Provider Based Billing | Sentara Healthcare
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Sentara Medical Group
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Provider Based Billing 

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This office is a hospital-based practice.
As a provider-based practice, we are considered an outpatient hospital department by Medicare. By recognizing our practice in this way, Medicare is recognizing Sentara's strength as a clinically integrated health system and how that coordination of quality care benefits our patients. What that means: our already high focus on quality and patient safety will be further elevated as part of this integration process.

How does this affect my billing?
As a hospital-based practice, also known as "provider-based" in Medicare terms, Sentara is required to bill health services in two parts – one for the physician’s care and another for the hospital/facility fees. This may result in two separate billings for a single date of service, which may also lead to two explanations of benefits from your payor and two separate statements for services.

Once Medicare has processed their portion of the charges, the balance will be submitted to a secondary payor if you have one. If there is a balance after the secondary insurance processes the claim, or if you do not have secondary insurance, you will receive a bill for the small remaining balance.

Will my supplemental insurance cover this fee?
Most Medicare patients will be covered by their supplemental insurance and will not have to pay more out of pocket. Depending on your insurance coverage, it is possible that your benefits may differ and result in additional or higher coinsurance payment. We encourage patients to 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.

Medicare secondary payer (MSP) questions
As a participating Medicare provider, Sentara Medical Group is required to ask our customers Medicare Secondary Payer (MSP) questions on each visit. These questions are designed to determine if any other insurance should pay before Medicare. Please note this may lengthen your registration process but will ensure your visit is covered correctly.

If you have trouble paying for healthcare services
Sentara offers financial assistance programs to patients who qualify. If you need assistance, please contact our financial counseling office at 757-252-3080.

If you have more questions or concerns
We understand these changes can be confusing and want to assist you with any concerns you have. We have a team ready to help you. If you would like to discuss this billing change, please let us know when you check in for your appointment or call 757-252-3080.

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