Hospital Billing Services
Built Around Accurate Reimbursement
Facility billing is a distinct discipline from physician billing. EmdeonMD equips hospitals and health systems with end-to-end inpatient & outpatient billing, DRG coding, and proactive denial prevention to protect every dollar.
- HIPAA Compliant
- 99.9% Clean Claim Rate
- Inpatient + Outpatient
99.9%
Clean Claim Acceptance
IP + OP
Inpatient & Outpatient Coverage
SOC 2
HIPAA & Audit Compliant
1-on-1
Dedicated RCM Specialist Team
Why hospital billing is not physician billing
Hospitals bill for the facility, not the clinician. Claims are institutional (UB-04 on paper, 837I electronically) and carry far more data than a professional claim, with payment driven by DRGs for inpatient stays and APCs for outpatient services.
One missing value code or wrong discharge status can change payment without ever triggering a denial. That is why facility billing needs specialist attention.
Revenue codes
Condition codes
Occurrence codes
Value codes
Discharge status
POA indicators
Inpatient vs Outpatient Billing
Inpatient billing
- IPPS pays a lump sum per stay
- MS-DRG assigned from principal diagnosis and procedures
- CC/MCC capture depends on strong documentation
- DRG validation protects against downgrades
Outpatient billing
- OPPS pays by APC with status indicators
- Packaging and comprehensive APCs affect payment
- Revenue codes and HCPCS must align
- Separately payable services must be captured
Understanding the Institutional Claim
01
Revenue codes
Identify the department or service that generated each charge.
02
Discharge status
Shows where the patient went next and can change payment.
03
Value codes
Carry amounts and quantities payers use in pricing.
04
Condition codes
Flag special circumstances that affect processing.
05
Occurrence codes
Record key dates and events tied to the claim.
06
Diagnosis codes
Principal and secondary diagnoses that drive DRG assignment.
07
POA indicators
Show whether a condition was present on admission.
Where Hospital Revenue Is Lost
DRG downgrades
Missed CC/MCC capture or thin documentation lowers the assigned DRG.
Charge capture leakage
Services delivered but never captured or billed.
Incorrect status
Inpatient vs observation errors and two-midnight rule issues.
Missing claim data
Absent value codes, occurrence codes or discharge status.
POA issues
Incorrect present-on-admission indicators.
OPPS packaging
APC, status indicator and packaging mistakes.
No denial does not mean no revenue loss
Some leakage never produces a denial. It does not appear on a denial report and can continue unnoticed, often starting with charge capture or coding gaps. Finding it takes a facility-level review, not just denial tracking.
Six Steps From Verification to Optimization
01
Verify
Eligibility, authorization and enrollment.
02
Code
Facility inpatient and outpatient coding.
03
Query
Documentation and coding clarification.
04
Submit / Appeal
Claims submission and denial management.
05
Recover
Aged A/R and underpayment recovery.
06
Optimize
Reporting and continuous improvement.
Why hospitals outsource billing
Payer rules keep changing, facility coding is specialized and billing staff are hard to hire and keep. Outsourcing gives hospitals access to a team that works on these issues every day.
- DRG expertise
- OPPS/APC expertise
- Denial management
- A/R recovery
- Charge capture review
- Audit support
General Billing Company vs EmdeonMD
General billing company
- Limited institutional billing expertise
- Often focused on professional billing
- Limited DRG expertise
- Limited OPPS/APC expertise
- Limited facility audit experience
EmdeonMD
- Hospital-focused billing support
- Revenue-cycle expertise
- Coding support
- Denial management
- A/R management
- Claims optimization
- Dedicated support
Benefits of Partnering With EmdeonMD
01
Patient admission
02
Eligibility
03
Authorization
04
Documentation
05
Coding
06
Claim submission
07
Adjudication
08
Payment
09
Denial management
10
A/R follow-up
Benefits of Partnering With EmdeonMD
Acute-care hospitals
High-volume inpatient and outpatient billing.
Critical-access hospitals
Rural facilities with specific payment rules.
Rehabilitation hospitals
Inpatient rehab claims and documentation.
Psychiatric hospitals
Behavioral health facility billing.
Long-term care hospitals
Extended-stay acute care claims.
Hospital outpatient departments
OPPS and APC-based billing.
Provider-based departments
Hospital-owned clinics and departments.
Psychiatric hospitals
Behavioral health facility billing.
Benefits of Partnering With EmdeonMD
HIPAA compliant
Strict guidelines for patient data security and confidentiality.
Find Out Where Your Hospital Revenue Is Being Lost
EmdeonMD can review your billing and revenue-cycle processes and point out where to improve.