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differences between physician hospital billing

First, is that Physicians are mobile. The amount of mobility depends on their type of practice and location. A rural doctor, for example, may provide services at a variety of smaller healthcare facilities. She may have a Private Practice. Or a physician may provide specialist services to a hospital. The arrangement between physicians and Hospitals can vary. An OBGYN has to have agreements to deliver babies in several hospitals in larger urban settings for example. Second, is that the type of coding primarily used to submit bills to to the Insurance Industry are different between physicians and hospitals. And third, the processing time to process billing by hospitals versus physician billing would impact-delay physicians reimbursement for their services provided.

Physicians can work with just one medical billing professional who specializes in physicians medical codes, and supporting documentation that is needed, by billing seperately then grouped with the hospitals. Because their time is at a premium in demand, especially if traveling between facilities, interacting with several different medical billing professionals would be time consuming. Also there could be inconsistencies between how different specialist process the claims which could result in more questions from the Insurance Industry. More questions mean examiners take more time to pay claims. Building a relationship with the medical billing professional allows bills to be processed more rapidly. Utilizing the hospitals processor, for example, might mean competing for the specialist’s time with other physicians.

The third reason is perhaps the most important as far as being reimbursed. By maintaining control over their own billing, Physicians can assure that they are submitted more quickly which reduces turn around time. Also the Insurance Industry has its own examiners to specialize in reviewing physicians bills versus hospital bills. In general, hospital bills are more complex as they ususally include a time element. For example, determination that a patient was admitted or just an out-patient becomes critical. Time spent in various areas of a hospital can also have an impact on billing. But hospitals see more patients in total then an individual physician does so they have more bills to process and submit. So if physicians had to submit their bill with a hospital bill it would; 1) be delayed by the processing 2) encumbered with any issues of the hospital’s issues brought up by the Insurance comapany before payment is released. Then by being co-mingled the physician would have to wait for the hospital to issue a seperate payment. Some hospitals have investors and operating capital and can wait longer for reimbursement than a Physician’s practice can, especially if it is a recently practicing physician