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Hospital-Based Billing Questions and Answers

Northern Regional Hospital (Northern) has converted many of its physician clinics to hospital-based outpatient clinics. If you are covered by Medicaid, Medicare or a Medicare Advantage plan, have a managed care insurance plan, or do not have insurance, your out-of- pocket costs for seeing a physician and receiving services in a hospital-based outpatient clinic may be more, compared to the out-of-pocket cost for the same services in a private physician office.

Below are Frequently Asked Questions (FAQs) related to this change.

Q: What does “Hospital-based Outpatient” mean?
A: Hospital-based outpatient clinics are considered part of the hospital; “private” physician offices are not (generally, these are smaller physician offices out in the community). Clinics located miles away from the main hospital campus may still be considered part of the hospital. Hospital-based outpatient clinics are subject to stricter government rules, making them more complex and more costly to operate. When you see a physician or receive services in a hospital-
based outpatient clinic, you are being treated within the hospital rather than the physician’s office.
Q: How will this change affect patients?
A: According to Medicare billing rules, when you see a physician in a private office setting, all services and expenses are bundled in a single charge. When you see a physician in a hospital- based outpatient clinic, physician
and hospital charges are billed separately. Providing services in a hospital-based outpatient clinic costs more and depending on your insurance plan, may result in greater out-of-pocket expenses for you.
Q: What should I ask my insurance carrier?
A: Making informed healthcare purchasing decisions is important. Ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient clinic and how much of the charge is covered or will be applied to your deductible.
Q: How does this affect a Northern Medical Group patient who has Medicare or NC Medicaid?
A: In a hospital-based outpatient clinic some patients will receive two (2) separate bills for services provided in the clinic - one from the doctor and one from the hospital. Patients with Medicare, Medicaid and some commercial payers, will be required to pay two copayments for the clinic visit - one copayment for the physician visit and one copayment for the hospital visit. Medicare patients will be required to pay a co-pay for professional services and co-insurance and/or deductible amounts for hospital services.
Q: What are the hospital-based locations under Northern Regional Hospital?
A: The following are the hospital-based locations under Northern Regional Hospital:
Northern Family Medicine
Northern Gastroenterology
Northern General Surgery
Northern Medical Group, Medical Specialists
Northern Obstetrics & Genecology
Northern Orthopaedics
Northern Pain Management
Northern Pediatrics
Northern Primary Care
Northern Urology
Other locations will be included as Northern Regional Hospital continues to expand services to meet patient needs.
Q: Where can a patient call with financial questions or concerns?
A: Northern Medical Group, has staff available through our Central Billing Office (CBO) to assist with questions. If you have questions, please contact the CBO at one of the numbers below. We will be glad to answer any questions you may have.
For billing questions call:
Family Medicine       336-719-7187
Gastroenterology               336-719-7186
General Surgery   336-719-7186
Medical Specialists  336-719-7186
Obstetrics & Genecology              336-719-7186
Orthopaedics                                     336-719-7186
Pain Management                           336-719-7186
Pediatrics                                            336-719-7186
Primary Care 336-719-7186
Urology 336-719-7186