Professional Billing Vs Hospital Billing | SPT Medical Billing

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So, there are two main ways billing happens in healthcare. When you go see a doctor and they charge for their advice or treatment, that’s professional billing. Now, if you use a hospital’s room or their tools, that’s where hospital billing comes in. It’s like paying for the doctor’s time versus paying for using the space and stuff in a hospital. Both are important to make sure doctors and hospitals can keep helping people.

What is Professional Billing?

Professional billing is when someone keeps track of all the health checks and treatments a doctor gives and then asks the insurance or the patient to pay for it. It’s like making sure the doctor gets a ‘thank you’ in the form of money for helping people stay healthy.

Example of Professional Billing in Action

Let’s say you go to the doctor because you have a sore throat. The doctor looks at your throat, maybe does a test to see if you have an infection, and gives you some medicine. Each thing the doctor does has a special code, kind of like a price tag. Professional billing is like making a list of those codes to show the insurance company what to pay for.

How We Help at SPT Medical Billing

  • Checking Insurance: At first check eligibility verification because we make sure your insurance will pay for your visit before you even see the doctor.
  • Keeping Track of Payments: After your doctor visits, we watch out for the money the doctor should get and help get it faster.
  • Filling out Forms: We handle all the paperwork and send it to the insurance company so your doctor doesn’t have to wait for their money.
  • Fixing Mistakes: If the insurance says ‘no’ to paying, we look into it, fix whatever’s wrong, and ask them again.

By having us help with billing, your doctor can worry less about forms and codes and spend more time making sure you feel better. If you want to see how we can make things easier for your doctor’s office, just give us a call and we’ll chat about it. We make things super simple so everyone’s happy.

What is Hospital Billing?

Hospital billing involves compiling all the costs incurred during a patient’s stay or treatment in a hospital and requesting payment from insurance companies or the patients directly. This process is more complicated than other types of medical billing due to the range of services and care levels provided in hospitals.

Example of Hospital Billing

Suppose any patient named Alex goes to the hospital for a minor surgery. During their stay, Alex receives various types of care including:

  • Pre-surgery tests
  • The surgery itself
  • Medication
  • Post-surgery care
  • A stay in the recovery room

Each service has a specific code and cost. Hospital billing compiles all these costs into one bill that shows what the insurance company or patient needs to pay.

How SPT Medical Billing Can Help

At SPT Medical Billing, we specialize in making this process smoother and more efficient for hospitals. Here’s how we do it:

  • Eligibility Verification
  • Claim Submission 
  • Denial Management
  • Account Receivable Management
  • Optimized Revenue Cycle Management

Differences Between HB Vs. PB billing

Get to know the core 4 differences between Hospital Billing (HB) and Professional Billing (PB) in simple terms, focusing on the form used, how billing works, and the challenges each typefaces.

Form Used

  • Hospital Billing (HB)

Hospitals use a form called the UB-04 for billing. This form is designed for the complex and varied services hospitals provide, from overnight stays to surgeries.

  • Professional Billing (PB)

Professional billing, on the other hand, uses a different form called the CMS-1500. It’s used by doctors and other healthcare providers outside of the hospital setting for services like check-ups and minor procedures.

How Their Billing Works

  • Hospital Billing

HB involves compiling costs for a wide range of services and accommodations provided during a hospital stay. This can include room charges, surgeries, medication, and any tests performed.

  • Professional Billing

PB is focused on billing for services provided by healthcare professionals, such as doctors, nurses, and therapists. This typically involves billing for consultations, treatments, and procedures performed outside of a hospital stay.

Challenges of Professional Billing

  • Keeping Up with Codes

With new treatments and technology, keeping up with the correct medical coding for procedures and services is a constant challenge.

  • Insurance Plan Variability

Make yourself familiar with the details of different insurance plans and what they cover can make billing tricky.

  • Claim Denials

Incorrect or incomplete claims often lead to proper denial management needs, requiring extra work to correct and resubmit the claims.

Challenges of Hospital Billing

  • Complexity

Hospital bills are more complex due to the variety of services offered, making it easy for errors to occur in the billing process.

  • Coordination between Departments

You have to confirm that all services and treatments from different departments are accurately captured and billed is a significant challenge.

  • Insurance Authorization

Getting pre-authorization for hospital services can be more cumbersome and complex, given the higher costs and stakes involved.


Alright, Hospital Billing is like a giant puzzle with lots of pieces (services) to put together, and it uses a big form called UB-04. Professional Billing is more like filling out a shorter story about one doctor’s work, on a form called CMS-1500. Hospital billers face big challenges like coordinating many moving parts, while doctor billers have to be super precise with codes and rules. Both types try to make sure doctors and hospitals get paid without a headache!

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