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Professional Vs Institutional Medical Billing: Understanding The Key Differences

Medical billing is a crucial part of the healthcare industry. It is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by healthcare providers. Medical billing can be done in two ways – professional and institutional.

Professional medical billing refers to the billing done for the services rendered by individual healthcare providers like physicians, nurses, and therapists. Institutional medical billing, on the other hand, is the billing process for services rendered in a hospital or other healthcare institution, such as clinics or nursing homes.

Both professional and institutional medical billing are essential for the proper functioning of the healthcare industry. In this blog post, we will discuss the key differences between professional and institutional medical billing.

What Is Professional Medical Billing?

Professional medical billing is the process of submitting claims to health insurance companies for the services provided by individual healthcare providers. Professional medical billing can be done by a billing specialist, who is responsible for preparing and submitting the claims to the insurance company.

In professional medical billing, the claim is submitted by the healthcare provider or their billing specialist. The healthcare provider provides the necessary information to the billing specialist, who then prepares the claim and submits it to the insurance company.

Professional medical billing is primarily used for services provided by individual healthcare providers, such as physicians, nurses, and therapists. The billing specialist must have a good understanding of medical terminology and coding to ensure that the claims are accurate and comply with the insurance company’s regulations.

What Is Institutional Medical Billing?

Institutional medical billing is the process of submitting claims to health insurance companies for services provided in a hospital or other healthcare institution. Institutional medical billing can be done by a billing specialist or by the hospital’s billing department.

In institutional medical billing, the claim is submitted by the hospital or other healthcare institution. The billing specialist or department is responsible for preparing and submitting the claims to the insurance company. Institutional medical billing is primarily used for services provided in a hospital, clinic, or nursing home.

The billing specialist or department must have a good understanding of medical terminology and coding to ensure that the claims are accurate and comply with the insurance company’s regulations. Additionally, they must also be knowledgeable about the specific regulations and guidelines of the healthcare institution where they work.

What Is The Key Differences Between Professional And Institutional Medical Billing?

There are several key differences between professional and institutional medical billing. These differences include:

Billing Process

In professional medical billing, the healthcare provider or their billing specialist is responsible for preparing and submitting the claim to the insurance company. In institutional medical billing, the hospital or other healthcare institution is responsible for preparing and submitting the claim to the insurance company.

Types Of Services

Professional medical billing is used for services provided by individual healthcare providers, such as physicians, nurses, and therapists. Institutional medical billing is used for services provided in a hospital, clinic, or nursing home.

Reimbursement Rates

Reimbursement rates for professional medical billing are generally higher than those for institutional medical billing. This is because individual healthcare providers are typically paid at a higher rate than hospitals or other healthcare institutions.

Billing Regulations

Both professional and institutional medical billing must comply with the regulations and guidelines set forth by health insurance companies. However, there are specific regulations and guidelines that must be followed for each type of billing.

For professional medical billing, the billing specialist must ensure that the claim accurately reflects the services provided by the healthcare provider. For institutional medical billing, the billing specialist or department must ensure that the claim accurately reflects the services provided by the hospital or other healthcare institution.

Conclusion

Medical billing is an essential part of the healthcare industry. Both professional and institutional medical billing are necessary for the proper functioning of the industry. Understanding the key differences between professional and institutional medical billing is crucial for healthcare providers, billing specialists, and healthcare institutions. RhinoMDs Billing Services has been serving the medical billing industry from past one decade. We have done medical billing for small to medium practices to boost their revenue with providing top-notch Revenue Management Services.

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