Don’t know the difference between professional and institutional billing? Here are all the differences if you compare professional vs institutional billing.

When it comes to medical billing, people often get confused between professional and institutional billing. Understanding the difference between these two types of medical billing is important for both healthcare providers and patients, as it can impact the cost and coverage of medical services. In this professional vs institutional billing guide, we will be discussing the key differences between these two common types of medical billing. So let’s start:

What is Professional Billing?

Professional medical billing is the process of submitting and following up on claims with insurance companies in order to receive payment for services rendered by a healthcare provider. This process involves the use of standardized codes or coding to describe the medical services provided, as well as the submission of detailed patient and insurance information.

Medical billing professionals are responsible for accurately coding and submitting claims to insurance companies, as well as following up on any denied or unpaid claims. They may also be responsible for managing patient billing accounts, including sending out bills and collecting payments from patients.

What is Institutional Billing?

Institutional medical billing refers to the process of submitting and processing claims for medical services provided to patients in a healthcare facility, such as a hospital or nursing home.

This includes billing for inpatient and outpatient services, as well as any additional charges such as supplies, medication, and equipment. The institutional medical billing process involves obtaining the necessary information and documentation, accurately coding the services provided, and submitting the claim to the concerned payer.

It also involves following up on denied or unpaid claims and negotiating payment terms with payers.

6 Key Differences between Professional and Institutional Billing

1-Type of Service

One of the main differences we find when comparing professional vs institutional billing is the type of services that are included.

Professional billing typically includes healthcare services such as consultations, physical exams, and individual therapies, while institutional billing includes services such as diagnostic testing, emergency treatments, and surgeries.

2- Bill Creation and Submission

Another key difference is the way that the bills are created and submitted. Professional billing is typically handled by the individual healthcare professional, who will create and submit the bill to the patient or their insurance provider.

Institutional billing, on the other hand, is often handled by the healthcare facility’s billing department, which will create and submit the bill on behalf of the facility.

3-Cost

The cost of healthcare services can also vary between professional and institutional billing. Professional billing is typically more expensive, as it involves the cost of the healthcare professional’s time and expertise.

Institutional billing is typically less expensive, as it involves the cost of the healthcare facility’s services and resources. However, it is important to note that the cost of healthcare services can vary significantly depending on the specific services being provided and the patient’s insurance coverage.

4-Insurance Coverage

Insurance coverage is another key difference between professional and institutional billing. Insurance policies typically cover a different range of services under professional and institutional billing. For example, an insurance policy may cover a certain number of physical exams or individual therapies under professional billing, but may not cover the same services under institutional billing.

It is important for patients to understand their insurance coverage and how it applies to both professional and institutional billing in order to fully understand their out-of-pocket costs for healthcare services.

5-Billing Process

There are also differences in the billing process between professional and institutional billing. Professional billing is typically a more straightforward process, as the healthcare professional is responsible for creating and submitting the bill directly to the patient or their insurance provider.

Institutional billing, on the other hand, can be more complex, as it involves multiple healthcare professionals and services, and may require additional documentation and paperwork.

6-Payment Collection

Another difference between professional and institutional billing is the way payments are collected. Professional billing typically involves the healthcare professional collecting payment directly from the patient or their insurance provider.

Institutional billing, on the other hand, may involve the healthcare facility’s billing department collecting payment from the patient or their insurance provider.

Conclusion

Understanding the difference between professional vs institutional billing is crucial for both healthcare providers and patients.

Healthcare providers need to understand the billing process in order to accurately create and submit bills for their services, while patients need to understand their insurance coverage and out-of-pocket costs to make better decisions regarding their healthcare.

By understanding both professional and institutional billing, healthcare providers can ensure that they offer the best possible care at a cost that is manageable