Provider-Based Clinics

Provider-Based Clinics

Like many other medical centers, Coffeyville Regional Medical Center, is converting some of our physician clinics to hospital-based outpatient clinics. Below are some questions and answers that will help you understand what these mean to you as a patient.

What does the term “provider-based” mean?

This is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that we bill Medicare in two parts (Part A and Part B).

What is Provider-Based Billing (PBB)?

PBB refers to the billing process for services rendered in a hospital department or location. This process takes place when the hospital owns space and employs physicians and other support personnel who are involved in patient care.

Will there be a change in how patients receive care?

No. Patients will continue to receive excellent quality care with their physician, and scheduling appointments and tests will be handled as they always have been in the past. However, there is a change in how CRMC will bill your insurance carrier for these services.

How does this affect the billing process?

Because care is provided in a department of the hospital, Medicare and Medicaid patients will receive a bill from CRMC, as well as a separate bill for the professional services provided by their physician. This also includes physicians who interpret the results of diagnostic tests.

Medicare and Medicaid beneficiaries are responsible for the co-insurance amount on the services you receive. These amounts are determined by Medicare and Medicaid and are based on the services performed. Medicare patients who have supplemental insurance may have coverage that will reimburse their co-pays and deductibles. Please check with your insurance plan.

The total cost of charges for Medicare and Medicaid patients will not exceed charges incurred by non-Medicare/Medicaid patients receiving the same service.

Will Medicare patients have to pay more for services?

Some Medicare patients may be covered by their supplemental insurance and will not have to pay out-of-pocket; Medicare patients without supplemental insurance may have to pay a small additional amount for their coinsurance.

Where can patients call for more information?

Patients can call PAYRHEALTH at 1-866-822-8104 for more information.