Understanding the Major Differences Between Physician Billing and Hospital Billing

by BIS Global Business Integrity Services

In the healthcare industry, there are two major types of medical billing. Physician Billing and Hospital Billing. Both these billings are important for the revenue cycle management. Understanding what each one of them is and the differences between these two help us raise flawless claims, reduce denials, and manage the revenue flow better. Let us explore these billings in detail.

Physician Billing

Physician billing is commonly termed as Professional billing are the claims raised for the medical services rendered by physicians, specialists, suppliers, and other non-institutional providers. Professional Billing includes claims for both outpatient and inpatient services.

Professional charges are captured on CMS-1500 Form. Physicians and suppliers (non-institutional provider) use this CMS-1500 Form to raise claims for the service charges. It is a white colour form and letters written in red ink. The same form in the electronic mode is termed as 837-P. ‘P’ stands for Professional format. However, certain insurance companies accept claims in paper forms only.

It is very important to note that professional billing may include medical coding. In most cases, a medical biller is trained and can perform both billing and coding.

Hospital Billing

Hospital Billing, also known as Institutional Billing, includes claims for inpatient and outpatient services rendered by hospitals, clinics, nursing homes, or any other medical institution, including the usage of services like laboratory, skilled nurses, radiology, equipment, etc.

Institutional charges are captured on UB-04 Form. It is the claim form used by hospital or institution providers to raise claims for their charges. It is a white colour form and letters written in red ink. The same form in the electronic mode is termed as 837-I. ‘I’ stands for Institutional format.

Hospital billers are often responsible for billing only and a few may include collections also in their duties. Due to the complexity in the hospital coding process, medical coding for hospital claims is done by coders and not by billers.

Professional Billing Vs Hospital Billing

Professional Billing

Hospital Billing

·         Used for billing professional charges for the services of a physician or a specialist or a non-institutional provider/supplier

·         Used for billing charges of a hospital, institution for usage of medical facilities like laboratory services, radiology services, medical equipment etc. 

·         Form used – CMS-1500 or 837-P

·         Forms used – UB-04 or 837-I

·         Billers do both medical billing and coding in most cases

·         Billers do only medical billing and or collections. Coding is handled separately by coders.

·         Less complicated

·         More complicated


While both Physician and Hospital billing come under the same umbrella of medical billing, there is a complete difference between the two. While they may sound similar for a common man, healthcare experts clearly differentiate the two with what services come under them and who bill them.


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Created on Oct 27th 2021 03:38. Viewed 245 times.


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