- Why are Coordinated Health outpatient clinics billing as provider-based?
- What does provider-based billing mean?
- How will a patient be billed for services and where will the bills come from?
- What do facility fees cover?
- How is the amount of a facility fee determined?
- What does Coordinated Health do to educate patients about facility fees?
Why are Coordinated Health outpatient clinics billing as provider-based?
Coordinated Health’s outpatient locations achieved provider-based status in 2011, after passing a rigorous inspection by the Joint Commission and Department of Health, which determined we met the standards required by hospitals for quality of care and patient safety.
Obtaining provider-based status in the outpatient facilities of our hospital network requires that we comply with the same set of standards and regulations to deliver patient care as our two hospitals are required to follow.
What does provider-based billing mean?
Provider-based billing refers to the process used by Coordinated Health and other providers to bill services that are rendered in a hospital outpatient clinic or location.
How will a patient be billed for services and where will the bills come from?
For services rendered in a provider-based facility (a hospital or outpatient clinic), the charge for the patient’s visit is separated into two different bills. One bill is specifically for the services of the provider or physician. The second bill is for the services the provider-based facility provides.
All Coordinated Health’s outpatient clinics achieved their provider-based status under our Allentown Hospital license. The official name of our Allentown Hospital is Coordinated Health Hospital of Allentown (or CHHA). For our outpatient, provider-based facilities, the facility fee is billed from CHHA since those facilities are considered outpatient departments of the Allentown Hospital.
The bill a patient receives from one of our providers is from the Coordinated Health Systems Professional Practice (or CHSPC). The CHSPC is the company that employs all of our providers so this is the company that bills for provider services.
Since our Bethlehem Hospital has a separate license from the Allentown Hospital, it has its own official name – Coordinated Health Orthopedic Hospital (or CHOH). Patients receiving services from the Bethlehem Hospital receive bills from CHOH. The Bethlehem Hospital does not have any outpatient facilities under its license.
What do facility fees cover?
The Department of Health and Joint Commission regulations that govern the policies and procedures for provider-based hospitals and outpatient facilities ensure the same standard of care is met, regardless of which location provides services. Meeting and maintaining these regulations come at a higher cost, which is supported by facility fees. The facility fees, billed by provider-based organizations, support all the components of service needed to deliver patient care that don’t include the physician, such as medical assistants, clerical staff, scheduling staff, and more.
Facility fees also support the cost of compliance with government-mandated health care reform. This compliance comes at a cost. Health care spending has risen $800 billion since the RAND report, released in 2005, recommended the implementation of Electronic Health Records (EHRs). These EHRs are one example of what is now being mandated by the federal government.
How is the amount of a facility fee determined?
The amount is dependent on the level of care a patient receives, as delivered by their physician or professional. Providers cannot predetermine what level of care each patient needs. The level is based on clinical procedure coding guidelines from the American Medical Association and can only be determined after the patient has been receiving care.
In some cases, it’s possible that patients receiving care at a Coordinated Health provider-based location, or any other provider-based facility, may pay more for some outpatient services and procedures. It is beneficial for patients to review their insurance benefits for their specific coverage since their policy determines what will be paid and what their out-of-pocket expenses may be.
What does Coordinated Health do to educate patients about facility fees?
While healthcare can be a complex and confusing system, we embrace transparency. We educate Coordinated Health patients on facility fees via our:
- Solution Center (24/7 live support)
- All outpatient facilities
Facility fees for provided services are also available to Coordinated Health patients upon request.