Billing is the process in which invoices are generated to recover the price of sales from customers. Hospital billing pertains to the process where a healthcare provider submits and claims payments for the services rendered. Most hospital claims are submitted to health insurance companies. In contrast, office billing has more to do with the process where invoices or bills are sent to customers for goods bought and services offered. However, these two modes of billing differ in their coding books, processes, and explanations and also in terms of prospective payment systems and diagnostic-related groups by plagiarism checker search engine. For example, in regards to coding books and processes, the office billing charges are billed on a CMS-1500 form, which is usually the ‘red-ink-on-white-paper’. The form is also used by offices to claim billing. In addition, there is also the electronic way of CMS-1500 office billing known as 837-Professional format. In this format, every person submits his/her claims separately.

In contrast, the hospital billing utilizes the UB-04 form, which is the ‘red-ink-on-white-paper. The form is used by hospital institutions to claim billing. This too has an electronic version of the UB-04 known as 837-Institutional format. In this format, all bills for all services are submitted on one claim. Furthermore, in hospital billing, in case a patient wants to set up an appointment with the health specialist, they must effectively pre-register for the visit, unless it’s not the first visit in which case their information is already in the record. The billing also includes a confirmation describing the scheduled patient’s doctor visits. There is also a patient check-in and check-out process, which is done at the front office when a patient arrives. To avoid errors, low levels of efficiency and also to save on time while getting to the payers like the Medicare, or Medicaid billers claim, billers may choose to use electronic claims. A claim undergoes adjunction the moment it reaches a payer, the payer here evaluates the medical claim and decides whether it’s valid or not. After the receipt of the report from the payer, the biller makes a statement for the patient, which is the bill for the services that the patient received from the provider once the patient agrees.

Office billing process on the other hand entails the collection of information necessary to create invoices that will be billed to customers. The process entails accessing the sales or shipping log, accessing the billing module, and well as price verification. The office billing process also necessitates the acknowledgment of both cash and credit customers. The process also requires efficient communication between the dispatch staff and the accounts receivables team. In this regard, it is apparent that the hospital and office billing might have similar processes even though the hospital bill is more complicated. Nonetheless, just like in the hospital billing process, it is also important to keep a paper trail when it comes to office billing. The other aspect to consider is the prospective payment system and the diagnostic-related group. In this context, a prospective payment system refers to a method of reimbursement where payment is based on a specific predetermined amount.

In contrast, a diagnostic-related group encourages cost containment and standardizes prospective payment. For example, in a prospective payment system, hospitals receive fixed payments for pre-visits for patients with Medicaid whether the intensity is long or short. Unlike office billing, in hospital billing, prospective payments are standardized by a diagnosis-related group, which covers charges incurred while treating an inpatient. Therefore diagnosis-related groups are for inpatient claims in hospitals only and so is the prospective payment system as it addresses the expensive care in hospitals.