Provider Based Billing

Back on September 1, 2015 Brattleboro Memorial Hospital joined hospitals across Vermont and New England in transitioning its medical practices to Medicare and Medicaid Provider Based Clinics. This new system, approved by the Center for Medicare and Medicaid Services (CMS) affected most BMH Medical Group practices.

The important thing to know is this: You can expect the same great health care from your existing provider. The way you are billed will only change if you have Medicaid or Medicare. From September 1, 2015 onward, every time you receive care from a BMH Medical Group practice, you will receive two statements; one from the Brattleboro Memorial Hospital (BMH) Medical Group for the professional care, and one from Brattleboro Memorial Hospital for the clinic service.

Please take a few minutes to review the list of commonly asked questions below.

Commonly Asked Questions About Provider-Based Status

What does Provider-Based Billing mean?
“Provider-Based” or “Hospital-Based Outpatient” refers to the billing process for services rendered in a hospital-owned medical practice that is clinically integrated into a hospital. This is the national model of practice for healthcare organizations that provide both hospital and physician clinic services to their patients.

What will be different?
You will still receive the exact same medical care from your regular provider. Scheduling appointments and lab work will be handled as they always have been. BUT: From September 1st onward, every time you receive services from a BMH Medical Group practice you will receive two statements; one from the Brattleboro Memorial Hospital (BMH) Medical Group for the professional care and one from Brattleboro Memorial Hospital for the clinic charge.

Why is this necessary?
Brattleboro Memorial Hospital views your ability to access local physicians as critical to our mission. In order to support our continued ability to provide these services, we are adopting the same type of billing process in our practices as we do for outpatient care in all of the hospital departments. This ensures more appropriate payment for services provided by hospital staff and physicians.

Will this affect my co-pays, co-insurance, or deductibles?
You may be responsible for additional out-of-pocket expenses depending on which clinical services are provided.

What if I have secondary insurance coverage?
Co-insurance and deductibles may be covered by a secondary insurance policy. We recommend that you consult directly with your insurance company to find out which portions of your charges will be covered under the provider-based system.

Which Brattleboro Memorial Hospital locations will be affected by this change?
This change affects the following Brattleboro Memorial Hospital departments and BMH Medical Group practices:

  • BMH Neurology
  • BMH Orthopaedics & Sports Medicine
  • BMH Podiatry
  • BMH Urology
  • Brattleboro Family Medicine
  • Brattleboro General Surgery
  • Center for Cardiovascular Health
  • Four Seasons OBGYN & Midwifery
  • Maplewood Family Practice
  • Putney Family Healthcare
  • Windham Family Practice