Some Emory Healthcare locations are hospital outpatient departments, which means that one of Emory Healthcare’s hospitals is operating the clinic. In some cases, this change may affect how you are billed. You can determine if a location you visit is a hospital outpatient department by checking the information in its description in our location finder. To help you understand your bill, here are some common questions many patients ask.
Hospital outpatient departments are required to comply with Medicare requirements including billing procedures, sometimes referred to as “provider-based billing.” Under the provider-based billing rules, the hospital is required to bill separate charges (a facility fee and professional fee) for the hospital and medical professional providing your care. The facility fee represents the charge associated with hospital items and services including space, staff, supplies, and equipment. The professional fee represents the costs of services rendered by a physician, nurse practitioner, physician assistant, or other similar advanced practice provider.
The provider-based billing rules apply to most governmental payors, which include Medicare, Medicare Advantage, Medicaid, Managed Medicaid, Tricare, and VA insurance. Patients with these plans will be responsible for the coinsurance and deductible amounts related to each of these fees. Accordingly, Emory Healthcare’s patients covered by governmental payors may see a slight increase in their co-insurance and deductible for hospital outpatient services.