Medicare rules require some of your services to be billed as two separate charges. The following information will help you understand these rules and how they affect your billing statement.
Why are some services divided into two charges?
Medicare rules require hospital-based clinics to bill some services as two separate charges. One charge is for the provider's services (provider fee). The other charge is for the costs of nursing staff, supplies, equipment and building expenses (facility fee).
What kinds of services are divided into two charges?
Clinic services (including office visits and some treatments given in the office), X-ray, lab and EKG charges are the most common types.
Does this mean I am being billed twice for the same service?
No. The total of the two charges is equal to the full charge for the service. Fairview’s hospital-based clinics will submit all claims to Medicare.
What about my Medicare supplemental insurance?
We file separate charges for the provider and facility fees to your Medicare supplemental insurance.
What is Medicare crossover?
This is a benefit that is offered by Medicare. The patient allows Medicare to process claims and payments to the patient's secondary plan.
What is Medicare Part D?
This is a plan that provides prescription drug coverage through Medicare.
Why aren't my Part D co-pays covered by Medical Assistance?
Medicaid and Medicare are both government plans. They each require a co-pay.
What is a "donut hole"?
The term "donut hole" refers to a gap in coverage under Medicare Part D (prescription drug program). Under the standard benefit, there is a gap in coverage between the initial limit and the catastrophic threshold. Within this gap, you would pay 100 percent of the cost of your prescription drugs. The government agencies and insurers prefer the term "coverage gap," but "donut hole" is more widely used.
Does Fairview offer any financial assistance to patients?