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 firstname.lastname@example.org.