Types of Medical Billing: Institutional Billing vs. Professional Billing

Touseef Riaz

June 8, 2022

medical billing services

Most of us have visited the hospital at least once, but people are not familiar with the internal process of the medical office. We get the information about the medical care we receive and exit from the venue. 

People receive few phone calls or emails through healthcare providers and medical insurance companies for communication. But have you ever thought of the process running after you leave the hospital and follow-up communication about your bill? Here comes the duty of medical billers and coders to play their roles. 

This article will explore the types of medical billing and the procedures involved in these types. 

types of medical billing

Types of Medical Billing 

There are two types of medical billing, namely professional and institutional billing. We have drawn an easy Institutional Billing vs. Professional Billing comparison. Let’s have a look: 

Professional Billing Institutional Billing 
  • Under this type, both billing and coding are performed. 
  • Bills using CMS 1500 form or 837-P.
  • Billing and collections are undertaken but not coding. 
  • Medical bills using UB-04 or 837-I.

Professional Billing 

Most medical tasks performed in healthcare centers are the same across all, but medical billing is different from them. 

Medical office staff handles the administration tasks, greets patients, receives fees, schedules appointments, and conducts medical billing. 

Professional billing specialists should have complete knowledge of billing and coding systems as they are responsible for claims management. Their adequate knowledge makes the reimbursements successful and ensures patient satisfaction. 

Medical charges are billed on CMS 1500 form, which is a standard claim form used for claims by physicians and suppliers. Few claims are billed on paper, and most insurance companies only accept electronic claims. 837-P is the electronic version of CMS 1500. P refers to professional format. 

The job of professional billers is quite different from institutional billers. They have to know both coding and billing. The majority of the training programs provide medical billing and coding knowledge together, and the more focus is stressed on teaching more about coding.  

Suppose the professional biller knows all about the coding procedures, probability of generating successful claims increases. These billers have to deal with patients and insurance companies to collect payments and complete the process successfully. 

Institutional Billing

Institutional billers manage billing procedures of hospitals, nursing homes, etc. These billers also cover outpatient and inpatient duties like radiology and laboratory service, and so on. 

Institutional billing charges are billed on UB-04. This forum is used for claim billing. 837-I is the electronic version of the UB-04 form. I refer to the institutional format. 

The duties of institutional billers are different from professional billers. Institutional billers are also responsible for performing billing tasks and collections. The coding in institutional billing is much more complex than professional coding.

Fundamental Skills Required

The common thing between institutional billing vs. professional billing is the skill. No matter whether you are related to the professional or institutional billing profession, you must learn the following points: 

  • For the effective submission of medical claims, you must have excessive information about insurance companies. 
  • Each medical biller should abide by the HIPAA laws and ensure the safety of patient’s private data. 
  • Efficient billing software can make your medical billing tasks easy, minimize errors, and prevent hurdles. Conduct training programs of software learning to train your staff to increase their efficiency. 
  • You must know how to claim bills so that no delays happen in payments. 
  • Every aspect of the medical claim should be covered from the start of patient scheduling to the end of patients receiving services. 

How Can Professional and Institutional Billing Escalate Revenues?

Both professional and institutional billing plays a crucial role in generating revenues for healthcare providers. Claim denials or any fraudulent actions can damage the reputation of healthcare centers and can face penalties.  It’s the fundamental responsibility of professional billers to check every aspect of medical billing so that nothing remains unobserved. One should understand the common problems that emerge in medical billing and coding. It is essential to cross-check all the information in medical billing claims to avoid any uncertainty. 

Most healthcare providers outsource their professional and institutional billing to avoid any uncertain mistakes. It’s not an easy process to handle with complete accuracy. You have to hire deserving candidates and invest in training them, which is time-consuming and expensive. Therefore, hospitals prefer to outsource their medical billing and coding procedures rather than develop in-house teams. 

Medical Billing Company- Ucontrol Billing

At Ucontrol billing, you will receive complete medical billing and coding services with cost-effective solutions. We are a renowned medical billing company looking forward to enhancing your revenue cycle management process to ensure that you receive high returns. 

Between institutional billing vs. professional billing no matter what you choose; you can rely on us because we are: 

  • Cost-effective solution to your medical billing tasks. 
  • We are HIPAA certified company. 
  • Competitive pricing. 
  • Maximize Reimbursements.
  • Handling every medical billing and coding process effectively from the initial point to the end. 
  • Extensive experience in handling every medical billing and coding tasks. 

We are a complete solution for all of your medical billing services. Our focus is to increase your revenue collections and satisfy you with our authentic services. Leave the headache of medical coding services on us and spent your valuable time on patient care. 

Conclusion

We have discussed two common types of medical billing; Institutional Billing vs. Professional Billing. Professional and institutional billing are different fields and require expertise to do their respective jobs effectively. Both medical billers should have excessive knowledge of medical billing and coding procedures to do their job effectively. 

To hire the staff of professional and institutional billers, you need a lot of financial resources to spend on employing procedures and providing them salaries. To save your cost and increase your healthcare center’s financial efficiency, you can outsource your medical billing and coding tasks from Ucontrol Billing. 

FAQs

What are the types of medical billing?

There are two types of medical billing, professional and institutional billing. 

What is US medical billing?

Hospitals in the US forward the medical claims to billing teams that include all the necessary information required for successful claims. 

What are medical billing and coding?

Medical billing and coding are fundamental areas of the healthcare field. Their central role is to generate successful claims from insurance companies and improve revenue cycle management. 

You May Also Like…

0 Comments

Submit a Comment

Your email address will not be published.

Ready To Get Started?

Pin It on Pinterest