Provider Based Billing for Medicare & Medicaid Patients
Thank you for being a valued patient at one of Memorial Health System’s employed (provider based) physician locations. These physician locations now function as departments of Memorial Health System.
What is Provider Based Billing (PBB)?
PBB refers to the billing process for services rendered in a hospital department or location. This process takes place when the hospital owns space and employs physicians and other support personnel who are involved in patient care.
This benefits patients as all departments of the hospital are subject to rigorous quality standards and are monitored by HFAP, an independent, not-for-profit organization that accredits health care organizations and programs in the United States. It is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
Will there be a change in how patients receive care?
No. Patients will continue to receive excellent quality care with their physician and scheduling appointments and tests will be handled as they always have been in the past. However, there is a change in how the hospital will bill your insurance carrier for these services.
How does this affect the billing process?
Because care is provided in a department of the hospital, patients will receive a bill from Memorial Health System as well as a separate bill for the professional services provided by their physician. This also includes physicians who interpret the results of diagnostic tests.
Medicare beneficiaries are responsible for the co-insurance amount on the services you receive. These amounts are determined by Medicare and are based on the services performed.
Will Medicare patients have to pay more for services?
Some Medicare patients may be covered by their supplemental insurance and will not have to pay more out-of-pocket; Medicare patients without supplemental insurance may have to pay a small amount. Patients with other health insurance should check with their insurance provider and ask whether it covers facility charges or Provider Based Billing. Depending on specific insurance benefits, additional out-of-pocket expenses may be incurred by Provider Based Billing.
Where can patients call for more information?
Contact a financial counselor at 740-374-1673.