Provider Based Billing

The Centers for Medicare and Medicaid Services has designated Grand View Health System (GVHS) healthcare providers as "Provider Based". GVHS Clinics will be considered outpatient hospital departments.

How does this change affect you as a Medicare patient?

Billing Process:

Medicare requires that Provider Based healthcare provider services be billed in two parts:

• Facility fee - filed to Part A Medicare
• Healthcare provider fee - filed to Part B Medicare

The total cost of both charges for Medicare patients will not exceed charges incurred by other non-Medicare patients receiving the same services.

• Medicare patients will receive two Medicare Summary Notices (MSNs) for services provided at Grand View Health System’s Clinics.
• Both services will appear on our GV Clinic billing statement.

Medicare Secondary Payer (MSP) Questions:

• As a participating Medicare provider, GVHS will be required to ask our Medicare patients the MSP questions. These questions are designed to determine if any other insurance should pay before Medicare.
• These MSP questions will be asked during registration prior to every appointment.

More Information:

If you have questions or concerns regarding this change, please call our Billing Office at 906-932-6210.