Provider-Based Billing
Some Tidelands Health outpatient locations operate as hospital departments and are subject to provider-based billing. Please refer to these frequently asked questions for more information.
What is provider-based billing?
Provider-based billing is a type of billing for services provided in a clinic or department considered part of a hospital. The “provider-based” designation status was established by Medicare and Medicaid. Facilities located several miles away from the main hospital campus may be considered part of the hospital. When you see your regular care provider in an outpatient setting that is provider-based, your visit is billed under the hospital.
What Tidelands Health facilities are billed as provider-based billing?
The following locations are departments of Tidelands Georgetown Memorial Hospital or Tidelands Waccamaw Community Hospital and are subject to provider-based billing:
- Tidelands Health Center for Pediatric Development
- Tidelands Health Endoscopy Center at Waccamaw Medical Park West
- Tidelands Health Imaging at Murrells Inlet
- Tidelands Health Imaging at Waccamaw Medical Park West
- Tidelands Health Neurological Rehabilitation Center
- Tidelands Health Oncology at Georgetown
- Tidelands Health Oncology at Murrells Inlet
- Tidelands Health Oncology at Myrtle Beach
- Tidelands Health Pain Management Services at Georgetown
- Tidelands Health Pain Management Services at Murrells Inlet
- Tidelands Health Rehabilitation Services at Andrews
- Tidelands Health Rehabilitation Services at Carolina Forest
- Tidelands Health Rehabilitation Services at Conway
- Tidelands Health Rehabilitation Services at Georgetown
- Tidelands Health Rehabilitation Services at Murrells Inlet
- Tidelands Health Rehabilitation Services at Myrtle Beach
- Tidelands Health Rehabilitation Services at North Myrtle Beach
- Tidelands Health Rehabilitation Services at Pawleys Island
- Tidelands Health Women’s Imaging
- Tidelands Health Wound Care and Infusion Center at Georgetown
- Tidelands Health Wound Care and Infusion Center at Murrells Inlet
How is my bill affected by provider-based billing?
Some patients who are treated in a location subject to provider-based billing may receive two separate bills. One bill is for professional services delivered by physicians and other care professionals. The second bill is for facility costs associated with the visit. Some patients may receive two Medicare Summary Notices or insurance explanation of benefits.
The requirement to list professional services and facility charges separately is unique to the Centers for Medicare and Medicaid Services. Only patients with Medicare, Medicaid, Medicare Advantage or Medicaid HMO plans are billed with the professional service and facility charges listed separately. Other insurance plans and networks do not require charges be shown and billed separately.
Do I have to pay more under provider-based billing?
Depending on specific insurance coverage, some patients may pay a higher cost because a portion of the billed service is being charged as a hospital charge and is subject to an annual deductible and co-pay. The increase in cost is a result of the health plan’s co-insurance and deductible and is not an increase in actual fees. Patients who are covered by supplemental or secondary insurance may not have any additional out-of-pocket expenses for care. Check with your insurance provider about your specific coverage.
Why does Tidelands Health use provider-based billing for some locations?
This is a national model of practice for large health care networks in which a hospital owns space and employs support staff who assist with patient care. The model has been adopted by many medical centers locally and nationally. All hospital departments are subject to strict quality standards and are monitored by The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States. Medicare and Medicaid have distinct payment programs for provider-based billing and require that hospitals make it clear to the public which departments are part of the hospital.
Will my appointment be different in a location that is provider-based?
There is no difference in clinical care at locations with provider-based billing. At every visit, however, Medicare patients are asked to complete a Medicare questionnaire containing 10 to 15 questions. This is a government requirement.
Who can I call for more information?
It’s important that you make informed health care purchasing decisions. We encourage you to contact your insurance provider with specific questions about your coverage. You may want to ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient department and how much of the charge is covered or will be applied to your deductible or subject to insurance. You may also contact our oncology financial navigators at 843-652-8071 or 843-652-8419 for assistance.
What if I can’t afford my bill?
Tidelands Health offers financial assistance to qualifying patients. Please talk with an oncology financial navigator or contact Patient Financial Services at 843-520-8883 for information and assistance.
