What Sets Apart Professional And Institutional Claims?

When considering the distinction between facility and professional billing, it’s important to understand that these two categories involve distinct types of healthcare services and billing procedures. Facility claims primarily pertain to services provided by hospitals and laboratories, encompassing a wide range of medical procedures and diagnostic tests conducted within these healthcare facilities. On the other hand, professional claims specifically relate to physicians who practice in medical offices, including general practitioners and specialists. These medical professionals bill for their services independently, such as consultations, examinations, and treatments, and their billing processes differ from those employed by healthcare facilities. In essence, the key distinction lies in the nature of the healthcare service providers and the corresponding billing protocols within these settings.

If you’re considering embarking on a career in medical billing and coding, it’s essential to gain a comprehensive understanding of the two primary types of medical billing practices prevalent in the healthcare industry. These two categories are professional billing and institutional billing. Professional billing typically involves billing for services provided by individual healthcare providers, such as doctors and specialists, in various medical settings. In contrast, institutional billing pertains to the billing procedures for healthcare institutions like hospitals, clinics, and long-term care facilities. This knowledge is crucial for anyone aspiring to enter the field of medical billing and coding. (Note: I have removed the date “9th July, 2020” as it seemed unrelated to the topic.)