Provider-Based Billing FAQs
THE FOLLOWING ARE OUTPATIENT DEPARTMENTS OF THE HOSPITAL:
- JCH Orthopedic Center
- JCH Heart Center
- JCH Surgery Center
- JCH Podiatry
- JCH Advanced Wound and Healing Center
You will be charged for any services performed by your physician and receive separate charges from the hospital for facility services. Depending on your insurance, there may be an additional co-pay or coinsurance (one for the physician and one for the hospital) for one visit. If you have secondary coverage, any additional co-insurance and deductible may be covered by your secondary insurance. This billing model, called Provider Based, complies with specific Medicare regulations and is a national model of practice for integrated healthcare delivery systems such as JCH.
Frequently Asked Questions
Provider Based status is a status sanctioned by Medicare for hospitals and clinics. It is a national model of practice for integrated healthcare delivery systems like JCH that includes hospital and physician offices. Simply put, it means that physician offices are departments of the hospital.
There will be a facility charge for an office visit that will then be applied to the patient’s insurance plan and be billed accordingly. The patient’s insurance plan coverage will be applied to both bills and the remaining balances will be billed to the patient – one bill for hospital facility fees and one for physician services. Typically, both bills will be included in one statement. This is no different than the way JCH currently bills for other hospital based services like the Emergency Department, Lab services and surgical procedures.
Provider Based billing will not change your covered services, but it may affect your copayments and deductible.
JCH has a number of options for those struggling to pay medical bills, including payment plans and free or discounted health care through the JCH Financial Assistance Program. If you’d like to hear more on these options, call JCH Patient Financial Services at (618) 498-8326.
The rising cost of health care and lower reimbursements prompted JCH to make this change for its physician office locations. The Medicare-approved Provider Based model ensures JCH is compensated fairly for services provided and allows JCH to participate in a federal drug purchasing program that will help lower the total cost of care.
Like all Illinois hospitals, JCH is experiencing significant reductions in reimbursement.
JCH is taking proactive steps to ensure high-quality care is available to our community now and in the future. By converting to the provider-based model, JCH is ensuring it is reimbursed fairly for services it provides.