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Hospital billing for inpatient, outpatient and professional services
Facility and professional billing support for hospitals, including UB-04 claims, DRGs and APCs, A/R backlogs, denial projects and payer follow-up.
How hospital billing works
Hospital facility claims are billed on the UB-04 / 837I with revenue codes. Medicare pays inpatient stays through MS-DRGs under the inpatient prospective payment system and outpatient services through APCs under OPPS. Professional services by hospital-employed physicians are billed separately on the 837P.
Inpatient versus outpatient status, including Medicare’s two-midnight rule, has a large effect on payment.
Codes we bill every day
| Code | What it covers |
|---|---|
| TOB 11x | Hospital inpatient |
| TOB 13x | Hospital outpatient |
| MS-DRG | Inpatient payment group |
| APC | Outpatient payment group under OPPS |
| Condition code 44 | Inpatient changed to outpatient |
| Rev codes 0450 / 0360 | Emergency room and operating room services |
Code descriptions are summarized. Payer coverage and documentation rules vary by plan and state.
Denials we prevent
- Inpatient admissions denied for medical necessity or status
- Clinical validation denials on DRG diagnoses
- Missing authorizations for elective admissions
- Charge capture gaps between departments
- Late charges after the claim was billed
Payer rules to watch
We work hospital A/R and denial backlogs by payer and DRG, prepare clinical appeals with your utilization review team and help prevent repeated status and authorization denials.
Questions about hospital billing
Can you work only our backlog?
Yes. Many hospitals use us for specific A/R or denial projects alongside their in-house team.
Get a free hospital billing audit
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.