While many people have made at least one trip to a doctor’s office in their lifetime, understanding everything that goes on around a medical office is an entirely different story. The delivering of care to patients is one aspect of the medical industry, but then there’s the process of billing the patients. There are two main types of medical billing that we will be reviewing for you today.
Common Responsibilities Regarding Medical Billers and Coders
Medical billers and coders are the staff members who need to correct coding and get bills processed so that everyone has the needed data to properly document all the services that healthcare providers have offered to their patients. This means that all stakeholders, such as patients, insurance companies, healthcare facilities, and doctors, need the right information.
While medical billers and coders aren’t the ones offering care to patients directly, they are still a necessary part of the medical industry, and they do plenty of good work with all of the healthcare staff in the facility.
Professional Fee Medical Billing
Professional medical billing is what is the term used for ambulatory physician practices. Any provider that uses professional fee billing will typically have to understand not just billing but also the coding system.
These are some of the more unique traits that professional billing has:
- It is done by using CMS-1500 forms
- Certain organizations, such as Medicaid and Medicare, are fine accepting electronic filing for medical claims, but sometimes paper forms are still used, mostly when additional information is required.
- Electronic claims are filed by using 837-P forms. These are the electronic equivalents of CMS-1500 forms.
Institutional Medical Billing
Medical billers that are dedicated to institutional billing must be capable of handling billing for various facilities, including clinics, rehabilitation centers, nursing homes, and hospitals, among other places. The billing that is done covers both inpatient and outpatient services, including laboratory services, equipment, and radiology services, to name a few.
These are a couple aspects of institutional billing that separate it from professional billing:
- The standard type of claim form that institutional billing uses is the UB-04.
- If you are doing an electronic claim, you instead use the 837-I form.
- The specific tasks each employer will need to handle may vary slightly when you work in the institutional billing business, but billing and collections are the primary jobs to handle. Medical coders often handle all the medical coding because of how complex institutional billing can be when compared to professional billing.
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