What makes hospital billing different
Our hospital billing services are built for facility claims, which live in a different world from physician billing: the UB-04 claim form, revenue codes, condition codes, bill types, and payment systems that price whole encounters rather than individual services. Whether you run a community hospital, a hospital outpatient department or a growing health system, the revenue cycle has to handle inpatient, outpatient, emergency and observation work under one roof. Fastora's certified billing and coding professionals handle facility claims as part of our wider medical billing services.
Hospital claims are bigger, slower and more scrutinized than office claims. A wrong revenue code, a missed condition code or an inpatient order that does not support the admission can hold up thousands of dollars for months. Our claims management process validates facility claims against payer edits before submission, with clean-claim review tuned for the UB-04 rather than the physician claim form.
UB-04 claims: revenue codes, condition codes and bill types
| Revenue code | Category | Billing note |
|---|---|---|
| 0250 | Pharmacy, general | Drug charges; some payers require NDC detail |
| 0300 | Laboratory, general | Lab services on the facility claim |
| 0320 | Radiology, diagnostic | Imaging charges by modality |
| 0360 | Operating room services | Surgical facility charges |
| 0450 | Emergency room | ED facility claim line |
| 0762 | Observation room | Observation hours billing |
The UB-04 carries far more structure than a physician claim: type of bill, condition codes, occurrence codes and value codes that tell the payer what kind of encounter this was. Condition codes in particular change how the claim is priced, for example flagging a status change from inpatient to outpatient. We validate the bill type and condition codes against the medical record before the claim goes out, because a missing code here reprices the whole stay.
Inpatient billing: MS-DRGs and the two-midnight rule
Inpatient stays are paid under the inpatient prospective payment system, grouped into MS-DRGs by diagnosis, procedures and complications. The DRG, not the length of stay, drives payment, so complete diagnosis coding and present-on-admission indicators decide the final group.
Admission status itself is a billing decision. Under the two-midnight rule, an inpatient admission is generally appropriate when the physician expects the patient to need hospital care spanning two midnights. When the record does not support inpatient status, the hospital can change the order to outpatient with Condition Code 44, reported on the outpatient claim, but only before discharge and with proper documentation. We review admission orders against the record so status decisions are made while they can still be fixed.
Outpatient billing: APCs, packaging and observation
Outpatient hospital services are paid under the outpatient prospective payment system, grouped into ambulatory payment classifications. Many ancillary services are packaged into the primary procedure's payment rather than paid separately, so the claim has to show the full encounter for the packaging logic to work.
Observation stays are billed with hourly observation codes when the patient meets the minimum hours, and the observation record has to support medical necessity for the full period. Short stays that do not meet the threshold, or observation billed without a qualifying order, are routine denial targets.
Chargemaster accuracy and charge capture
The chargemaster is the price list behind every facility claim: each charge code maps to a revenue code and, where needed, a HCPCS code. When the mapping is wrong, claims deny or underpay for months before anyone notices, because the same error repeats on every encounter.
Our medical coding team audits chargemaster mappings against current code sets, adds new services with the right revenue and HCPCS pairing, and retires dead codes. Charge capture reviews then check that documented services actually made it onto the claim, closing the gap between care delivered and care billed.
Common hospital denials and how we prevent them
| Denial | Typical cause | Prevention step |
|---|---|---|
| Inpatient not medically necessary | Record does not support two-midnight expectation | Admission orders reviewed against the record before billing |
| Condition Code 44 rejected | Status change after discharge or undocumented | Status decisions made and documented pre-discharge |
| Outpatient authorization missing | Procedure done without required approval | Authorizations verified before scheduled procedures |
| Packaging shortfall | Ancillary services missing from the claim | Full encounter built before submission |
| Timely filing | Large claims stalled in follow-up | AR worked by payer and age with filing limits tracked |
Hospital denials are worked by dollar impact first. A single inpatient denial can equal a month of office denials, so our follow-up prioritizes high-balance facility claims and tracks payer-specific edit patterns back to registration, coding or the chargemaster.
How Fastora supports hospitals
Fastora works inside your existing EHR and patient accounting system under the user access you grant, with no software to install and no hidden setup fees. You get a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call with your leadership team.
Fees are quoted after a free assessment, so we can see your encounter volume, payer mix and denial patterns first. Start with a free billing assessment and we will show you where facility claims are slowing down before you commit to anything.
A hospital billing company for facility, inpatient and hospitalist billing
Fastora works as a hospital billing company for facilities that need billing run like an operation, not a side task. Hospital revenue cycle management spans the whole facility cycle — registration data quality, charge capture, claims, remits and A/R — and our hospital RCM services keep each stage accountable with weekly reporting. Facility billing services cover the inpatient and outpatient facility side; inpatient billing services add the DRG and per-diem claim discipline that facility claims require. Hospitalist billing is its own track: hospitalist billing services handle the professional claims from the hospitalist group — admissions, consults, daily management — and hospitalist medical billing keeps those professional charges reconciled against the facility census so nothing is missed on either side. Critical access hospital billing gets dedicated attention too, since cost-based reimbursement and swing-bed rules do not behave like PPS claims. And hospital privileges credentialing keeps employed and contracted physicians billable across the facilities they round in, tracked on the same calendar as revalidations. Our services behind this page: revenue cycle management, credentialing and enrollment, denial management.