Provider-Based Billing
Understanding your medical bill charges
Firelands Health utilizes "provider-based billing" (also known as hospital outpatient billing). If you receive care at one of our hospitals or a provider’s office, you may see two distinct charges on your statement:
- Hospital services: Covers the cost of the facility, medical supplies, and support staff.
- Physician services: Covers the specific clinical care, treatments or procedures performed by your doctor.
This billing method is used by many healthcare organizations across the country and is in compliance with federal regulations regarding provider-based billing.
Offices using provider-based billing
Provider-based billing FAQ
What does “provider-based” or “hospital outpatient” mean?
“Provider-based” or “hospital outpatient” refers to the billing process for services rendered in a hospital outpatient clinic or location. This is the national billing method of practice for integrated delivery systems, where the hospital owns space and employs support personnel involved in patient care.
Why is this change being made?
Changing to this type of billing process ensures more appropriate payment for services provided by hospital staff and physicians.
How does this change affect patient billing?
Medicare, Medicaid and self-pay patients will receive two bills for a hospital visit: one for professional services, and a second for facility charges. Copay amounts may change, depending on insurer’s policies. These patients will likely see an increase in their out-of-pocket requirement, depending on their supplemental/secondary payers and the type of services they receive.
What are “professional services” and “facility charges?"
The “professional services” bill covers the cost of the care provided, while the “facility charge” covers the cost of the outpatient hospital space, exam room, and equipment use and other services provided by the hospital. This is how patients currently receiving care at outpatient facilities are billed.
How will ancillary testing or procedures be billed?
Ancillary testing or procedures performed in a provider’s office will be billed as provider-based services.
Can patients still receive charity care/discounted payments under this model?
Patients treated in the provider-based setting will still be eligible for charity care and discounted payment arrangements.
Who do patients contact for more information about their payments, discounts or charity care?
For more information about Patient Billing, please call 419-557-7879.
