Provider Based Billing

What is provider-based billing?

Provider-based billing is a type of billing for services provided in a clinic or department that is considered part of a hospital facility.

Why provider-based billing?

Provider-based billing has become a common model of practice for health systems locally and around the U.S. Patients benefit because all participating hospital facilities must follow stricter quality standards and offer additional resources for patients and their families.

How will my bill look for provider-based billing?

The Centers for Medicare and Medicaid have separate payment programs for provider-based billing and requires Baptist to make it clear to our patients which health care services are part of the hospital. Provider-based billing only applies to patients with Medicare, Medicaid or select Medicare Advantage plans. The billing statement for each visit or service you receive will show:

• One charge for the professional services from the provider you see.
• One charge for the facility, which covers the use of the room and any medical or technical supplies, equipment and support staff.

Which Baptist medical practice locations are provider-based?

In 2019, most of the physician and provider clinics of Baptist Physician Enterprise, which encompasses Baptist Medical Group, Baptist Heart and Vascular Institute and Andrews Institute for Orthopaedics & Sports Medicine became hospital-based departments of Baptist Hospital. This changed freestanding clinics to provider-based hospital outpatient departments designed to more fully integrate the care a patient receives across the Baptist Physician Enterprises and Baptist Hospital. Departments are clinically integrated with the hospital and will be subject to the DNV Patient Safety and Service quality guidelines.

Will there be a change in how I receive care?

No. You will continue to receive excellent quality care from the same doctors you have come to know and trust. Scheduling for appointments and tests will not change.

Are all patients billed using provider-based billing?

The requirement to list professional services and facility charges separately is unique to the Centers for Medicare and Medicaid. Only patients with Medicare, Medicaid, Medicare Advantage or Medicaid HMO plans are billed with professional service charges and facility charges listed separately. All other insurance health plans and networks do not require charges to be shown and billed separately. They are listed as one charge.

Does provider-based billing increase my cost?

Depending on a patient’s particular insurance coverage, it is possible that some patients may pay more for certain outpatient services and procedures at provider-based clinic departments. We recommend you review your insurance benefits or contact your insurance provider to determine what the policy will pay and what out-of-pocket expenses may be incurred.

Who can I contact for other billing questions?

Contact customer service at 448.227.3600, or email billing@bhcpns.org.