What Are the Categories of Medical Billing?

Medical billing is an important part of the healthcare industry. It ensures that healthcare providers receive compensation for their services. The process involves translating healthcare services into standard codes, submitting insurance claims, and managing payments. Medical billing is divided into several categories, each with its own regulations and processes. Understanding these categories will help you to create efficient and accurate billing. This blog will examine the primary categories in medical billing.

1. Professional Billing

Physician billing is also called professional billing. It refers to services provided by healthcare professionals such as doctors, specialists, and nurses. This category includes a variety of services including:

• Office visits: Billing of routine checkups, consultations, and follow-up appointments.
• Procedures: Charges for medical procedures that are performed by a healthcare provider.
• Therapies: Billing of physical therapy, occupational therapies, and other therapy services.

The CMS-1500 is used by professionals to submit claims for non-institutional care services. It’s the standard form that Medicare and other insurers use.

2. Institutional Billing

Billing for healthcare institutions includes billing for hospitals, clinics, and nursing homes. This category includes:

• Inpatient Services: This is the billing for hospitalized patients who stay overnight. It includes services such as surgery, intensive care and maternity.
• Outpatient Service: Billing of services provided to patients who visit the facility, but do not stay overnight, such as diagnostic testing, minor surgery, and emergency room visits.
• Facility charges: Charges for the use of an institution, such as room and board, supplies and equipment, and medical supplies.

The UB-04 (also called CMS-1450) is used for institution billing. It is the standard form to submit claims for services provided by institutions and Medicare.

3. Durable Medical Equipment Billing

DME billing includes the cost of renting or purchasing medical equipment used at home. This includes items like:

• Wheelchairs: Billing of manual or electric wheelchairs.
• Oxygen equipment: Charges related to oxygen tanks and other supplies.
• Home Health Supplies: Invoices for hospital beds, walkers, and nebulizers.

Similar to professional billing, DME claims can be submitted by using the CMS-1500.

4. Pharmacy Billing

The pharmacy billing category includes prescription drugs and pharmaceutical services. This category includes:

• Prescription Medication: Billing of medications prescribed by healthcare providers.
• Specialty Medicines: Charges associated with high-cost, complex, or complicated medications that need special handling or administration.
• Compounded Medicines: Billing of medications that are tailored to individual patients.

The National Drug Code is often used in pharmacy billing. It may also use electronic claim submissions that are tailored to pharmacy services.

5. Dental Billing

Dental billing is a category that focuses on services provided by dentists, dental specialists, and other dental professionals. This category includes:

• Preventive Care: Billing of routine dental cleanings and exams.
• Restorative Care: Charges for crowns, fillings, and bridges.
• Orthodontic Services: Billing for braces, and other orthodontic treatments.

Dental billing is done using the ADA Dental Claim Form, and it often uses different coding systems such as Current Dental Terminology codes.

Conclusion

Medical billing is an intricate process that ensures providers of healthcare receive payment for services rendered. The main categories of medical billing–professional billing, institutional billing, DME billing, pharmacy billing, and dental billing–each have unique requirements and standards. It is important to understand these categories and the processes they follow to ensure accurate and efficient billing. Medical billing is essential to the financial health and well-being of healthcare providers. It also ensures that patients get the care they require without being burdened with excessive costs.

This post was written by Physicians Choice Medical Billing, LLC. Physicians Choice Medical Billing, LLC has been providing exceptional, and comprehensive Full-Service Practice Management including medical billing companies in Florida, coding, revenue cycle management, credentialing and consulting services to our clients. Whether you are a new startup or an established medical group, PC has the experience and dedication to make your practice a financial success. The staff bring multiple years of experience and dedication. Fingerprinting in Tampa and Fingerprinting in St Pete with Physicians Choice provides the highest quality, professional digital Live Scan fingerprints in a comfortable professional office atmosphere. Physicians Choice offers both individual and corporate account service.