Provider Based Clinic Services
SJRHC Provider-Based Billing General Information
October 1, 2013
Thank you for trusting your health care to St. Joseph Health System. Since 1936, our goal has been to provide excellent care to help you maintain the best health possible.
We share this letter with you to inform you of changes being made in our billing policies for the St. Joseph hospitals and clinics. Similar to the changes being made at hospitals across the country, St. Joseph Regional Health Center (SJRHC) is taking a more active role in the care delivered in clinic locations outside of the hospital, where most of patients’ day to day medical needs are provided.
As a result, SJRHC is converting many of its physician clinics to hospital-based outpatient clinics. Hospital-based outpatient clinics are a way to increase collaboration between hospitals and physicians by emphasizing better coordination and communication between physician offices and hospital and focusing attention to quality and clinical outcomes. Provider-based clinics, such as St. Joseph is creating, are required to meet the same stringent level of regulations that hospitals do.
Under our new policies, patients will continue to receive a bill from the doctor, but may also receive a separate bill for some “hospital-based services” provided by St. Joseph Regional Center. The amount you owe for your care will be determined by the services you receive from the hospital and services you receive from the doctor. For example, laboratory work and x-rays are provided by departments of St. Joseph Regional Health Center and will be billed by SJRHC as a hospital-based service - even though they are delivered in an outpatient clinic environment. The professional services fee for care provided by your doctor will be billed as “physician services” by the physician group (such as St. Joseph Family Medicine).
With these changes, patients may receive two statements from their insurance carrier, one being for hospital-based services and the other for physician services. These statements will show any amount owed for the visit, as determined by your insurance plan’s specific benefits.
Estimate of Charges
Medicare requires that we provide you with an estimate of your Part A and Part B coinsurance
amounts. These amounts will vary based on the type and number of services received. An estimate of your coinsurance amounts are as follows:
Part A Part B
Office Visit $11-$17 $12-$27
Radiology $20-$40 $ 2-$12
Minor Procedure $10-$50 $ 5-$10
As your health care provider, St. Joseph is committed to offering you the best care possible. We are also committed to helping you understand our financial and billing policies, so if you have questions regarding these billing policy changes, please feel free to call us at 979-774-2121.
Provider-based billing and the information contained on this page pertain to Medicare patients only.
Thank you for being a valued patient at one of St. Joseph Health System's "provider based" locations. St. Joseph clinic locations across the Brazos Valley now function as part of St. Joseph Regional Health Center as a hospital outpatient facility. (See list of clinic locations below). The Centers for Medicare and Medicaid Services (CMS) have designated St. Joseph Clinics as a "Provider Based" or "Hospital Outpatient" departments of St. Joseph Regional Health Center in Bryan, TX.
This designation means that if you are seen in a SJRHC provider based clinic there will be:
1. one coinsurance and deductible for professional services
2. and one coinsurance and deductible for facility services
This change in billing practice went into effect October 1, 2013.
What is Provider- based Billing (PBB)?
PBB refers to the billing process for services rendered in a hospital outpatient clinic or department. This is the national model of practice for integrated delivery systems where the hospital operates the service and employees support personnel involved in patient care.
This benefits patients as all departments of the hospital are subject to strict quality standards and are monitored by The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
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 St. Joseph Health System 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, patients will see two charges on your St. Joseph Health System combined statement. One charge will be for the professional services provided by your physician. This is also called the professional fee. One charge will be for the facility charge. Previously, all services were provided by the physician’s office and charges were grouped together for your clinic visit.
Medicare beneficiaries are responsible for the co-insurance amount on the services you receive. These amounts are determined by Medicare and are based on the services performed.
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 more out-of-pocket. Depending on their particular insurance coverage, its possible patients may pay more for certain outpatient services and procedures at our provider based/hospital outpatient locations than at one of our other sites. We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses they may incur based on the location of the services provided.
Why does the Medicare Secondary Payor (MSP) Questionnaire need to be completed?
As a participating Medicare provider, St. Joseph Regional Health Center is required to screen Medicare patients according to the Medicare Secondary Payer (MSP) rules. At each visit, business services representative will ask you the MSP questions. These questions will help to confirm if Medicare or another payer should process the claim as primary.
Does this apply if I have private insurance like Blue Cross Blue Shield, United Healthcare, Cigna or Aetna?
No. Many private insurance companies do not follow the same billing rules required by Medicare and Medicaid, and therefore, do not recognize hospital-based billing.
What can patients do if they are having difficulty paying for health care services?
St. Joseph Health System offers financial assistance options. Detailed information is available online or by calling SJHS Patient Financial Representatives at 979-774-2121.
Where can patients call for more information?
If you have question about these provider-based changes, you may call us at 979-774-2121 between 8 a.m. and 5 p.m. Monday through Friday.
St. Joseph Regional Health Center Provider-Based Clinic Locations:
St. Joseph Family Medicine - 29th St.
St. Joseph Family Medicine - Holleman
St. Joseph Family Medicine - South College Station
St. Joseph Family Medicine - University Drive
St. Joseph Express - College Station
St. Joseph Express - Bryan
St. Joseph Express - Hearne
St. Joseph Family Medicine Clinic - Normangee
St. Joseph Orthopeadic Associates
St. Joseph Central Texas ENT
St. Joseph Urology
St. Joseph Neurology