Hospital Billing Services

Hospital billing has two sides. The facility bills for the hospital's resources, such as rooms, supplies, and ancillary services, on a UB-04 claim. Physicians and other clinicians bill separately for their own work on a professional claim. The two must agree, and errors on one side can hold up the other.

Medicare generally pays inpatient stays under a diagnosis-based system, and outpatient services under their own payment rules. Charge capture, coding, and clean documentation drive the result. Westmont Revenue Partners connects hospitals and hospital-affiliated groups with vetted billing experts who can support facility and professional revenue cycle needs.

Who this is for

• Community and critical access hospitals
• Hospital-owned physician groups
• Hospital outpatient departments
• Independent physician groups that bill for hospital-based services
• Administrators who need help with denials and aging accounts

What gets billed

• Inpatient room and board
• Emergency department services
• Operating room and recovery services
• Laboratory and pathology services
• Imaging services
• Pharmacy and supplies
• Physical, occupational, and speech therapy
• Observation services
• Outpatient clinic visits
• Professional visits by hospital-based physicians

Commonly billed codes

Code	Type	What it covers
0250	Revenue code	General pharmacy charges
0270	Revenue code	General medical and surgical supplies
0300	Revenue code	General laboratory charges
0360	Revenue code	General operating room services
0420	Revenue code	General physical therapy charges
0430	Revenue code	General occupational therapy charges
0440	Revenue code	General speech therapy charges
0450	Revenue code	General emergency room charges
99221-99223	CPT	Initial hospital inpatient or observation visits by a physician
21	Place of service	Inpatient hospital
22	Place of service	On-campus outpatient hospital
19	Place of service	Off-campus outpatient hospital

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in hospital billing

• Charge capture. Services that are not recorded are not billed. A biller works with departments to find gaps between orders, documentation, and charges.
• Facility and professional alignment. The UB-04 and the professional claim must tell the same story. A biller reviews both so one does not contradict the other.
• DRG assignment. Inpatient payment often rests on the diagnoses and procedures coded for the stay. Coders review documentation so the record supports the final grouping.
• Observation versus inpatient status. Status affects how a stay is paid and what the patient owes. Billers follow payer rules and watch for denials tied to status.
• Prior authorization and medical necessity. Many payers deny stays or services without approval. A biller tracks authorizations and responds to review requests quickly.
• Revenue code accuracy. Revenue codes must match the service and the charge line. Mismatches cause rejections or payment delays.
• Patient balances. Hospital bills can be large, and patients need clear statements and financial assistance information. A biller follows hospital policy and applicable rules.

How Westmont can help

• Matching you with vetted billing experts experienced in hospital facility and professional billing
• End-to-end revenue cycle support, from registration to payment posting
• Denial management and appeal follow-up
• Support with payer enrollment and credentialing
• Help reviewing charge capture and claim edits

Frequently asked questions

What is the difference between facility and professional billing?

Facility billing covers the hospital's costs, such as rooms, supplies, and equipment, and uses the UB-04 claim form. Professional billing covers a clinician's own work, such as a surgeon's visit, and uses a different claim form. A patient often receives separate bills for each, and both need to match the record.

What is a revenue code?

A revenue code is a four-digit code on a facility claim that groups charges by department or type of service, such as pharmacy or emergency room. It does not replace the procedure code. Each line usually needs a revenue code, and an incorrect one may cause a rejection.

What is a DRG?

A DRG, or diagnosis-related group, is a way payers group inpatient stays for payment. Medicare generally uses it for inpatient hospital stays. The group depends on diagnoses, procedures, and other factors from the record. Accurate coding and documentation are central. Check current-year payment rules.

Why do hospital claims get denied?

Common reasons include missing authorization, status disputes, coding errors, missing documentation, and eligibility problems. A biller reads each denial reason, fixes what can be fixed, and appeals with records when the case supports it. Timely filing limits apply, so speed matters.

Can a hospital outsource billing?

Many hospitals outsource some or all billing tasks, such as follow-up on aged accounts or denial work. The right approach depends on your systems, staff, and goals. Review reporting, security practices, and how a partner works within your software before deciding.

Related billing services

• Emergency Medicine
• Hospitalist Medicine
• Surgical Hospitals
• Ambulatory Billing
• Anesthesiology
• Radiology