What Are Two Types of Medical Billing?

For those not trained in the field of Medical Billing, it’s not uncommon to be unsure of what exactly happens to your medical bills once you leave the Doctors office.  For many, they just know that they have received their medical care, and they will wait to receive further communication in the mail (or by phone) from their healthcare provider or their insurance company.  There’s a lot happening behind the scenes though from the moment a patient leaves their healthcare provider to that point when they receive follow-up communication about their bill.  Here’s where Medical Biller come into play.

What Are Two Types of Medical Billing?

They are responsible for correctly processing bills to ensure all parties (patients, doctors, healthcare facilities, and insurance companies) all have what they need to document the services provided and process payment (to the doctor and/or healthcare provider) for these services.  Part of this process involves knowing which type of Medical Billing will come into play.  Today we’re going to further explain the two types of Medical Billing used in the healthcare industry.

Professional Billing

Here’s the rundown on Professional Billing and what makes it different from Institutional Billing:

  • Professional Billing is completed exclusively on the CMS/HCFA-1500 Forms.
  • Professional Billing is typically used in individual physicians’ practices.
  • Medicare, Medicaid and some other companies will accept electronic filing of claims, but some are still made via paper.
  • If an electronic claim is filed, it uses the 837-P, which is the electronic version of the CMS 1500 form.

Institutional BillingMedical Administration and Billing

Now let’s take a look at what makes Institutional Billing different from Professional Billing:

  • Institutional Billing usually covers billing for hospitals, clinics, rehab facilities, nursing homes, etc.
  • The UB-04 is the standard claim form used in Professional Billing.
  • For electronic claims in Professional Billing, the form used will be the 837-I.
  • While specific job duties will vary from employer to employer, those who work in Institutional Billing, will likely only focus on billing and/or collections. Medical Coding is handled by designated coders.  This is because coding for institutional services if often more complex than what is seen in professional billing, which necessitates the attention of a dedicated coder.

The Medical Administration and Billing program at Dorsey Schools

The Medical Administration and Billing program at Dorsey Schools is designed for those interested in pursuing an administrative-oriented career in the healthcare field.

Training in the Dorsey Schools Medical Administration and Billing program includes:

  • Introduction to best practices in medical billing, coding, and practice management.
  • An overview of industry-current software for electronic health records (EHR) which is used in physician’s offices, hospitals, and other healthcare facilities.
  • Coverage of medical coding systems using CPT, ICD-9-CM, ICD-10-CM, and HCFA terminology, as well as hospital and institutional medical billing and coding.
  • The topics of medical terminology, anatomy, and physiology.
  • The principles of accounting and business communication.
  • Prior to graduating, students will be required to take part in an externship during the final module of training.  The externship will take place in an actual occupational setting such as with a local physician’s office, long-term care facility, or other medical facility, allowing students an opportunity to apply the knowledge and skills they have learned throughout their program.

The Medical Administration and Billing diploma program is offered at the following Dorsey Schools campus locations:

Ready to take the next step and learn more about training for a new career in Medical Billing?  Give Dorsey Schools a call at 888-422-1188 or you can request info online!





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