The Importance Of Healthcare Claims
Claims are an important part of the healthcare process. Claims are a “request of payment, or itemized statement of healthcare services and their costs, provided by a hospital, physician’s office, or other healthcare provider” (Castro and Forrestal, 304). Understanding the difference between professional and facility healthcare claims are important the utilization processes of reimbursement.
Professional and facility healthcare claims are submitted differently. Professional claims are submitted on an individual basis. However, facility healthcare claims submit “all services for a single patient for each date of service at the same facility” (Hamilton, 2014). There can be many professional claims within a facility healthcare claim. When a healthcare organization submits a claim, the healthcare organization is looking for “compensation or repayment for healthcare service
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The diagnosis code within the professional claim are “relevant to the encounter by a single provider, and pointers are used to link specific codes to each procedure” (Hamilton, 2014). However, diagnosis code in a facility healthcare includes all services for a single patient. A patient can be tested or have services performed in different parts of a healthcare organization. Therefore, the facility healthcare diagnosis code includes all services for a single patient in that date of time. There are no pointers used in the diagnosis code for facility healthcare.
The major dividing line between professional and facility healthcare claims are the date of service. Professional claims have a “from and thru date span” (Hamilton, 2014). Therefore, professional claims contain multiple days within the claim. Facility health care claims contain a single and specific date of service. The professional claim will have more reimbursement because having multiple days; therefore, the healthcare professionals need to be
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