Provider-based Billing
Henry County Hospital Clinics are outpatient departments of Henry County Hospital.
As a result, you will notice that when you receive services at your physician’s office, care is classified as care at an ‘outpatient department of Henry County Hospital.’ Your billing statement will show services in two categories as noted below:
Technical Services: cover the use of the room and any medical or technical services, supplies, or equipment. The hospital’s charge for technical services will be shown here, even if the visit takes place in a physician’s office.
Professional Services: cover your physician and clinical professional service fees.
If You Have Medicare:
Because the clinics are an outpatient department of Henry County Hospital, you may be responsible for coinsurance amounts related to the hospital’s charge for technical services and for the physician’s professional services. In addition:
You will receive one Medicare Summary Notice (MSN) for Part B.
If you have secondary insurance, we will submit any balance to that insurance company.
If your secondary insurance does not cover the remaining balance, or if you do not have secondary insurance, the balance will be billed to you.
If you have questions about the amount covered by your secondary insurance, we encourage you to contact your insurance carrier.
Contact Information
If you have additional questions concerning your bill, you may contact one of our financial counselors or patient accounts customer service representatives at 833-991-2882.
FAQs
Q: What can patients expect to see on their bill for a provider-based clinic?
A: According to Medicare billing rules, when patients see a provider in a private office setting, all services and expenses are bundled into a single charge. When patients see a provider in a provider-based clinic, provider (professional) and clinic (facility) charges are billed separately.
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First Charge A facility charge from the hospital, which covers the use of the room and any medical or technical supplies, equipment, and support staff. |
Second Charge A professional or provider charges for outpatient services and/or procedures from the medical provider you see. |
For patients with insurance, provider services will be processed under provider benefits, which are generally subject to patient copays. Hospital services will be processed under hospital benefits and subject to deductibles and coinsurance.
Q: Does this only apply to certain insurance carriers?
A: The requirement to list professional services and facility charges separately is unique to the Centers for Medicare and Medicaid.
Q: What should patients ask their insurance carrier?
A: Making informed healthcare decisions is important. Patients may want to ask their insurance company the following:
- Does my benefit plan cover facility charges in a provider-based/hospital outpatient clinic?
- How much of the charges (what percent) are covered by my plan?
- Will the charges be applied to my deductible or subject to coinsurance?