Indian River Medical Center physician practices are considered hospital-based outpatient clinics. Hospital-based outpatient clinics are considered part of the hospital not a private physician office.
Clinics located miles away from the main hospital campus may still be considered part of the hospital. Because hospital-based outpatient clinics must follow stricter government rules, they are more complex and more costly to operate. All IRMC outpatient clinics have received Joint Commission Accreditation. Achieving and maintaining this accreditation demonstrates our commitment to quality and patient safety and supports a culture of excellence.
A hospital-based outpatient clinic is different than a private physician office.
How this affects patients with private health insurance.
It is important that you ask your health insurance company the following questions:
Many private health insurance companies do not require that we follow the same billing rules as Medicare and Medicaid. If you have private health insurance, the hospital component of the physician office visit is billed as part of the physician bill and is processed by the health insurance company under the patient’s physician benefits.
How this affects patients with Medicare, Medicare Advantage or Medicaid
In a hospital-based outpatient clinic, Medicare and Medicaid patients receive two separate bills for services provided in the clinic, one from the doctor and one from the hospital. Adult Medicaid patients are required to pay two co-payments, one for the physician visit and one for the hospital visit. If you are covered by Medicare or Medicare Advantage plans, you are responsible for paying non-physician charges billed by the hospital after meeting your deductible.
How this affects secondary insurance coverage.
Coinsurance and deductibles may be covered by a secondary insurance. Check with your health insurance company for details.
Why the Medicare Secondary Payer (MSP) questionnaire needs to be completed.
As a participating Medicare provider, we are required to screen Medicare patients according to the MSP rules. At each visit, you will be asked the MSP questions. These questions help us confirm if Medicare or another payer should process your insurance claim as primary.
What to do if you have questions or are having difficulty paying for health care services.
Contact our Customer Service Center at 772-794-5611 or visit our Patient Financial Services office located at 1155 35th Lane, Suite 203, Vero Be ach, FL 32960.
Patient Financial Services (hours of operation)
Office Hours: Mon. – Fri., 9 a.m. – 4:00 p.m.
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