Provider-Based Billing FAQs
Effective September 18, 2023, Singing River Health System has made the decision to move several clinics from outpatient departments of Pascagoula Hospital and Ocean Springs Hospital to outpatient departments of Singing River Gulfport, often known as a provider-based clinic. All impacted clinics will still be operating under the Singing River Health System network. This decision was made to ensure patients continue to receive the same quality of care as they have in the past. Patients will see no impact from an insurance or quality perspective. Patients may see some changes to signage and other collateral.
What is Provider-based or Hospital-based billing?
“Provider-Based” or “Hospital-Based” refers to the billing process for services rendered in a hospital outpatient clinic or location. This is the national model of practice for large, integrated delivery systems involved in patient care.
Why is Singing River Health System changing to PBB?
Provider-based billing has become a common model of practice for health systems locally and around the US. This change will ultimately ensure that Singing River Health System and clinics continue to provide safe and high-quality patient care. This change benefits patients because all departments and clinics of the hospital are subject to strict quality standards and are monitored by DNV, an independent, not-for-profit organization that accredits and certifies healthcare organizations and programs in the US. In addition, the Centers for Medicare and Medicaid Services (CMS) have distinct payment programs for PBB and require that healthcare systems make it clear to the public which practices are part of the hospital.
Will PBB affect my co-pays or deductibles?
Patients’ copays and deductibles at provider-based clinics will depend on their specific insurance benefits. Patients may have additional out-of-pocket expenses at provider-based clinics. For most Medicare patients, the additional facility charge copay and deductible may add about $25 in out-of-pocket costs. However, the exact cost will vary depending upon services rendered and patients’ supplemental insurance coverage. Medicare patients will incur a coinsurance cost to the hospital under PBB. Coinsurance and deductibles are generally covered by secondary insurance with Medicare. Patients should check their benefits or contact their health insurance company for details or questions. Patients can contact their provider’s office or call Singing River Health System Financial Services at (228) 762-8876 to request an estimate for services.
Will PBB change my appointments in any way?
You will continue to see your regular doctor and healthcare team to receive high-quality care. No changes will be made to scheduling appointments and tests. Effective April 1, 2023, Medicare patients will be asked to complete a Medicare Secondary Payor Questionnaire (MSPQ) at each visit. We understand this will be repetitive, but this is a required regulation from CMS. The goal of this questionnaire is to make sure that your bills are sent to Medicare or the appropriate agency responsible for paying them.
What if I have questions about PBB or my bills?
As your healthcare provider, we are committed to helping you understand our financial and billing policies. For questions about PBB, including hospital and physician charges, call Singing River Health System Financial Services at (228) 762-8876.
Does this apply to patients with private insurance like BCBS, United Healthcare or Aetna?
Many private insurance companies do not require that we follow the same billing rules required by Medicare and Medicaid. For patients with private insurance, the facility component of the physician office visit will be billed as a part of the physician bill and will be processed by the insurance company under the patient’s physician benefits defined in their individual plans.
Insurance benefits vary significantly by insurance company, but in general, physician services are processed under the benefit plan’s physician benefits and are subject to co-payment amounts from the patient. Laboratory and radiology services provided by the hospital are billed by the hospital regardless of the type of insurance. Hospital services are generally processed under the benefit plan’s hospital benefits and are subject to deductibles and coinsurance amounts.
What if a Medicare patient has a secondary insurance?
Co-insurance and deductibles may be covered by a secondary insurance. Check your benefits or with your insurance company for details.
How does this affect a patient who has Medicare, Medicare Advantage or Medicaid?
In hospital-based outpatient clinics, Medicare and Medicaid patients could receive two (2) separate bills for services provided in the clinic – one from the doctor and one from the hospital. Adult Medicaid patients who have a spend down agreement will be required to pay for the clinic visit—and the facility fee—until they have met their pre-determined spend down amount through Medicaid. For patients covered by Medicare or Medicare Advantage plans, non-physician charges billed by the hospital will be subject to coinsurance.
What can patients do if they are having difficulty paying for healthcare services?
Please don’t hesitate to contact us with concerns. We have different options for different situations and are available to help. Visit our Financial Services Page to learn more.
What are Singing River Health System’s provider-based or hospital-based outpatient locations?
What should I ask my insurance carrier?
Making informed healthcare decisions is important. You may want to ask your insurance company the following:
- Does my benefit plan cover facility charges in a hospital-based outpatient clinic?
- How much of the charges are covered by my plan?
- Will the charges be applied to my deductible or subject to coinsurance?
Should I expect a change in my billing?
Yes. As of 9/18/23, your statements will reflect Singing River Gulfport as the billing entity.