Provider-based billing and the information on this page pertains to Medicare patients only.
Thank you for being a valued patient at one of Mercyhealth’s provider-based locations. Wisconsin clinic locations now function as part of Mercyhealth Hospital and Trauma Center–Janesville as a hospital outpatient facility. See list of clinic locations below.
What is provider-based billing (PBB)?
PBB refers to the billing process for services rendered in a hospital outpatient clinic or department. This is the national model of practice for integrated delivery systems where the hospital owns space, and employees support personnel involved in patient care.
This benefits patients as all departments of the hospital 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. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
Will there be a change in how patients receive care?
No. Patients will continue to receive excellent quality care with their physician. Scheduling appointments and tests will be handled as they always have been. However, there is a change in how Mercyhealth will bill your insurance carrier for these services.
How does this affect the billing process?
Because care is provided in a department of the hospital, patients will see two charges on their Mercyhealth combined statement. One charge will be for the professional services provided by your physician. This is also called the professional fee. One charge will be for the facility charge. Previously, all services were provided by the physician’s office and charges were grouped together for your clinic visit.
Medicare beneficiaries are responsible for the co-insurance amount on the services you receive. These amounts are determined by Medicare and are based on the services performed.
Will Medicare patients have to pay more for services?
Some Medicare patients may be covered by their supplemental insurance and will not have to pay more out-of-pocket. Depending on their particular insurance coverage, it is possible benefits may differ for certain outpatient services and procedures at a provider-based, hospital outpatient location. We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses they may incur based on the location of the services provided.
Where can patients call for more information?
You can call Mercyhealth Customer Service at (608) 741-7630 or (866) 269-7115, Monday-Friday, 8 am-4:30 pm.
To contact Mercyhealth Hospital–Rockton Avenue, please call (815) 971-5000.