COMMON PROVIDER-BASED BILLING QUESTIONS
What is provider-based billing?
Provider-based billing is a type of billing for services rendered in a hospital outpatient department including medical offices.
Why provider-based billing?
Provider-based billing is used for integrated health care across the nation. Patients benefit because all hospital outpatient departments are subject to additional stringent quality standards and are monitored by accreditation organizations. The Centers for Medicare and Medicaid (CMS) 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.
How does provider-based billing affect the billing process?
For patients with Medicare, Medicare Advantage, and Medicaid, billing statements will show one charge for the professional services rendered by the provider seen; and one charge for the facility, which covers the use of the room and any medical or technical supplies, equipment, and support staff.
Provider-based billing does not affect commercial or self-funded plans.
Will I have to pay an additional fee for my next visit?
Depending on insurance, patients may experience a change in co-pay or co-insurance responsibility. This change will not affect patients covered by Medicaid. All patients should check with their insurance company to see if additional fees could exist.
Will there be a change in how I receive care?
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. Scheduling for appointments and tests will not change either.
THE FOLLOWING ARE OUTPATIENT DEPARTMENTS OF GIBSON AREA HOSPITAL & HEALTH SERVICES
- Gibson Area Hospital Cardiology Clinic
- Gibson Area Hospital ENT Clinic
- Gibson Area Hospital General Surgery Clinic
- Gibson Area Hospital Neurology Clinic
- Gibson Area Hospital Orthopaedics Clinic
- Gibson Area Hospital Pulmonology Clinic
- Gibson Area Hospital Rheumatology Clinic
- Gibson Area Hospital Urogynecology Clinic
- Gibson Area Hospital Urology Clinic
- Gibson Area Hospital Therapy Services