Answers
"Physician billing" describes who's doing the billing, not who gets the bill. You are looking for someone experienced with billing for physician services as opposed to hospital or other facility services. The bills go to third parties (insurance companies usually) as well as to patients.
Who's the client? Is it a vendor wanting a software developer, or a medical practice or outsourcer wanting someone to actually do the billing?
I used to work for a division within a Medical School focusing on analyzing patient data. Physician billing is also known as Part A claim data and patient billing or hospital billing is also known as Part B claim data. Part B data came from insurance company while Part A data came from HIPAA.
The key difference between physician and patient billing is that patient billing (hospital billing) contains diagnostic codes such as ICD9.
Physician billing (Professional Services) usually refers to the physician's own practice. Most of the time it includes services that are performed directly with the patient.
Patient billing usually involves billing from a hospital or care center. A physician may order a certain Lab test, but not perform it. The Lab would then bill the patient for the services; physicians are indirectly involved.
Administrative Services: Are basically everything that a physician does for their agency that is not direct patient contact, plus any patient visits that are made only for the purpose of eligibility assessment.
Technical Services: Are services that generally do not involve direct physician-patient contact, and do not require your professional expertise as a physician. Examples would be radiology and laboratory services provided in a physician’s office.
Patient billing comes in two main flavors: hospital (or other major provider) and physician. There are some minor differences but the processes are essentially the same. When the patient schedules an appointment, the hospital/provider/physician should obtain all insurance information, in order to determine where the revenue will be coming from. There may be preferred contracts with some providers which will affect the amount of payment, and whether the insurance company will pay at all. Sometimes the patient will bear the full responsibility if the insurance company doesn't contract with this provider. This can be a problem since it may be harder to collect from an individual than from an insurance company. Hospitals and insurers have specific "chart of accounts" that determines the amount billed for each service received by the patient. Some providers ask for the patient to pay his/her co-pay at the time of service, others collect this from the patient after the insurer has paid. All bills are based upon specific coding schema. These includ CPT codes; ICD9/10 codes, e-codes. My experience is with hospital information system I am less familiar with physician billing, other than as a patient. Hope this helps.
As consumer buying health care services:
1. Billing is a complete puzzle and pieces never seem to fit together.
2. Physician billing - billing for particular doctors services, and/or labs/tests run within their office at time of visit.
3. Patient billing - Part 1: If extract doctor service time from #2 above, could be labs/tests done within doctors offices, Part 2: If hospital services - everything except the human doing the services - MRI/CT, lab work - but not the doc reading the MRI/CT, etc. Learned doctors/readers bill separately.
Medical billing is a joke and brain surgery.
Sorry I can't be of more help, the differences are in the codes that are used in the billing, so when someone goes to school they learn the codes for both, but when you are working in a physician setting you use certain codes more often for obvious reasons, so therefore based on the repetition of use with different insurance companies you get a solid feel for which codes are accepted by the different insurance companies. This is why your manager wants this so much, they will have a high level of experience with which codes are accepted by which insurance company, to speed the payment process up.
The physician bills exclusively by CPT - Common Procedure Codes (five digit number) that is procedure based, but these CPTs are very strictly defined and some require extensive, precise documentation (such as Evaluation/Management - E/M).
So a physician office may conduct an ECG and bill CPT 93005 (technical) and Medicare pays $14.53; a cardiologist will read the ECG and report on it, bill CPT 93010 (professional) and Medicare pays $8.43; or a physician's office will performa and read an ECG and bill CPT 93000 (global) and Medicare pays $22.96.
Hospitals use the CPTs, along with more important ICD-9 diagnostic codes, to "group" these into appropriate DRGs - Diagnostic Related Groups - 3 digit codes, and basically paid for that one DRG. So, if you have DRG 106, open heart surgery, the hospital is paid about $33,000 (whether you had 1 or 30 ECGs. But, if the physician orders 20 ECGs, the physician is paid 20 X $8.43.
Hospitals make money by keeping you as short as possible and not doing extra tests, but physicians order tests and make money from each one.
In lay mans terms Hospitals work like a business center, here the various departments do their services and issue bills, for eg. pharmacy, radiology,MRI etc.The Physician also does his job and issues a bill this is the Physician billing.
The hospital in tun consolidates all these department bills and issues one bill
called the Patient billing.
Patient billing would be the patient billing the insurance company directly for the physician/hospital charges - no one generally does this type of billing except as an individual on their behalf. And they don't need to know the diagnosis codes since those are supplied by the physician/hospital.
I'd say if you know how to do "medical billing" you'd be set in any provider environment.
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