Understanding Provider-based Billing

Provider-based billing: What you need to know

Provider-based billing happens when the clinic you visit is considered to be part of the hospital rather than a standalone practice.

Because of this, Medicare requires your visit be billed in two parts:

•    Provider (professional) fee: For the care you receive from your provider
•    Facility (technical) fee: For the clinic, equipment, and support services

This means you could get two charges. This is simply a billing process. It doesn’t change the care you receive.

Your appointment will go the same way it always does. You’ll see the same trusted providers, receive the same treatments, and experience the same high-quality care. The only difference is how the visit appears on your bill.

Patients with Medicare or certain government plans might have higher out-of-pocket costs because of how deductibles and coinsurance are applied. This isn’t an increase in charges from Reid Health — it’s simply how Medicare processes these services.

If you have secondary insurance such as a Medicare supplement plan, you might see little to no difference in what you pay.

Provider-based billing allows us to offer consistent, high-quality care across locations while meeting important safety and regulatory standards. It supports a better, safer experience for every patient we serve.

This type of billing typically applies to:

•    Traditional Medicare
•    Traditional Medicaid
•    Managed Medicaid
•    VA and TriCare

Most private insurance plans don’t require separate provider and facility charges. Lab and radiology services are always billed by the hospital, regardless of insurance.
 

Helpful billing terms

•    Deductible: What you pay each year before insurance starts to pay 
•    Coinsurance: The percentage you pay after your deductible 
•    Copay: A set amount you pay at the time of your visit

Locations using provider-based billing

Richmond locations (effective 12/15/2025)

Allergy, Endocrinology, ENT, Gastroenterology, General Surgery, , Infectious Disease, Neurology, OB/GYN, Palliative Care, Peri-Op, Pulmonary, URO/GYN, and Urology

Connersville locations (effective 4/13/2026)

Allergy, Cardiology, Endocrinology, ENT, General Surgery, Neurology, OB/GYN, Oncology, Orthopedics, Podiatry, Primary Care, Pulmonary, Urology, and Wound Care