Patients benefit because all hospital outpatient departments are subject to additional stringent quality standards and are monitored by The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 21, health care organizations and programs in the United States.
The Centers for Medicare and Medicaid have separate payment programs for provider-based billing and require us to make it clear to our patients which health care services are part of the hospital. For patients with certain insurance coverage, your billing statement for each visit or service you receive will show:.
For most patients, both charges add up to the same amount previously charged to all patients for the same service. Effective, June 8, , our Marshfield Medical Center-Park Falls medical offices location will use provider-based billing. In the future, other Marshfield Clinic Health System centers, which are located on an integrated medical campus, will become hospital outpatient services.
No — how you receive care remains the same. You will continue to receive excellent quality care from the same providers you have come to know and trust. The requirement to separately list professional services and facility charges for each office visit or service is required by the Centers for Medicare and Medicaid.
Other payors, such as commercial insurance companies, do not require charges be shown and billed separately. Cost of care will depend on the particular insurance coverage.
Benefits may be different for certain outpatient services at a provider-based billing location. Some Medicare patients may be covered by supplemental insurance and may not have to pay more out-of-pocket. Medicare beneficiaries are responsible for the co-insurance amount on the services received. The co-insurance amounts are determined by Medicare and based on the services performed.
You will need to review your insurance plan to determine what is covered and what you are responsible for. Provider-Based Billing Questions. Skip to navigation Skip to Content. You will continue to see your regular doctor and health care team, and continue to receive excellent-quality care. Scheduling appointments and tests will be handled as they have been in the past.
At every visit, Medicare patients will be asked to complete an MSP questionnaire containing 10 to 15 questions. We recognize this may feel repetitive, but it is a government requirement. Are all patients being billed this way? The requirement for breaking out charges for each office visit was set by the Centers of Medicare and Medicaid.
Thus, only patients with Medicare, Medicare Advantage and Tricare insurance are billed using provider-based billing. At this time, commercial insurance companies do not require this breakout. What if I have questions? We ask you to review your insurance benefits or contact your insurance provider to determine any changes to what your policy will cover. In addition, we have trained staff who can help answer your questions.
Call What should I ask my insurance carrier? Making informed health care purchasing decisions is important. Ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient clinic and how much of the charge is covered or will be applied to your deductible or subject to insurance.
What can I do if I am having difficulty paying for health care services? We offer financial assistance to help qualifying patients.
In hospital-based outpatient clinics, Medicare and Medicaid patients could receive two 2 separate bills for services provided in the clinic — one from the doctor and one from the hospital. Adult Medicaid patients who have a spend down agreement will be required to pay for the clinic visit — and the facility fee — until they have met their pre-determined spend down amount thru Medicaid. For patients covered by Medicare or Medicare Advantage plans, non-physician charges billed by the hospital will be subject to coinsurance.
Co-insurance and deductibles may be covered by a secondary insurance. Check your benefits or with your insurance company for details.
Memorial Healthcare has staff available to assist with questions. Please contact What can patients do if they are having difficulty paying for healthcare services?
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