Thank you for choosing Presbyterian Hospital as your healthcare provider. You are visiting a physician practice which functions as a department of the hospital to assist our ability to provide you with a remarkable patient experience. We are committed to providing you with the highest level of care, and our strong connection to Presbyterian Hospital allows you care to be more seamless and comprehensive.
As a Medicare patient, this means Medicare will receive two bills from this practice. One is the physician fee, the other is the facility fee. You will receive two Medicare Summary Notices, we understand that this may seem complicated and apologize in advance for any confusion this may cause.
What does "Provider Based" designation mean?
This is a Medicare status for hospitals and clinics that comply with specific Medicare regulations. Medicare has determined that Presbyterian Hospital has met these regulations and has now been designated as such. This status requires that Presbyterian Hospital bill Medicare in two parts.
How does "Provider Based" affect my billing?
When seeing a Presbyterian Hospital healthcare provider for any type of outpatient services, you will see a change in the way you are billed. Under "Provider Based" status, Medicare requires Presbyterian Hospital to bill all healthcare provider services in two parts. When your medical services are completed, Presbyterian Hospital will submit two claims to Medicare:
Facility fee - Part A
Healthcare provider fee - Part B
You will receive two Medicare Summary Notices (MSNs) from Medicare. Once Medicare has processed their portion of the charges, the balance will be submitted to a secondary payer. If there is a balance after the secondary insurance processes the claim, or if you do not have secondary insurance, you will receive a bill for the remaining balance.
Estimate of your financial responsibility
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.
Estimate of coinsurance amounts:
Part A Part B
Office Visit $10 to $26 $2 to $37
Radiology $8 to $16 $2 to $4
Bone Density $14 to $29 $2 to $4
Pulmonary Test $8 to $43 $2 to $6
Certain tests and procedures have higher coinsurance amounts due to their complexity.
Why does the Medicare Secondary Payer (MSP) questionnaire need to be completed?
As a participating Medicare provider, Presbyterian Hospital is required to screen Medicare patients according to the Medicare Secondary Payer (MSP) rules. At each visit, business services representatives will ask you the MSP questions. These questions will help to confirm if Medicare or another payer should process the claim as primary.
