Outpatient vs. Inpatient Billing & Coding – A Brief Discussion

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The entire process involving medical billing and coding functions is quite tricky. Therefore, it is highly important that billing specialists ‘dot the i’s and cross the t’s’ of their claims before submitting them to the Payers. In addition, they have to pay special care in handling inpatient and outpatient billing processes, as they have varied code sets and coding methodologies. In view of that, Healthcare Providers and Facilities should get a clear picture on these varied healthcare billing services before they start working on them. Let’s delve into more details:

Outpatient Medical Billing & Coding: CPT codes are used to bill for services rendered to patients in an outpatient facility setting. Medicare, Medicaid and other commercial payers make payments based on the unique RVUs (Relative Value Units) assigned to each CPT code. The complexity of this physician billing process is quite less when compared to the inpatient billing process. The charges are included in the CMS 1500 form or what is commonly called the HCFA form.  Some of the services like injections; DME etc. are still billed out on the UB-04 form.

Inpatient Medical Billing & Coding: It involves two components, namely professional and technical, which increases the complexity of this physician billing process. To process the technical component, billing specialists should first list out the number of surgical/medical supplies used for treating a particular patient. Then these hospital services or expenses are included in the CMS 1450 form or what is commonly called the UB-04 billing form.

The professional component is processed by assigning ICD-9-CM Diagnosis and Procedure Codes to professional services rendered to patients based on the MS-DRG (Medical Severity-Diagnosis Related Grouping) Classification System which includes grouping the DX codes along with the codes for the Morbidity and Co-morbidity conditions.

Errors are likely to occur in both billing processes, especially inpatient medical billing and coding has more risk due to its complexity. Therefore, it would be a judicial decision for Healthcare Providers and Facilities to outsource their healthcare billing services to a renowned medical billing and coding company like www.mgsionline.com

About MGSI:

When it comes to outsourcing medical billing and collections, MGSI has been a pioneer in every sense. It has over 20 years of experience in offering physician billing services. Based in Florida, this medical billing company offers a helping hand to several Providers in both office and Hospital based or affiliated settings. For more details, log on to www.mgsionline.com