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    Medicare coverage can be a confusing and complicated subject to the very people it covers. Our billing staff is always here to help. But we have learned that one of the most helpful tools in understanding your coverage is the Medicare website. The Medicare website offers a wealth of up-to-date information depending on your situation and location. It's often the place we go to get information for you.

    What is a Rural Health Clinic and what are the benefits?

    A Rural Health Clinic (RHC) is a clinic certified to receive special Medicare and Medicaid reimbursement. The purpose of the RHC program is improving access to primary care in under-served rural areas. RHCs are required to use a team approach of physicians and midlevel practitioners such as nurse practitioners and physician assistants to provide services. The clinic must be staffed at least 50% of the time with a midlevel practitioner. RHCs are required to provide out-patient primary care services and basic laboratory services.

    RHCs receive special Medicare and Medicaid reimbursement. Medicare visits are reimbursed based on allowable costs and Medicaid visits are reimbursed under the cost-based method or an alternative Prospective Payment System (PPS). Ordinarily, this will result in an increase in reimbursement. RHCs may see improved patient flow through the utilization of NPs and PAs as well as more efficient clinic operations.

    What is Provider-Based Billing (PBB)?

    PBB refers to the billing process for services rendered in a hospital department or location. This process takes place when the hospital owns space and employs physicians and other support personnel who are involved in patient care.

    This benefits patients as all departments of the hospital are subject to rigorous quality standards and are monitored by The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 17,000 healthcare organizations and programs in the United States.

    The 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 and scheduling appointments and tests will be handled as they always have been in the past. However, there is a change in how Portage Health 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 may receive a bill from Portage Health Hospital as well as a separate bill from Portage Health Medical Group for the professional services provided by their physician. In addition, physicians who interpret the results of diagnostic tests may send you a bill from Superior View Radiology.

    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?

    Medicare patients without supplemental insurance may have to pay a small amount. Medicare patients with supplemental insurance should check with the insurance provider prior to care to see if the service will be covered. Patients with other health insurance should check with their insurance provider and ask whether it covers facility charges or Provider-Based Billing. Depending on specific insurance benefits, additional out-of-pocket expenses may be incurred by Provider-Based Billing.  

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  • Factsheets for patients with Medicare & Medicare Coverage

    To assist patients and providers, the Centers for Medicare & Medicaid Services (CMS) has posted additional resources that can help address questions related to coverage, network providers, premium payment, copayments, cost sharing and other issues.

    Below are links to a number of CMS factsheets available to assist consumers and providers with plan specific information. 

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