Hospital-Based Billing

Like many medical centers and community hospitals across the nation, Skagit Regional Health operates several of its physician clinics as hospital-based outpatient clinics. For your convenience, the answers to frequently asked questions about hospital-based billing are found below.

If you would like to receive information about price comparisons between our hospital-based and freestanding clinics, call 360-814-7575.

Hospital-Based Billing Frequently Asked Questions (FAQ)

What does “hospital-based” outpatient mean?
The Centers for Medicare and Medicaid Services (CMS) have designated several Skagit Regional Health clinics as “hospital-based” outpatient departments of Skagit Valley Hospital or Cascade Valley Hospital.

“Hospital-based” refers to the billing process for services rendered in a hospital outpatient clinic or location. This is the national model of practice for integrated health care systems like Skagit Regional Health, where the hospital (Skagit Valley Hospital or Cascade Valley Hospital) owns space and employs support personnel who utilize hospital department resources involved in patient care in outpatient clinics.

How does “hospital-based” outpatient billing affect patients?
Patients with certain insurance plans who receive outpatient services (i.e. office visits, procedures, treatments, etc.) at one of the hospital-based outpatient clinics will see two charges for their visit. One charge represents the charge for using hospital department resources and the other represents the professional or physician fee for outpatient services or procedures.

Patients are advised to review their insurance benefits to identify any out-of-pocket expenses they may incur.

Please note: some plans apply a hospital surgery deductible and/or copay to hospital based clinic surgical procedures.

What are the benefits of being cared for at a “hospital-based” outpatient clinic?
Medicare acknowledges the value of providing care in an integrated, collaborative environment. Hospital-based outpatient clinics are held to nationally recognized service and patient care standards, leading to high quality care for patients. Financial assistance is available to those who qualify.

Does this mean I will pay more for services?
Medicaid patients will not see any increase in out-of-pocket expenses.

Patients with some insurance plans will be charged a facility fee that would not be owed if the facility were not hospital-based, depending on individual plan benefits. Patients may have to pay more for certain outpatient services and procedures at a hospital-based outpatient location than they would at one of the free-standing clinic locations.

Is my insurance plan affected by hospital-based billing?

Here is the list of insurance plans affected by hospital-based billing:

Medicaid
Medicaid Managed Care (Apple Health)
Medicare (traditional)
Medicare Advantage Plans
Tricare
Indian Health

What if the Medicare patient has secondary or supplemental insurance coverage? Coinsurance and deductibles may be covered by a secondary or supplemental insurance policy. The patient should check with his/her benefits or insurance company for detailed answers related to his/her secondary or supplemental insurance. For instance, he/she may ask whether the insurance covers facility charges or hospital-based billing. If it does, patients should ask what percentage of the charge is covered and verify what their hospital outpatient insurance benefits are, as they typically are applied toward a deductible, coinsurance, and/or copays depending on the individual’s benefit plan.