Provider-Based Billing FAQs

Provider-Based Billing FAQs

Provider-Based FAQs

THE FOLLOWING ARE OUTPATIENT DEPARTMENTS OF THE HOSPITAL:

  • JCH Orthopedic Center
  • JCH Heart Center
  • JCH Surgery 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

  1. What is provider-based status?
  2. Will I have to pay an additional fee for my next visit?
  3. How will this affect my next visit?
  4. What if I'm confused about the bills I get in the mail?
  5. What if I'm having trouble paying my medical bills?
  6. Why is JCH converting to this model for most of its physician office locations?

What is Provider-Based Status?

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.

Will I have to pay an additional fee for my next visit?

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.

How will this affect my next visit?

Provider Based billing will not change your covered services, but it may affect your copayments and deductible.

What if I'm confused about the bills I get in the mail?

If you have questions about your bills, please call JCH Billing Services at (618) 498-7518 .

What if I'm having trouble paying my medical bills?

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.

Why did JCH convert to this model for most of its physician office locations?

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.