What Are the Two Most Common Types of Medical Billing?

Many people have never been inside a medical office. We receive the medical attention we need and are soon on our way. Many people are familiar with communication sent by healthcare providers and health insurance companies via email, phone, or mail. What happens from the time a patient leaves the office of a healthcare provider until they receive a follow-up communication regarding their medical bill? Here’s where billing and coding professionals come in. We will discuss medical billing in detail below.

What Are the Common Responsibilities of Medical Billing and Coding Jobs?

It is the responsibility of those who are in charge of billing and coding in the medical industry to correctly code and process medical bills. All parties need the information to properly document and bill for healthcare services. This includes providing accurate data to patients and healthcare providers, as well as insurance companies. It is important to first have the proper training if you want to work in medical billing and code jobs. To pursue a career in medical billing and coding, you should have training in several areas.

  • To submit claims efficiently, medical billers and codes should have information about each insurance company.
  • Medical billing personnel have regular access to patient data. In order to comply with HIPAA privacy rules, medical billing staff must be trained on the proper handling and procedures of patient information.
  • Billing software can be used to save time and reduce errors.
  • Medical billers must be able to understand the proper order of billing claims to avoid delays in payment.

Billing and coding professionals work with doctors, nurses, and other healthcare professionals. Medical coders and billers are an essential part of any healthcare facility. A career in medical billing can be an excellent way to join the healthcare team.

Medical Coding: Two Types of Billing and Coding

You should be familiar with the two main types of billing used in the healthcare industry, namely professional billing and institutional billing.

Professional Billing

Medical billing used by individual doctors is called professional billing. Professional billing specialists are required to be familiar with both the billing system and the coding system.

Below are more details about professional billing1

  • The CMS-1500 forms are used to complete professional billing.
  • Medicare, Medicaid, and other companies accept electronic claims, but you can still file some paper claims. Professional billing also includes filing paper claims.
  • When a claim is submitted electronically, the medical biller will use the CMS 1500 electronic form, the 837P.

Institutional Billing

The institution billing system is used for billing hospitals, rehab centers, nursing homes, and other healthcare facilities. It may also include outpatient and inpatient services such as equipment, laboratory services, radiology, etc.

Please see below for more information on Institutional Billing1:

  • The standard claim form used for Institutional billings is the UB-04.
  • Use the 837I form to submit electronic claims for institutional billing.
  • The job duties of those in the institutional billing field may vary depending on their employer, but they will most likely be limited to billing or collections. In these settings, medical coding is handled by medical coders. Medical coding in institutional settings is more complex than professional billing and often requires the attention of a coder.

Pursuing a Career in Medical Billing and Coding

Do you want to pursue a career in medical billing and coding? Billing and coding skills are required to organize and manage the health information. It could also mean that more claims will need to be submitted for reimbursement by insurance companies. The addition of records and the use of EHRs by many providers could lead to an increase in the need for medical billers who can organize and manage the information.

This post was written by Physicians Choice Medical Billing, LLC. Physicians Choice Medical Billing, LLC has been providing exceptional, and comprehensive Full-Service Practice Management including medical consulting companies Florida, revenue cycle management, credentialing and consulting services to our clients. Whether you are a new startup or an established medical group, PC has the experience and dedication to make your practice a financial success. The staff bring multiple years of experience and dedication. Fingerprinting in Tampa and Fingerprinting in St Pete with Physicians Choice provides the highest quality, professional digital Live Scan fingerprints in a comfortable professional office atmosphere. Physicians Choice offers both individual and corporate account service.