Provider-Based Clinic Billing

The term “provider-based clinic” is a federal classification used to describe clinics that are part of the hospital even if the service location isn’t directly in or attached to the hospital. The Centers for Medicare & Medicaid Services (CMS) has specific guidelines to differentiate provider-based clinics and their billing practices. This means your bill for provider-based clinics will feature two separated charges, rather than the one bundled charge, that is used in physician-based clinics. Provider-based clinics must comply with Medicare facility accreditation standards and are surveyed on a regular basis to ensure compliance with standards.

No. Rest assured, you will still receive care from the same trusted team of providers and staff you know and trust.

Operating provider-based clinics helps keep Faith Regional strong as the regional referral center of northeast Nebraska. This designation allows us to operate more efficiently, maintain higher quality standards, and ensure patients have access to the care they need. As a non-profit hospital, our emergency services are open 24/7 to care for everyone who comes through our doors. This change supports our ability to keep vital services and specialists in the community to provide you and your family with access to comprehensive, high-quality care close to home.

Your bill will look different as it will be broken out into two sections. According to CMS health care billing rules, when a patient sees a physician in a provider-based clinic, physician and hospital charges are to be billed separately.

After a visit in a provider-based clinic, patients will see their bill split into two parts:
1. Professional Fee: For the care you received from your doctor or advanced practice provider.
2. Technical Fee: For the clinic, its equipment and staff support during your visit.

Depending on the patient’s specific insurance coverage, it is possible that benefits will differ for services and procedures at our provider-based clinic locations. Services at provider-based clinics are billed differently, which may result in higher out-of-pocket expenses. Many insurance plans may cover technical charges in provider-based clinics. Please contact your health insurance company if you are unsure about your specific benefits or have insurance coverage questions.

Patient responsibility is dependent on their specific type of insurance coverage. It is possible to pay more or see no change for certain outpatient services and procedures at provider-based clinics. We advise you to review your insurance benefits and reach out to your insurance company to determine what your out-of-pocket expenses will be.

Coinsurance and deductibles may be covered by a secondary insurance. Please check your carrier benefits or ask your insurance company for details.

This depends on each patient’s specific insurance benefits. Additional out-of-pocket expenses may be incurred in a provider- based clinic. Medicare patients will incur a coinsurance cost to the hospital.

Who can I call with financial questions or if I am having difficulty paying for health care services?