicaid, and some other organizations will accept electronic claims as to the primary method of filing, some claims may still be submitted on paper. Another essential component of professional billing is the submission of paper claims.
  • When filing an electronic claim, a medical biller will utilize the 837-P, which is the electronic equivalent of the CMS 1500

Forms used in professional billing

As mentioned earlier, let’s discussed the above important information. In the professional billing sector, the CMS-1500 form is used to bill medical payments. The CMS-1500 is the standardized claim form used by healthcare professionals and suppliers for claim billing. It is written in red ink on white paper.

Although some claims are still invoiced on paper, Medicare, Medicaid, and the vast majority of other insurance providers now accept electronic claims as to the principal billing method. The CMS-1500 digital version is known as the 837-P, with the P representing for professional format.

2. Institutional billing

The term institutional billing is also known as hospital billing. Because institutional billing can be used to invoice claims for in-patient and out-patient fees paid by a healthcare facility or medical facility. The facilities of skilled nurses are also billed for claims under this billing form. Furthermore, hospital billing is used to bill statements for medical facilities such as laboratory services, medical materials and services, and radiology, among other things.

It is crucial to remember that Institutional billing solely addresses the billing process and does not address medical coding. As a result, institutional billers are exclusively educated in billing and collections.

Apart from professional billing, institutional billing is exclusively in charge of billing and payments. Institutional is more difficult than professional billing.

Forms used in institutional billing

As professional medical billing forms, institution medical billing also have a specific type of form. The UB-04.2 form is used to bill institutional costs. The UB-04 is a standardized claim form used by the institutional service providers for claim billing that is written in red ink on white paper. The electronic form of the UB-04 is referred to as the 837-I, which stands for institutional version.

Private providers, Medicaid, and other third-party providers may utilize multiple claim forms depending on their unique claim payment criteria. Some providers have used CMS-generated forms, while others have created their own forms based on the CMS standard.

Increasing Revenue through institutional and professional billing

These different types of medical billings come to increasing income, hospital billing and physician billing are very different. However, both of these billing procedures play a significant role in keeping the cash flow from being disrupted by adverse events like as rejected claims or frauds. The skilled biller guarantees that no claim or service is unpaid. However, due to the complexities involved in both of these administrative responsibilities, an unskilled biller is more likely to make mistakes while doing hospital or physician billing. As a result, many hospitals outsource hospital and physician billing services to medical billing and collection organizations.

Duties of different types of medical billing?

Medical billers play an essential role in the healthcare industry, whether they work in professional or institutional billing. To be effective and work effectively, all billers must understand five critical areas. There are,

  • Medical billers must know or have access to a large number of details for each insurance organization in order to file medical claims properly.
  • Medical billing personnel have access to sensitive, confidential patient medical information and must be aware of HIPAA (HIPAA stands for Health Insurance Portability and Accountability Act) security and privacy requirements.
  • Experience with the billing software in use saves time, reduces mistakes, and eliminates hassles. Use the training software suppliers give and, if required, engage them when problems arise.
  • Knowing synchronization of benefits information requires knowing how to bill claims in the proper order to avoid payment delays.
  • Each section of a medical claim reflects the information gathered from the moment a patient arranges an appointment to the time the patient gets treatment.

Different types of medical billing systems

On the other hand, we can be categorized it by different types of medical billing system-wise. Medical billing is a huge system that is part of the larger healthcare network. Everything including medical bills to quality standards for patient care, health institutions, and private clinics is part of the healthcare network. Medical billing systems are complicated and may be classified into three basic types.

  • Open system

An open system is one that enables for transfers between healthcare professionals, practices, and facilities, for example. EHRs, or electronic health records, are an example of how to use an open medical billing system. People in the medical field may use the terms EMR and EHR interchangeably, although EHRs are a highly collaborative track approach that allows everyone to have access to the patient’s heath. To have an open system, the medical billing applications (AdvacedMD, AllMeds, GE Centricity, McKesson, and so on) must be able to interact and work effectively.

  • Close system

In the context of medical billing systems, this indicates that this system is focused on a single practice. Using EMRs, or electronic health records, in your clinic is the most obvious example of a closed system. EMRs are essentially computerized copies of traditional paper charts. While this is still utilized in current procedures, it is mixed in with other sorts of data. EMRs are, as the name indicates, closed systems.

A totally isolated system is one that is totally isolated from healthcare facilities, professionals, and practices. Individual health records, or PHRs, are utilized in isolated medical billing systems. All of their medical information is kept by the patients, who also design and maintain them. These records are distinct and should not be confused with EMRs or EHRs. They are simply intended to assist patients in managing their health information.

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