Provider Based Offices
Questions About Billing?
Contact our Customer Service team Monday-Friday, 8:00a.m.-4:30p.m.
- Phone (757) 534-6971
- Email at: AccountHelp@rivhs.com
Riverside Regional Medical Center has committed to implementing provider based status for relevant affiliates of the health system. Through this change, these affiliated office locations become outpatient departments of Riverside Regional Medical Center. Aligning these practices closer to the health system allows them to keep and attract high quality physicians, establishes enhanced quality and safety standards like those required of hospitals, provides more consistency in the delivery of care, and supports up to date facilities.
Frequently Asked Questions About Hospital Outpatient Departments
Why did my physician's office become a part of the hospital?
Your physician practice has become a department of Riverside Regional Medical Center to strengthen our integration with the health system. This results in better teamwork and improved continuity of care. It also enhances our electronic health record capabilities, resulting in even safer, higher quality care. The Federal government is also encouraging integration and collaboration through its health care reform legislation.
As an outpatient department of the hospital, the office is required to function within the same regulatory standards as the hospital. This means that your physician practice will be surveyed by the Joint Commission, a hospital regulatory agency, and held to the same high standards as the hospital.
What is the Joint Commission and how does it affect the operations of a facility or physician practice that converts to a department of the hospital?
The Joint Commission is the largest accrediting organization for hospitals. CMS or Centers for Medicare and Medicaid require that hospitals be surveyed by an approved accrediting body in order to receive payment for patient services. Hospitals have annual reporting requirements to the Joint Commission and are surveyed on an unannounced basis every 36 months.
The Joint Commission creates accountability to proven hospital healthcare safety and quality standards, such as fire safety, patient safety, infection prevention, and quality improvement while promoting close collaboration between the physicians and team members. The Joint Commission also provides public acknowledgement of facilities meeting their high safety and quality standards.
What is Provider Based?
“Provider based” is a Medicare status that an office receives by complying with specific Medicare regulations. When a facility or physician practice converts to a department of a hospital, and meets the attendant requirements, such as the application of the Joint Commission Accreditation standards, then it may be considered provider based and a department of the hospital. In the case of a physician practice, “Provider” refers to Riverside Regional Medical Center.
Will there be changes to the check-in process?
Depending on your insurance, you may see changes during check-in:
- The Centers for Medicare and Medicaid Services (CMS) require that we verify whether or not Medicare is your primary insurance at every visit. This requires an additional form be completed prior to being seen.
- When you have any form of Medicare, we are required to provide an estimate of your out-of-pocket costs to you prior to services being performed. This information will be presented to you for your review and signature.
In general, the check-in process can take a little longer than previously, so it is more important than ever that patients arrive at least 15 minutes prior to their scheduled appointment time.
Why am I receiving my bill in two parts?
When an office becomes part of the hospital, some insurance payors, such as Medicare, require us to split your claim into two parts for your office visits and services. These parts are mailed separately so patients may not receive them at the same time. One part will be for the professional or clinical fees from the visit and the other part will be for the facility fee.
- Professional Fees will be billed by your physician group. This professional or clinical fee covers the time the physician has spent with you as a patient, along with the consultation and any medical advice that was provided during your visit.
- Facility Fees will be billed by Riverside Regional Medical Center. This facility fee is the charge for administrative and other costs that are required to support the hospital-based clinic, including but not limited to office space, nursing staff, clerical support, and supplies.
Questions regarding either or both parts of the patient bill can be directed to the Patient Accounting Navigator or to (757) 534-6971. You can also email your questions to AccountHelp@rivhs.com.
Patient with other insurance types may not see any change in their billing.
Will I pay more for services?
As with all healthcare services, cost depends on insurance coverage. Patients who receive care at hospital based offices may pay more for outpatient services and procedures. We recommend that all patients review their insurance policies to determine the insurance and out-of-pocket expenses that may be incurred. We encourage you to contact our Patient Accounting Navigator or dedicated Customer Service team if you have questions by calling (757) 534-6971 or sending email to AccountHelp@rivhs.com.
Would you name some of the provider based offices that are outpatient departments of Riverside Regional Medical Center?
Yes. Some examples of offices that function as outpatient departments of Riverside Regional Medical Center include:
- Riverside Hampton Surgery Center
- Peninsula Gastroenterology
- Riverside Diagnostic Centers
- Riverside Cancer Infusion Centers
- Riverside Doctors’ Surgery Center
- Riverside Cardiology Specialists
- Riverside Thoracic and Cardiovascular Surgery
- Riverside Vascular Specialists
As a patient, how do I benefit when a facility or practice becomes a department of Riverside Regional Medical Center?
This change is positive for our patients in many ways:
- Aligns the physician practices closer to the health system, resulting in better teamwork;
- Provides integrated electronic health records, helping to eliminate duplication and improve safety;
- Enhances safety standards and quality of care since our practice is now held to the strict standards set by the Joint Commission for hospitals;
- Enhances our ability to attract and retain high quality physicians to our area;
- Assures consistency in the delivery of care;
- Supports state of the art facilities;
- Unifies the outpatient setting and the hospital under the same hospital charitable care policy.
Our change to become a department of Riverside Regional Medical Center allows us to retain our high quality physicians and staff and implement increased quality and safety standards which benefit all of our patients immensely.
If you have any questions about this change, please let us know. Our first priority continues to be providing our patients with superior care that promotes safety, healing, kindness and respect.