Freeman has converted many of its physician clinics to provider-based outpatient clinics. Below, we have provided a list of frequently asked questions related to provider-based outpatient clinics.
What does provider-based outpatient mean?
Provider-based outpatient status is a Centers for Medicare and Medicaid Services (CMS) designation. Simply put, it means a physician office is part of a system that includes hospitals and outpatient clinics. Clinics located miles away from the main hospital campus may still be considered part of the hospital.
What is different about a provider-based outpatient clinic?
For those with governmental health plans like Medicare and Medicaid, provider-based status means that Freeman is required to split the visit charges into separate line items – one for physician and one for facility fees. The facility portion of a charge is processed under the patient’s hospital benefits, and the physician portion of the charge is processed under the patient’s physician benefits.
For clinics that are not provider-based, the facility and physician components of a charge are combined and billed under the physician benefit section of the health insurance plan.
How does provider-based billing affect a patient who has traditional Medicare or Medicaid?
In a provider-based outpatient clinic, Medicare and Medicaid patients will see separate charges for the facility and physician services they receive. These charges will be combined on one statement as separate line items.
Adult Medicaid patients may be required to pay a copayment for both the facility and physician portions of their visit.
For patients covered by traditional Medicare, both the facility and physician services are subject to coinsurance. However, Medicare patients who carry supplemental insurance may not see a change in their out-of-pocket costs.
What if a Medicare patient has supplemental or secondary insurance coverage?
Coinsurance and deductibles are typically picked up by supplemental and secondary insurance plans. Medicare patients with supplemental or secondary plans should not see any difference in their out-of-pocket responsibility. However, we recommend you verify your benefit coverage with your insurance company.
How are patients with private insurance (such as Blue Cross Blue Shield, United Healthcare, Cigna or Aetna) affected by this change?
Private insurance companies and Medicare Advantage Plans are not required to follow the same provider-based billing rules required by traditional Medicare and Medicaid. For patients with private insurance, the facility component of the office visit is billed as part of the physician bill and will be processed by the insurance company under the patient’s physician benefits.
What questions should I ask my insurance company?
Please ask your insurance company if the services you are seeking are covered under your benefit plan and how they will be processed so you can determine your financial responsibility. Please note that provider-based billing does not change the services that your insurance covers.
I have financial questions or concerns –whom can I call?
Freeman physician billing staff would be happy to help with questions. Please feel free to call 417.347.8400 or 800.626.3972. You may also visit us at Freeman Business Center, 3220 McClelland Boulevard, Joplin, Missouri.
Why do I have to complete the Medicare Secondary Payer (MSP) questionnaire?
As a participating Medicare provider, we are required to screen Medicare patients using the MSP questionnaire. At each visit, you will be asked the MSP questions. These questions help us determine if Medicare or another payer should process your insurance claim as primary.
What can patients do if they are having difficulty paying for healthcare services?
We have a number of options for those struggling to pay medical bills, including payment plans and a financial assistance program. To learn more, please call 417.347.8400 or 800.626.3972.