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Provider Based Billing

What does “provider based” or “hospital based outpatient” mean?

These are terms Medicare uses to describe outpatient clinics that are actually part of a hospital. Basically, Prairie Ridge Hospital and Health System Clinics (in Elbow Lake, Morris, Evansville, Hoffman, Herman and Ashby) are considered to be a part of Prairie Ridge Hospital. It is a very common model of practice for integrated health care systems and is found in many hospitals and facilities within our state and around the nation.

How does provider-based billing benefit our patients?

  • Your medical records will be better coordinated between your physicians.
  • The hospital and physicians will be able to better coordinate your care across clinics and hospital.
  • Our Clinics will be held to even higher clinical standards to maintain the highest patient safety and service quality standards.

How does this change what I will see on my bill?

  • You will see two different charges for your clinic visit. This is a federal regulation. One charge is for services provided by the physician and the other related to the facility-related expenses.
  • You may see two separate Explanation of Benefits from your insurance carrier for the same date of service.
  • Deductibles and co-insurance may apply to one or both charges for the visit, which may result in higher out of pocket costs. If you have a Medicare Supplement, they make cover those balances.

For More Information

If you have questions or concerns about billing please contact our Patient Financial Services staff at 218.685.7334 or pricing@prairiehealth.org.