Provider-based or Hospital Outpatient Billing

Provider-based or Hospital Outpatient Billing Brochure

Thank you for choosing Mercy Cardiovascular Testing. You are visiting a facility that functions as an outpatient testing department of Mercy Medical Center — Des Moines. This information intended to answer any questions you may have about provider-based billing practices and how it affects you as a patient.

What does "provider-based" or "hospital outpatient" billing mean?

"Provider-based" or "hospital outpatient" billing refers to the billing process used for services provided in a hospital outpatient clinic. This is the national model of practice for large, integrated health care systems (such as Mercy Medical Center — Des Moines) where the hospital owns space and employs support personnel involved in patient care.

How does this affect my billing?

Your test is being scheduled at a Mercy outpatient testing facility within Iowa Heart Center. Under this model, the care you will receive will result in two separate bills. You will receive one bill from Mercy Medical Center—Des Moines for the facility charge as well as a bill from Iowa Heart Center for the professional services or physician charge from the physician who interprets your test results.

Why this billing process?

Inpatients traditionally receive a facility fee and a professional services or physician charge on their hospital bill. Following this same type of billing in the outpatient setting ensures more appropriate payment for services provided by hospital staff and physicians and distinguishes facilities that function as hospital departments from free-standing facilities.

Does this mean patients will pay more for services?

Many insurance plans pay for health care services provided in an outpatient hospital clinic differently than those provided in a doctor's office. Your insurance plan may require you to meet your annual deductible before it pays for health care services you receive in an outpatient hospital clinic. Your insurance company may also require you to pay a percentage of the bill, called co-insurance, rather than just an office co-payment. We recommend that you review your insurance benefits or contact your insurance provider to determine your coverage and identify any out-of-pocket expenses you may incur.

In Summary

Receiving care at a Mercy Cardiovascular Outpatient Testing facility will result in two separate bills. You will receive one bill from Mercy Medical Center — Des Moines containing the facility charge and a separate bill from Iowa Heart Center containing the professional or physician charge from the physician who interprets your test results.

Depending on your insurance coverage, your insurance provider may treat these hospital outpatient testing charges differently than those provided in a doctor's office. We recommend that you review your insurance benefits or contact your insurance provider to determine your coverage and identify any out-of-pocket expenses you may incur.

Provider-based billing locations

Mercy Cardiovascular Testing
Iowa Heart Center
5880 University Avenue
West Des Moines, IA 50266

Mercy Cardiovascular Testing
Mercy Medical Center - Des Moines
411 Laurel Street, Suite 1250
Des Moines, IA 50314

Mercy Cardiovascular Testing
Iowa Heart Center
800 East 1st Street, Suite E220
Ankeny, IA 50021

Mercy Cardiovascular Testing
Iowa Heart Center
2006 North 4th Street, Suite 200
Indianola, IA 50125

If you have additional questions about "provider-based" or "hospital outpatient" billing, call (515) 633-3800.