Provider-Based Billing

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To our Medicare patients:

Medicare patients receiving care at Logan Health’s ‘provider-based’ locations may result in facility charge, as well as a practitioner charge for different components of outpatient services and/or procedures. ‘Provider-based’ or ‘hospital-based’ is a designation status established by Medicare and Medicaid that refers to the billing process for services rendered in a hospital outpatient location. The provider-based designation applies to patients seen at provider-based locations only.

What is a 'provider-based' clinic?

‘Provider-based or ‘hospital-based outpatient’ 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.

How will my bills be affected by 'provider-based' billing?

Under Provider Based status, Medicare requires this clinic to bill in two parts. With each visit to the clinic, Medicare will receive two (2) separate charges: one from the clinic for the health care provider (health care provider fee) and one from Logan Health Medical Center for all other costs associated with operating the clinic (the facility fee). Once Medicare has processed their portion of the charges, your co-payment balance will be submitted to your secondary insurance carrier. If there is a balance for the co-payment after the secondary insurance carrier processes the claim, or if you do not have secondary insurance, you will receive a bill for the remaining balance.

Why does Logan Health do 'provider-based' billing?

Because Logan Health employs many physicians, following the same type of billing process for outpatient care rendered at our hospitals ensures more appropriate payment for services provided by hospital staff and physicians and distinguishes facilities that function as departments of hospitals from those which are freestanding.

This is the national model of practice for large health care networks where the hospital owns space and employs support staff who assist with patient care. It has been adopted by many medical centers locally and nationally. This benefits patients as all departments of the hospital are subject to the higher quality hospital facility standards.

Will patients page more for 'provider-based' services?

Depending on your specific insurance coverage, it is possible that some benefits will differ for these services and procedures. Some patients may have to pay a higher cost because a portion of the billed service is being charged as a hospital charge. The increase in cost is a result of the health plan’s coinsurance and deductible, so not an increase in actual fees. People with a supplement plan are not likely to see much change.

Does this affect patient co-pays or deductibles?

Your out-of-pocket expenses will be based on the services that you actually receive and are also subject to final determination by the Medicare program.

Who should patients contact if I have more questions?

For assistance with your payment or questions regarding your account, please contact our Patient Accounting Department at (406) 751-6445. You can also visit our office at 1203 US Hwy. 2, Gateway Community Center- Entrance B in Kalispell.

Office Hours: 7:30 a.m. – 5:30 p.m. Monday through Friday.

Should you wish to meet with a billing service representative personally, please call to make an appointment, and be sure to bring your bills with you.