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Provider-Based Billing

Altru Health System is a provider-based health system designated by the Center for Medicare and Medicaid Services (CMS) in Title 42 Code of Federal Regulations (CFR). Provider-based billing is a type of billing for services provided in a clinic or department which is considered to be part of the hospital. 

Frequently Asked Questions

Provider Based is a Medicare status for clinics designated to be outpatient hospital departments.  Medicare designates Altru’s Clinic locations as departments of the hospital facility if they are located within 35 miles of the hospital facility. 

•    Your medical records will be better coordinated between your physicians.
•    The hospital and physicians will be able to better coordinate your care across clinics and hospital.
•    Our Clinics will be held to even higher clinical standards to maintain the highest patient safety and service quality standards.

•    You will see two different charges for your clinic visit.  One charge is for services provided by the physician, and the other is for facility-related expenses. This is required by federal regulation.
•    You may see two separate Explanation of Benefits from your insurance carrier for the same date of service.
•    Deductibles and co-insurance may apply to one or both charges for the visit, which may result in higher out of pocket costs. If you have a Medicare Supplement, that may cover those balances.

If you have questions about provider-based billing or items on your statement, please call 701.780.1500 or 800.464.7574 (toll-free).