About Hospital Outpatient
Departments
Some Emory Healthcare locations are hospital outpatient departments, which means that one of Emory Healthcare’s hospitals is operating the clinic. In some cases, this change may affect how you are billed. You can determine if a location you visit is a hospital outpatient department by checking the information in its description in our location finder. To help you understand your bill, here are some common questions many patients ask.
Hospital outpatient departments are required to comply with Medicare requirements including billing procedures, sometimes referred to as “provider-based billing.” Under the provider-based billing rules, the hospital is required to bill separate charges (a facility fee and professional fee) for the hospital and medical professional providing your care. The facility fee represents the charge associated with hospital items and services including space, staff, supplies and equipment. The professional fee represents the costs of services rendered by a physician, nurse practitioner, physician assistant or other similar advanced practice provider.
The provider-based billing rules apply to most governmental payors, which includes Medicare, Medicare Advantage, Medicaid, Managed Medicaid, Tricare and VA insurance. Patients with these plans will be responsible for the coinsurance and deductibles amounts related to each of these fees. Accordingly, Emory Healthcare’s patients covered by governmental payors may see a slight increase in their co-insurance and deductible for hospital outpatient services.
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The hospital outpatient department facility fee represents the use of hospital items and services including the space, equipment, supplies and staff (nurses, medical assistants, etc.) that are needed to run the clinic.
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The professional fee represents charges for the services personally provided by your physician, nurse practitioner or physician assistant (or other advanced practice provider).
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Your appointment location will not change. Your scheduled provider will not change.
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Government and private insurance plans may be impacted by this change. For government insurance plans, the exact amount of the coinsurance and deductible for each visit will depend on the services provided and the specific plan. If you have secondary insurance or managed care, it may cover the coinsurance and deductible fee.
- For private insurance plans, some patients may see a facility fee added to their insurance plan’s deductible and/or co-insurance payment. Deductibles and/or co-insurance are the amount you pay before your insurance plan pays the hospital and other Emory Healthcare providers for a procedure. Each private insurance plan is different and patients should review their specific plan to determine coverage. Patients covered by most private insurance plans will continue to be billed as a physician clinic/office.
- For patients with Medicare, Medicare Advantage, Medicaid, Managed Medicaid, Tricare, and VA insurance, the exact amount of the coinsurance and deductible for each visit will depend on the services provided. If you have secondary insurance or managed care, it may cover the coinsurance and/or deductible amounts.
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No, currently telemedicine appointments provided in a hospital outpatient department do not include facility fees for most payors. Sometimes, a telemedicine visit is an option for your care. Based on your health care needs and insurance coverage, your care team will decide if telemedicine visits is an option for you.
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Contact our billing department at 404-778-7318.
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If you have questions after receiving your bill, please contact our billing department at 404-778-7318 or visit emoryhealthcare.org . You can also send a billing message through your MyChart patient portal.
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If you have questions or concerns about your bill, please contact our billing department at 404-778-7318. You can also send a billing message through your MyChart patient portal. The billing team can also assist you with financial resources such as payment plans.
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Yes, Emory Healthcare offers payment plans. We also offer financial resources that include assistance for those who meet the requirements under Emory Healthcare’s patient financial assistance policy. Call 404-778-7318 or send a message through your MyChart patient portal if you want to:
- Apply for financial assistance.
- Set up a payment plan.
- Discuss other financial options.
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The impacted locations are now operated as part of an Emory hospital so that care is better coordinated and optimized. Hospital-based locations that operate as a hospital outpatient departments must meet specific Medicare requirements. These locations are clinically and operationally integrated with hospital services which allows for seamlessly coordinated care. As a result of this change, hospital-based outpatient department billing (also referred to as provider-based billing) must be implemented to comply with federal and state requirements and reflects that services are provided in a hospital outpatient department. The hospital will bill for the facility services of your visit which includes for example, hospital space, equipment, nursing care and supplies. The physician, nurse practitioner, physician assistant (or other advanced practice provider), will bill for services that he or she personally provides.