Hospital billing is a highly intricate and specialized process that goes far beyond simple claim submissions. With thousands of services provided daily, multiple departments involved, and a mix of government and commercial payers, managing hospital billing efficiently is essential for financial sustainability. At Progressive RCM, we provide comprehensive hospital billing services that help healthcare institutions maximize revenue, minimize denials, and maintain full compliance.
What is Hospital Billing?
Hospital billing refers to the process of billing patients and insurance companies for services provided in a hospital setting. This includes:
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Inpatient services
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Outpatient procedures
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Emergency room visits
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Lab tests
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Imaging services
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Surgeries
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Ancillary services
Each service has specific coding, billing guidelines, and reimbursement rules depending on the payer and the patient’s insurance coverage. Our expert team at Progressive RCM ensures that every charge is captured, coded, and submitted accurately to avoid delays and denials.
How Hospital Billing Differs from Physician Billing
| Aspect | Hospital Billing | Physician Billing |
|---|---|---|
| Facility vs. Professional | Charges for hospital resources & staff | Charges for individual physician services |
| Billing Systems | UB-04 (CMS-1450) form | CMS-1500 form |
| Payer Complexity | Multiple contracts, DRG-based payments | CPT/ICD-10 based reimbursements |
| Volume | High volume, multiple departments | Comparatively lower volume |
Key Components of Hospital Billing
At Progressive RCM, we manage all stages of the hospital billing process, including:
1. Patient Registration & Verification
We ensure accurate patient demographic collection, insurance verification, and financial eligibility checks before admission or service delivery.
2. Charge Capture & Coding
Our certified coders extract all billable services from clinical documentation and apply accurate ICD-10, CPT, and HCPCS codes. We ensure correct assignment of DRG (Diagnosis Related Groups) for inpatient cases.
3. Claims Submission
We prepare and submit institutional claims using the UB-04 format through electronic clearinghouses, with a focus on clean claim submission.
4. Payment Posting & Reconciliation
We post insurance and patient payments accurately, reconcile discrepancies, and identify underpayments based on payer contracts.
5. Denial Management
We track, analyze, and resolve denied or rejected claims. Our team corrects and resubmits claims efficiently, reducing AR aging.
6. Patient Billing & Collections
We send out itemized statements to patients and offer multiple payment options. Our team handles billing inquiries professionally and compliantly.
7. Financial Reporting & Analytics
We provide custom reports on revenue, claim status, denial rates, collections, and department-wise financial performance.
Challenges in Hospital Billing — and Our Solutions
| Challenge | Progressive RCM Solution |
|---|---|
| Complex service coding | Certified coders experienced in hospital billing |
| High denial rates | Denial trend analysis + proactive prevention |
| Delayed reimbursements | Real-time claim tracking and payer follow-up |
| Insurance eligibility issues | Pre-service verification and pre-authorizations |
| Compliance risks (HIPAA, CMS, etc.) | Full audit trails and compliance checks |
Why Choose Progressive RCM for Hospital Billing?
✅ Specialized Hospital Billing Experts
Our team is trained in UB-04 billing, DRG assignments, and hospital-based coding.
✅ Multi-Payer Expertise
We manage billing for Medicare, Medicaid, TRICARE, HMOs, PPOs, and private insurance efficiently.
✅ Custom Workflow Integration
We integrate with your existing EHR, EMR, and HIS systems to streamline data sharing and reduce errors.
✅ Focus on AR Reduction
Our team aggressively works on aging claims and reduces AR > 90 days with consistent follow-up.
✅ Detailed Reporting & KPIs
We track key performance indicators like clean claim rate, denial rate, net collection ratio, and more — and share insights with you regularly.
Our Hospital Billing Services Include:
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Inpatient & Outpatient Billing
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Emergency Room Billing
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Surgery & Procedure Coding
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Anesthesia Billing
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Radiology & Lab Billing
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Revenue Integrity Audits
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Medical Necessity Reviews
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Pre-Authorization Support
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Charge Master Review & Maintenance
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Insurance Contract Compliance
Benefits of Outsourcing Hospital Billing
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Maximized Revenue Collection – Avoid missed charges and increase reimbursements.
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Fewer Denials – Submit clean claims and appeal denials with expertise.
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️ HIPAA & CMS Compliance – Stay protected from audits and penalties.
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Reduced Administrative Load – Let your internal team focus on patient care.
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Data-Driven Decisions – Use reporting to improve departmental performance.
KPIs We Monitor in Hospital Billing
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Clean Claim Submission Rate
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First-Pass Resolution Rate
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Days in AR (Accounts Receivable)
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Denial Rate and Recovery Rate
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Net Collection Ratio
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Cost to Collect
Our goal is to boost efficiency, enhance compliance, and maximize financial performance across your hospital’s departments.
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Final Thoughts
Managing hospital billing requires deep expertise, strong systems, and constant vigilance. With ever-changing payer rules and increasing administrative complexity, hospitals cannot afford to make errors or miss revenue opportunities.
At Progressive RCM, we bring all the elements together — technology, compliance, expertise, and strategy — to deliver end-to-end hospital billing solutions that protect and grow your revenue.