Medical billing is a professional service
Medical billing is a professional service that involves submitting claims to insurance companies for payment for services provided by healthcare providers. There are two main types of medical billing: professional and hospital-based. Professional billing, also known as physician billing, is used for services provided by individual healthcare providers, such as physicians, surgeons, and specialists. This includes office visits, procedures, and diagnostic tests. The medical provider is usually responsible for submitting claims to the patient's insurance and collecting payment.
Professional billing uses Evaluation and Management (E/M) codes to determine the level of service provided during patient visits. These codes take into account factors like complexity, time spent, and medical decision-making. Professional charges are billed on the standard CMS-1500 form, which is a red ink on white paper claim form. However, most insurance companies, including Medicare and Medicaid, primarily accept electronic claims, which are submitted using the 837-P form.