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Provider-based billing

Notice: Effective January 1st, 2020, services rendered at any of the below listed locations will no longer bill under Provider-Based Billing (PBB).

Provider-based billing Q&A

What does "provider-based billing" mean?

Provider-based billing refers to the billing process for services rendered in a hospital department or location. This process takes place when the hospital owns or leases space and employs physicians and other support personnel who are involved in patient care. Medicare and Medicaid have designated specific rules and requirements for provider-based billing which we follow.

What clinics are operating under the provider-based billing structure?

Mary Rutan Hospital Urology
2160 Ewing Crawfis Circle
Bellefontaine, OH 43311 

Mary Rutan Hospital General Surgery
2160 Ewing Crawfis Circle
Bellefontaine, OH 43311

Mary Rutan Hospital Ear, Nose & Throat
921 E. Sandusky Ave.
Bellefontaine, OH 43311

Mary Rutan Hospital Jackson Center Family Practice
805 E. Pike St.
Jackson Center, OH 45334 

Mary Rutan Hospital Pediatrics
118 Dowell Ave.
Bellefontaine, OH 43311

Mary Rutan Hospital Orthopedics & Sports Medicine
2221 Timber Trail
Bellefontaine, OH 43311

Mary Rutan Hospital OBGYN
1125 Rush Ave.
Bellefontaine, OH 43311

Mary Rutan Hospital Internal Medicine
2231 Timber Trail
Bellefontaine, OH 43311

Mary Rutan Hospital Behavioral Health

2231 Timber Trail
Bellefontaine, OH 43311

118 Dowell Ave.
Bellefontaine, OH 43311

Mary Rutan Hospital Urbana Clinic
1880 East US Hwy 36
Urbana, OH 43078 

Mary Rutan Hospital Neurology
2160 Ewing Crawfis Circle
Bellefontaine, OH 43311

Will there be a difference in how I receive care?

Each of the above mentioned locations function as an outpatient department of Mary Rutan Hospital. Medicare and Medicaid patients will continue to receive quality care with their provider and scheduling appointments and tests will be handled as they always have been but there has been a change in how Mary Rutan Hospital and the above listed providers process billing (see billing process information below).

How is the registration process different?

Medicare and Medicaid patients will complete the necessary documents during the normal registration process. This process will include the completion of a General Consent form. For Medicare patients, a Medicare Secondary Payer Questionnaire form will be completed and you will also receive an estimate of the out-of-pocket expenses for that specific visit. Please note, these requirements DO NOT affect individuals with Medicare Advantage Plans.

How does this affect the billing process?

Because care is provided in a location that is considered a department of the hospital, there is a difference in how the Medicare patient is billed. If you are a Medicare patient and do not have Medicare Advantage, your bill will be separated and you will receive a bill from Mary Rutan Hospital for the professional services rendered by your provider and a separate bill for all other charges related to your visit. Although this will not have much effect on the total combined charge for services, Medicare beneficiaries are responsible for the co-insurance amount on each bill. These co-insurance amounts are determined by Medicare and are based on the services performed. Some Medicare patients will be covered by their supplemental insurance and will not have to pay more out-of-pocket costs but Medicare patients without supplemental insurance will have to pay additional out-of-pocket costs related to the provider-based billing structure. Please note, these billing changes DO NOT affect individuals with Medicare Advantage Plans.

Why has the name of my provider's practice changed?

Although Mary Rutan Hospital has managed the above physician clinics for years, Medicare and Medicaid require, through the provider-based billing structure, that it is clear to the public that these clinics are a part of Mary Rutan Hospital. The naming format is one of many requirements of the provider-based billing structure.

Why did these changes take place?

Medicare and Medicaid have distinct payment programs for provider-based billing. With the implementation of provider-based billing for our physician clinics, Mary Rutan Hospital is required to follow the above described billing structure.

Where can patients find more information?

Mary Rutan Hospital Billing Office, 937.599.1405 8 a.m. to 4 p.m.

What can patients do if they are having difficulty paying for healthcare services?

Mary Rutan Hospital offers discounting and charity policies to help qualified patients. Further details are available by calling Mary Rutan Hospital Billing office at 937.599.1405 8 a.m. to 4 p.m.