What is the difference between professional fees and facility fees on a claim?

• A. Professional fees cover the facility’s cost for providing services.
• B. Professional fees cover clinician services; facility fees cover the facility’s cost for providing services.
• C. Professional fees are charged to the insurer; facility fees are charged to the patient.
• D. Professional fees are for administrative costs; facility fees are for equipment depreciation.

Answer: (B)

The main distinction is between who is being billed for the service: the clinician’s time and expertise versus the facility’s costs to provide the service. Professional fees cover the clinician’s services—evaluation, interpretation, and procedures performed by the doctor or other treating clinician. Facility fees cover the costs of the place where care is provided—the hospital or clinic’s space, equipment use, supplies, and the non-clinician staff and overhead needed to run the facility. This is why the statement that professional fees are for clinician services and facility fees are for the facility’s cost is the correct way to think about claims. The other options mix up roles or describe aspects that aren’t the standard professional vs facility split (e.g., administrative costs or charging differences to patient vs insurer).