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Hospital Billing Services VS Professional Billing Services3 min read

Professional Billing Services
Understand the differences between professional billing and hospital billing. Learn how professional billing can optimize practice.

Various kinds of billing services can be differentiated according to the purpose and services they cover. Similarly, there is a difference between professional billing services and hospital billing services. In addition, it is important for medical billers to understand the difference between both types of billing before starting their professional journey. Also, medical billing outsourcing services can help providers amplify practice revenues while focusing on patient care. Let’s go through the major differences between professional Billing Services and hospital billing Services.

What is Professional Medical Billing?

Healthcare professionals provide treatments and services to patients with medical coverage. Professional Billing Services charges the claims for services physicians render. Similarly, it can be termed physician billing and contains administrative processes. From scheduling patient appointments to payment processing, professional billing caters to all aspects of practice. Further, the treatments offered to the patients are invoiced according to the insurance coverage.

What is Hospital Medical Billing?

Hospital billing, also called institutional billing, caters to charging claims for out-patient and in-patient services at hospitals. In addition, the services professional nurses offer come under the umbrella of institutional billing. Similarly, the laboratory services, medical equipment supplies, and other services at the hospitals are managed by hospital medical billing. So, the hospital billing team needs to understand the billing and collection process to work properly.

Major Differences

  • Professional billing services are associated with services rendered by physicians.
  • Hospital billing covers every service rendered during the patient’s stay at the hospital.

Understand These Critical Aspects of Billing

  • Going for medical billing outsourcing services helps to reduce the burden of medical practices and hospitals.
  • Stay compliant with HIPAA regulations and keep the patient data secure and confidential to avoid penalties.
  • Reduce billing and coding errors to streamline the revenue cycle process and save time and resources.
  • Submit clean claims by knowing the insurance eligibility details to avoid payment delays leading to revenue losses.

Types of Medical Billing Claims

Healthcare claims can be segregated into two types: professional claims and institutional claims.

What is a professional claim?

When a physician renders service to the patients, the CMS-1500 form will be used for submitting the claim. This is called the professional claim.

What is an institutional claim?

The hospital or healthcare organization will use the UB-04 (CMS-1450) claim form to submit the claim. This is called an institutional claim.

How Professional Billing Can Increase Practice Revenue

Summarizing the discussion of hospital billing services vs. professional billing services, let’s look at some aspects of improving the revenue cycle. Here are some tips to optimize practice revenues with efficient medical coding and billing:

  • Healthcare practices and hospitals can get more reimbursements with an efficient medical billing process.
  • Professional vs facility claims are meant to avoid claim denials and reduce revenue leakages.
  • Paying attention to detail results in clean claim submissions and prevents payment delays.
  • Understanding the end-to-end revenue cycle process helps practices to simplify the billing process.
  • Going for medical billing outsourcing services helps providers focus on improving the quality of care and increasing patient satisfaction.
  • Professional billing services enhance the revenue cycle of practices and hospitals to optimize revenue generation.



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