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There are two primary types of medical billing: hospital-based billing and professional billing. Hospital-based billing is used for services provided within a hospital setting, while professional billing is used for services provided by individual healthcare providers.
When discussing the provider-based billing model, also known as hospital outpatient billing, a distinction should be made between Medicare’s terminology of what defines a provider and supplier versus the more commonly used definitions.
How is billing different for a hospital-based clinic? The billing structure for hospital-based clinics (HBCs) is different from a stand-alone doctor’s office (where certain costs are bundled together).
What is provider-based billing (PBB)? PBB is a national model of billing practice that is regulated by CMS (Centers for Medicare & Medicaid Services). PBB refers to the billing process for services that are rendered in an outpatient clinic (department) of the hospital.
Key Differences: Hospital Billing vs Professional Billing. Professional billing is restricted to services rendered by one or more physicians. Contrarily, hospital-based billing includes all costs associated with interventions and administration while the patient is treated in a hospital or outpatient emergency room.
Hospital billing encompasses a broader range of services, including inpatient and outpatient care, while professional billing focuses on individual provider services. Billing Entities. Hospital billing is managed by the facility’s billing department, whereas professional billing is often handled by individual providers or their billing staff.
Learn the differences between hospital billing vs professional billing, including distinctions in complexity, insurance claims, payment types.
Two primary billing categories—physician billing and hospital billing—are essential to the financial management of healthcare services. While they may seem similar on the surface, the underlying processes, regulations, and financial implications differ considerably.
By contrast, facility billing by hospitals is based on the complexity of the patient’s condition and is generally done whether the hospitalization is considered an inpatient hospitalization or an outpatient hospitalization such as an observation stay.
Uncover the essential differences between Professional Billing vs Hospital Billing to navigate the complexities of healthcare claims accurately.