What does it mean to be provider-based?

A “Provider-Based” or “Hospital Outpatient Clinic” refers to services provided in hospital outpatient departments that are clinically integrated into a hospital. The clinical integration allows for higher quality and seamlessly coordinated care.

What is PBB healthcare?

What is Provider-Based Billing (PBB)? PBB refers to the billing process for services rendered in a hospital department or location. This process takes place when the hospital owns space and employs physicians and other support personnel who are involved in patient care.

What are three main types of healthcare services billing methods?

Traditional Reimbursement Models. Traditionally, there have been three main forms of reimbursement in the healthcare marketplace: Fee for Service (FFS), Capitation, and Bundled Payments / Episode-Based Payments.

What is the difference between hospital based and non hospital based?

One is the “facility/hospital” charge and the other is the “physician (professional)” charge. When you see a physician in a freestanding private office, they bundle services in a single charge. In addition, the cost of services in the hospital-based providers is often higher.

How CMS define clinic?

To meet the definition of a clinic, the facility must meet the following test of physician participation: The medical services of the clinic are provided by a group of three or more physicians practicing medicine together; and.

What is a PBB site?

What is provider-based billing (PBB)? PBB is a national model of billing practice that is regulated by CMS (Centers for Medicare & Medicaid Services). PBB refers to the billing process for services that are rendered in an outpatient clinic (department) of the hospital.

Who is billing provider?

Billing Provider means an individual, agent, business, corporation, or other entity who, in connection with submission of claims to the Department, receives or directs payment from the Department on behalf of a performing provider and has been delegated the authority to obligate or act on behalf of the performing …