On June 3, 2024, OrthoNebraska added two new provider-based billing therapy locations to expand access to high-quality services with the addition of new providers and locations.
On July 1, 2024, OrthoNebraska transitioned the Elkhorn therapy location from clinic billing to hospital provider-based billing.
Below are some answers to frequently asked questions about provider-based billing.
What is provider-based billing?
Provider-based billing is a Medicare classification for a type of billing for services provided in a clinic or department that is considered part of the hospital, even if the service is provided at a location not attached to the hospital. These locations are also often referred to as hospital-based billing.
Why provider-based billing?
Patients will benefit from the quality of care provided due to stringent quality standards and monitoring by The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 21,000 healthcare organizations and programs in the United States.
Provider-based billing has become a common model of practice for health systems locally and around the US. This change will ultimately ensure that OrthoNebraska continues to provide safe and high-quality patient care.
How does provider-based billing impact me?
Patients may incur additional out-of-pocket costs depending upon their specific outpatient hospital benefits with their health insurance carrier. If you are unsure about what your outpatient hospital benefits are, please contact your health insurance carrier.
What questions should I ask my insurance carrier?
If you are concerned about how these changes may impact your out-of-pocket costs, you may ask:
- Does my benefit plan cover facility charges in a hospital-based outpatient clinic?
- How much of the charges are covered by my plan? If your plan asks, some common codes are 97110, 97140, 97165, 97010, and 97161.
- Will the charges be applied to my deductible or subject to coinsurance?
Who should I contact if I have questions about my bill or provider-based billing?
To get an estimate, patients can visit the OrthoNebraska website or call Patient Financial Counselors at (402) 609-2423.
For other billing questions or questions about provider-based billing, call Patient Financial Services at (402) 609-2400 or submit a question via our website.
