SHA Physicians Group Billing Procedures

Notice: This practice is a Provider-Based Clinic, an outpatient department of Sweetwater Hospital Association

Sweetwater Hospital Association consists of the hospital, physician offices, and other facilities that serve the health care needs of the people in our community. Many of the Sweetwater Physician Group locations are now considered hospital-based outpatient departments. Thank you for choosing to receive your care with us.

Why the change?

Sweetwater Hospital Association has made this change to better integrate our physician practices and improve the overall quality of care for patients. This is the national model adopted by many large health care networks, where the hospital owns space and employs support staff who assist with patient care. This benefits patients as all departments of the hospital are subject to strict quality standards.

What does this mean?

“Provider-based billing” or “Hospital Out-patient Clinic” is a type of billing for services provided in a clinic or department that is considered part of the hospital. These clinics are clinically integrated into Sweetwater Hospital Association, allowing for seamlessly coordinated care. These provider-based clinics are held to a higher standard of care and are required to meet federal accreditation. Clinics located several miles away from the main hospital campus may be considered part of the hospital. Even though you’re seeing your regular physician in a clinic setting, your visit is billed under the hospital rather than the clinic or the physician’s office.

“Provider-Based billing” is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that we bill Medicare in two parts – one bill for the physician service and another bill for the hospital/facility resources.

What if I have Medicare, Medicare Advantage, or a Medicaid plan?

In a hospital-based outpatient clinic, if you have Medicare, Medicare Advantage, or Medicaid, you may receive two (2) separate explanation of benefits (EOB’s) for services provided in the clinic — one for physician services and another for the hospital/facility resource. The combined total charge is the same, but the components are split.

Will I pay more for services?

Depending on your specific insurance coverage, it is possible that some benefits will differ for these services and procedures. Some patients may pay a higher cost as a result of the health plan’s coinsurance and deductible, not an increase in actual fees.

What if I have questions?

If you have questions, please contact Sweetwater Hospital Association at 865-213-8401.
For patient estimates, please contact the Sweetwater Hospital Association at 865-213-8451.

Read about our No Surprise Billing Procedures.