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Hospital Outpatient Billing
A hospital outpatient visit produces two different claims when both the physician and the hospital are billing: a professional claim and a facility claim. Place of service 22 is the outpatient hospital. Place of service 11 is an office, and it pays the physician as if the practice owned the overhead. Vector Medical Billing, in Jamaica, New York, keeps those claims apart and uses the place of service the department actually is.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
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50 StatesRemote billing nationwide
Monthly fee
What hospital outpatient billing includes
Professional fees for outpatient hospital work, and facility billing when that engagement is actually yours — not both on one claim.
Independent groups usually bill only the professional fee on a CMS-1500, place of service 22. The hospital bills the facility fee on a UB-04. Putting both on one form, or billing place of service 11 because the payment is higher, misstates who bore the practice expense. Medicare's site-of-service rules pay the professional fee differently in a facility setting than in an office. A provider-based clinic that is part of the hospital is not an independent office, even if it sits in a medical office building. Inpatient day codes for hospitalists are a different page: hospitalist billing.
The fee is a percentage of net collections. The written rate is on pricing. Credentialing, a retrospective coding audit, and old A/R stay separate engagements.
What sits on this fee
- Professional claims at place of service 22 when the service is outpatient hospital
- Facility claims only when your organization is the one billing the facility fee
- No office place of service on a hospital department visit
- Denial follow-up on the professional claim, separate from the hospital's facility denial
Where hospital outpatient claims fail
The usual miss is treating a hospital department like a private office because the payment looks better.
Office place of service in a hospital department
Place of service 11 tells the payer the practice incurred the overhead. In a hospital outpatient department the facility is paid for that overhead. Billing 11 on those visits overstates the professional fee and is a review target.
Professional and facility on one claim
The physician's CPT line and the hospital's facility charge are different claims, different forms, and often different tax IDs. Combining them drops one side or sends the payer a claim it cannot price.
Employed physician billed as an independent group
If the hospital owns the professional fee through employment, the group does not also bill it. The audit starts by asking who is entitled to the pro fee before any charge is released.
How outpatient hospital work is split
Confirm who bills the professional fee and who bills the facility fee before the first claim.
| Check | How Vector handles it |
|---|---|
| Professional claim | CMS-1500 / 837P, place of service 22, for the physician or group that owns the pro fee. |
| Facility claim | UB-04 / 837I when the client is the facility. Not added onto the professional claim. |
| Provider-based clinic | Billed as hospital outpatient, not as a freestanding office, when the department is provider-based. |
| Inpatient work | Not this page. Hospitalist and admission coding live on the hospitalist specialty page. |
| Payment posting | Professional receipts posted to the group. Facility receipts posted only if that book is in scope. |
Other practice shapes: Hospitalist · ASC · Emergency medicine.
Not inside the monthly percentage
The monthly cycle bills claims that are already in the system. These are scoped on their own.
Written rate
The fee is a percentage of net collections. No setup fee on the monthly cycle. Month to month. The written rate follows volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
Separate work
A facility-side engagement, provider-based credentialing, and old A/R on the hospital's books are scoped separately from a professional-fee percentage.
Audit outpatient claims that used an office place of service
Send the practice shape, monthly visit or case volume, top payers, and the EHR name. We reply with what the open A/R shows and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Hospital outpatient billing questions
Straight answers for this practice shape.
Do you bill the hospital's facility claim and the doctor's claim?
Only the side your organization is entitled to bill. Most independent groups are the professional claim only. Both sides are not placed on one form.
Why not bill place of service 11?
Office payment assumes the practice carries the overhead. A hospital outpatient department's overhead is on the facility claim. The professional claim uses place of service 22.
Is this hospitalist billing?
No. Hospitalist billing is inpatient day codes. This page is outpatient hospital work. Both can be in scope; they are not the same claim.
How is the fee set?
A percentage of net collections on the book you hand over. No setup fee. Month to month. A facility book and a professional book are priced from the claim mix.
Do we change systems?
No. Billers work in the system that already holds the encounters.