Provider-Based Clinics

A provider-based outpatient clinic refers to services provided in hospital outpatient departments that are clinically integrated into a hospital. According to Medicare billing rules, when you see a provider in a provider-based outpatient clinic, the provider and hospital charges are billed separately. For patients with insurance, provider services are processed under physician benefits, which are generally subject to patient liabilities in the form of copayments, while hospital services are processed under hospital benefits subject to deductibles and coinsurance amounts.

Provider-based status is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that we bill Medicare (to include some Medicare Advantage plans and Medicaid) in two parts. For patients with certain insurance coverage, your billing statement for each visit or service you receive will show:

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

Many private insurance companies do not require that we follow the same billing rules required by Medicare. For patients with private insurance, the facility component of the provider office visit will be billed as part of the provider bill and will be processed by the insurance under the patient’s physician benefits.

Depending on the clinical services being provided, additional out-of-pocket expenses may be incurred in the provider-based clinic. Insurance benefits vary significantly by insurance company. Ask your insurance company if your benefit plan covers facility charges in a provider-based outpatient clinic and how much of the charge is covered or will it be applied to your deductible or subject to coinsurance. Co-insurance and deductibles may be covered by a secondary insurance policy.

You will continue to receive excellent quality care from the same providers who you have come to know and trust. Scheduling for appointments will not change.

Co-insurance and deductibles may be covered by a secondary insurance. Check your benefits or with your insurance company for details.

As a participating Medicare Provider, we are required to screen Medicare patients according to the MSP rules. At each visit, you will be asked the MSP questions. These questions help us confirm if Medicare or another payer should process your insurance claim as primary. It only takes a few minutes to complete the questionnaire.

Questions about your provider office bill can be directed to our business office at 270-707-2100.

Consistent with our mission to provide high quality health and wellness services for the community, Jennie Stuart Medical Center is committed to providing affordable care to our patients and as such offers financial assistance programs. Jennie Stuart Medical Center will not pursue extraordinary collections actions against an individual without first using reasonable efforts to determine if such individual is eligible for financial assistance.