Your Guide to Provider-Based Billing

Many Henry Ford Health System outpatient facilities, sometimes called medical centers or health centers, are designated by Medicare as provider-based facilities. For care and services provided at these facilities, you may receive two bills — one for the facility or hospital fee and one for the health care professional fee. This webpage explains how you are billed for services so that you will know what to expect and can plan for out-of-pocket costs.

What does it mean to be a “provider-based facility”?

As a provider-based facility, our outpatient facilities are treated as part of a Henry Ford Health System hospital. Services at such facilities impact the way Medicare calculates your bills and out-of-pocket cost. You may have different out-of-pocket costs if you do not have supplemental insurance (e.g. Medigap and/or secondary insurance).

Why provider-based billing?

The provider-based facility model is common across the country for integrated health systems that offer services to their community in many locations. Patients benefit because clinical integration enhances coordinated care, which permits your doctor and hospital to work together to provide you with the best possible care and services.

How will I be billed for services?

The Centers for Medicare and Medicaid Services require provider-based facilities to send separate bills for the hospital and medical professional providing the care.

So, the charge for certain services will be divided into two parts:

  • Professional Fee: covers the professional services of the physician and/or advanced practice provider (e.g. nurse practitioner and physician assistant)
  • Facility or Hospital Fee: covers all other services
    • Examples include nursing and support staff, building, equipment & technology (e.g. imaging machines), supplies, pharmaceuticals and other overhead

Can I get an estimate for my out-of-pocket costs?

Yes, Henry Ford Health System’s goal is to be up front with you regarding your out-of-pocket costs.

We can offer you with an out-of-pocket estimate regarding your specific bill.

We also provide typical coinsurance amounts for commonly performed procedures in our provider-based facilities. If you have supplemental insurance, your coinsurance costs are usually paid by that insurance.

Who do I contact for questions about my bill?

If you have questions about your bill or concerns about a current balance, please contact our Customer Service Department at (800) 999–5829.

 

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