Provider-based Billing and the information contained on this page pertain to Medicare patients only.
Thank you for being a valued patient at one of Mercy Health System’s provider based locations. Wisconsin clinic locations now function as part of Mercy Hospital and Trauma Center as a hospital outpatient facility. (See list of clinic locations below).
What is Provider- based Billing (PBB)?
PBB refers to the billing process for services rendered in a hospital outpatient clinic or department. This is the national model of practice for integrated delivery systems where the hospital owns space and employees support personnel involved in patient care.
This benefits patients as all departments of the hospital are subject to strict quality standards and are monitored by The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification 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 Mercy Health System 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 see two charges on your Mercy Health System combined statement. One charge will be for the professional services provided by your physician. This is also called the professional fee. One charge will be for the facility charge. Previously, all services were provided by the physician’s office and charges were grouped together for your clinic visit.
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. Depending on their particular insurance coverage, it is possible benefits may differ for certain outpatient services and procedures at a provider-based, hospital outpatient location. We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses they may incur based on the location of the services provided.
Where can patients call for more information?
You may contact Customer Service at 608-741-7630 or 866-269-7115. Customer Service Representatives are available 8:00am-4:30pm, Monday through Friday.
Listing of Locations:
Mercy Clinic South
849 Kellogg Ave., Janesville, WI 53546
Mercy Beloit Medical Center
2825 Prairie Ave., Beloit, WI 53511
Mercy Brodhead Medical Center
2310 First Center Ave., Brodhead, WI 53520
Mercy Clinic East
3524 E. Milwaukee St., Janesville, WI 53546
Mercy Clinic North
3400 Deerfield Dr., Janesville, WI 53546
Mercy Elkhorn Medical Center
839 N. Wisconsin St., Elkhorn, WI 53121
Mercy West Clinic
1000 Mineral Point Ave., Janesville, WI 53548
Mercy Michael Berry Clinic
1000 Mineral Point Ave, Janesville, WI 53548
Mercy Edgerton Medical Center
217 N. Main St., Edgerton, WI 53534
Mercy Evansville Medical Center
300 Union St., Evansville, WI 53536
Mercy Mall Clinic
1010 N. Washington St., Janesville, WI 53548
Mercy Milton Medical Center
725 S. Janesville St., Milton, WI 53563
510 N. Terrace St., Janesville, WI 53548
Mercy Walworth Hospital and Medical Center
Hwys. 50 and 67
N2950 State Road 67, Lake Geneva, WI 53147
Mercy Lake Geneva Medical Center
350 Peller Rd., Lake Geneva, WI 53147
Mercy Whitewater Medical Center
507 W. Main St., Whitewater, WI 53190
Mercy Delavan Medical Center
1038 E. Geneva St., Delavan, WI 53115
Mercy Sharon Medical Center
118 Plain St., Sharon, WI 53585