Provider-Based Outpatient Clinics
Prairie Ridge Health Clinic – Columbus is considered a Provider-Based or hospital outpatient department/clinic, which is a Medicare billing designation. If you are covered by Medicare Part B insurance, your out-of-pocket costs for seeing a physician and receiving services in our Columbus Clinic location may be more, compared to the out-of-pocket cost for the same services at Prairie Ridge Health Clinic – Beaver Dam or Marshall (non-provider based clinic). According to Medicare billing rules, when you see a physician in a non-provider-based office setting, all services and expenses are bundled into a single charge. When you see a physician in a provider-based clinic, the physician (professional charge) and facility (hospital charge) are billed separately.
Laboratory and Radiology services are provided by Prairie Ridge Health, Inc. (PRH) are billed by the hospital regardless of the type of insurance.
Below are frequently asked questions (FAQs) related to Provider-based outpatient clinics:
What is different about a provider-based outpatient clinic?
What is different about a provider-based outpatient clinic?
According to Medicare billing rules, when you see a physician in a private office setting, all services and expenses are bundled in a single charge. When you see a physician designated in a provider-based outpatient clinic, physician and facility charges are billed separately. For example, physician services are processed under the physician benefits and charges for hospital services are processed under the hospital benefits of the benefit plan. When your insurance company processes your claims for payment, you may be subject to patient out-of-pocket responsibilities in the form of co-payments, deductibles and/or coinsurance.
Does this apply to patients with Commercial or Medicaid plans?
Does this apply to patients with Commercial or Medicaid plans?
No. Effective May 7, 2024, this billing designation only applies to our Medicare patients and certain Medicare Advantage plans we are under contractual agreements with.
What if a Medicare patient has secondary insurance coverage?
What if a Medicare patient has secondary insurance coverage?
Co-insurance, co-payments and deductibles may be covered by a secondary insurance. Check your benefits with your insurance company for details.
