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Provider-based billing

What is provider-based billing?

Provider-based billing is a type of billing for services rendered in a hospital outpatient clinic, medical center or department. This billing model is also known as hospital outpatient billing.

Please note that provider-based billing and the information on this page pertain to Medicare patients only.

Why provider-based billing?

Provider-based billing is the national model of practice for integrated delivery systems, like Mercyhealth, where the hospital owns space, and employees support personnel involved in patient care.

Patients benefit from provider-based billing because hospital departments are subject to strict quality standards and are monitored by The Joint Commission. The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States. The 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 I receive care?

No. You will continue to receive excellent quality care from your doctor. Scheduling appointments and tests will not change. However, there is a change in how Mercyhealth will bill your insurance carrier for these services.

How does this affect the billing process?

Because care is provided in a clinic or department of the hospital, patients will see two charges on their Mercyhealth combined statement. One charge will be for the professional services provided by your doctor. This is also called the professional fee. One charge will be for the facility charge. Previously, all services were provided by the doctor'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.

Do I 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 your particular insurance coverage, it is possible benefits may differ for certain outpatient services and procedures at a provider-based, hospital outpatient location. We recommend you review your insurance benefits or contact your insurance provider to determine what your policy will pay and what out-of-pocket expenses you may incur based on the location of the services provided.

Where should I call for more information?

Mercyhealth Customer Service
608.741.7630 or 866.269.7115
Monday-Friday, 8 am-4:30 pm

Javon Bea Hospital–Rockton
Monday-Friday, 8 am-4:30 pm

Javon Bea Hospital–Riverside
Monday-Friday, 8 am-4:30 pm