billing - clinic

Effective January 2017

Provider Based Billing

The Memorial Hospital is a leader in providing information to our patients and consumers. We realize that it is important for you to make informed decisions regarding your healthcare and we are committed to providing tools necessary to help you understand your physician and hospital charges. The following information is being provided to you in an effort to help you understand provider-based billing.

Certain Memorial Hospital service locations qualify as "provider-based" in accordance with criteria established by the Center for Medicare and Medicaid Services (CMS). Clinics that are within a 35 miles radius of the Memorial Hospital (the "Hospital") are eligible to be provider-based if such clinics are operated, monitored and supervised as a hospital outpatient department, and integrate their services such that clinic patients have full access to the services offered by the hospital. Our provider-based clinics in the Memorial Hospital region are sufficiently integrated with The Memorial Hospital at Craig so as to be considered hospital outpatient departments. These provider-based facilities are therefore permitted to generate separate hospital charges, called "facility charges," to help cover expenses incurred by the Hospital in operating such facilities. Expenses incurred by the Hospital include but are not limited to the salaries of non-physician support staff, equipment and supplies, expenses associated with the operation/maintenance of the building(s), and the costs of maintaining a fully-integrated medical record that allows the Memorial Hospital providers to see a complete history of all inpatient and outpatient services provided to you throughout the Memorial Hospital at Craig system.

Based on these circumstances, when you receive care at one of the provider-based facilities listed below, you will receive two (2) charges: (1) a professional charge for the services provided to you by the physician or mid-level provider who rendered your care, and (2) a facility charge for the expenses incurred by the Hospital in operating the facility. These charges are equal to the amount that would have been billed as a single charge prior to the conversion to a provider-based clinic.

Many insurance carriers apply the facility charge toward the patient's hospital deductible. This may result in higher out of pocket expenses for patients depending on their individual coverage and benefits.

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TMH Provider-Based Clinics

The following Memorial Hospital clinics are provider-based, and a patient or their family member can expect to see a professional bill and an outpatient hospital bill for services received at these locations:

The Memorial Hospital Medical Clinic

785 Russell Street

Craig, CO 81625

  • Family Practice
  • Convenient Care/Walk-In Clinic
  • Pediatrics
  • General Surgery
  • Cardiology
  • Internal Medicine
  • Orthopaedics
  • Podiatry

Frequently Asked Questions

Frequently Asked Questions:

What is a provider based physician practice? A physician practice (Memorial Hospital Medical Clinic) that the Hospital (The Memorial Hospital at Craig) operates, maintains and supports as an outpatient department of the Hospital.

What are administrative and facility costs? They are costs incurred by the Hospital in operating the practice, (i.e. overhead costs such as electricity, phones, heating, cooling, etc., equipment/supplies, and compensation for non- professional staff. These costs are necessary in order for the Memorial Hospital Medical Clinic to see and treat its patients.

Why are you charging me twice for the same day? This clinic is a provider-based practice and based on Medicare guidelines, there is split billing for the professional fee and the facility fee. The Hospital incurs significant cost in operating and maintaining the clinic, and the facility charge helps to cover that cost. The professional fee is for the physician or ancillary provider service. These charges are equal to the amount that would have been billed as a single charge prior to the conversion to a provider-based clinic.

I did not go to the hospital; I went to see my doctor... The Memorial Hospital Medical clinic location where you were treated is an outpatient department of The Memorial Hospital at Craig. The Hospital is responsible for the cost to operate and maintain the clinic; therefore, based on Medicare regulations, it is an extension of the Hospital.

If my insurance company is not paying for the charges, why should I? We are required to bill you for balances not paid by your insurance company. Your claims were processed based on your benefits for outpatient hospital services and you are responsible for any balance not paid.

What if I don't have Medicare? Many private insurers recognize and value the integrated care provided to their insured members in provider-based facilities. Such insurers generally follow Medicare's guidelines in processing provider-based claims. However, claims will be billed depending on the requirements of your insurance policy.

Does this mean patients will pay more for services? Depending on their particular insurance coverage, it is possible patients may pay more for certain outpatient services and procedures at our provider-based/hospital outpatient locations than at one of our other sites. We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses they may incur.

Where can patients call with their questions or concerns? Patients may contact:

Neita Drake 970-826-8008

What can patients do if they are having difficulty paying for healthcare services? The Memorial Hospital offers various payment options. For further details please contact the Financial Counselor at the number listed above.