What is Provider-based Billing

What is provider-based billing?

Provider-based billing is a type of billing for services given in a hospital or hospital facility. The hospital facility may be called an outpatient center, doctor’s office or practice.

Why provider-based billing?

Provider-based billing is used across the U.S. by many healthcare systems, like Bronson. Patients benefit because all participating hospital facilities must follow more strict quality standards and offer additional resources for patients and their families.

How will my bill look for provider-based billing?

The Centers for Medicare and Medicaid have separate payment programs for provider-based billing and requires Bronson to make it clear to our patients which healthcare services are part of the hospital. Provider-based billing only applies to patients with Medicare, Medicaid or select Medicare Advantage plans. The billing statement for each visit or service you receive will show:

  • One charge for the professional services from the doctor you see;
  • One charge for the facility, which covers the use of the room and any medical or technical supplies, equipment and support staff.

Which Bronson medical practice locations are provider-based?

In 2016, some Bronson medical practices became hospital facilities. In December 2019, the majority of Bronson medical practices joined them. All Bronson practices that use provider-based billing include one of the following on their sign, letterhead, location page on the website and on some other materials:

  • “A Bronson Battle Creek Hospital facility” or "A department of Bronson Battle Creek Hospital"
  • “A Bronson LakeView Hospital facility” or "A department of Bronson LakeView Hospital"
  • “A Bronson Methodist Hospital facility” or "A department of Bronson Methodist Hospital
  • “A Bronson South Haven Hospital facility”

Will there be a change in how I receive care?

No. You will continue to receive excellent quality care from the same doctors you have come to know and trust. Scheduling for appointments and tests will not change.

Are all patients billed using provider-based billing?

The requirement to list professional services and facility charges separately is unique to the Centers for Medicare and Medicaid. Only patients with Medicare, Medicaid, Medicare Advantage or Medicaid HMO plans are billed with the professional service and facility charges listed separately. All other insurance health plans and networks do not require charges be shown and billed separately. They are listed as one charge.

Does provider-based billing increase my cost?

Your cost depends on your insurance coverage. Benefits may vary for some services at hospital facilities.

Who do I contact if I have questions about my insurance coverage?

Contact your insurance provider.

Who can I contact for financial assistance and other billing questions?

Bronson has a financial assistance program that may be able to help you with out-of-pocket expenses. For more information about this program or if you have other questions, contact Bronson billing at (269) 341-6117 or (800) 699-6117, or email patientbilling@bronsonhg.org.