Provider Based Billing


Billing Information for Provider and Hospital-based Clinic Care

If you receive care or services at a hospital-based outpatient clinic, your bill may include separate charges for the facility and for the professional who provided your care. Medicare and Medicaid billing rules require separate charges for provider and hospital-based outpatient services covered by Medicare, Medicare Advantage, and Medicaid.

To help you understand your bill, here are some common questions many patients ask. 

What is a hospital-based outpatient clinic?

Hospital-based outpatient clinics are considered a department of the hospital, even if that clinic is located miles away from the main hospital. Hospital-based outpatient clinics are subject to stricter government rules, making them more complex and more costly to operate. When you see a physician or receive services in a hospital-based outpatient clinic, you are technically being treated within the hospital. 

What is different about billing for a hospital-based outpatient clinic? 

According to Medicare billing rules, when you see a physician in a private office setting, all services and expenses are bundled into a single charge. When you see a physician in a hospital-based outpatient clinic, the physician and clinic (facility) charges are billed separately. Your billing statement will break out your charges for each office visit or service. Part of the total is for the main person you see (your doctor). The rest is for the place (building, support staff, equipment and other overhead expenses). The charges will add up to the same amount any patient would pay, but they are listed separately on your bill. 

Are all patients billed this way?

No. The requirement for breaking out charges for each office visit or service was set by the Centers for Medicare & Medicaid. Therefore, only patients with Medicare, Medicare Advantage, and Medicaid are being billed using Provider-Based Billing. At this time, all other commercial insurance companies do not require Munson Healthcare to break out charges; the facility component of the physician office visit will be billed as a part of the physician bill and will be processed by the insurance company under the patient's physician benefits defined in their individual plans.

Does this mean patients will pay more for services?

Depending on your specific type of insurance coverage, it is possible you can pay more for certain outpatient services and procedures at our provider-based/hospital outpatient locations than you would have paid at a non-provider based location. Because of this fact, we advise patients to call their insurance provider to determine what their out-of-pocket expenses will be, if any, before receiving service.

What if a Medicare patient has a secondary insurance?

Coinsurance and deductibles may be covered by a secondary insurance. Check your benefits or ask your insurance company for details.

Where can I call with financial questions or concerns?

Please refer to your billing statement for contact information if you have questions about your bill.