Professional vs Institutional Claims: CMS-1500 vs UB-04 Explained
Professional claims bill for a provider’s individual services on the CMS-1500 form (electronically, the 837P transaction). Institutional claims bill for a facility’s resources — room, equipment, supplies, nursing — on the UB-04 form (electronically, the 837I). The key point most explanations miss: a single hospital encounter usually generates both, one from the physician and one…