Patient Letter: Transition to Hospital-Based Clinics

Dear Patient:

Thank you for choosing OU Health Stephenson Cancer Center as your healthcare provider. Stephenson Cancer Center is going through an exciting transition that will allow us to provide even more seamless care between the center and our hospital partner, University of Oklahoma Medical Center (OUMC).

In conjunction with this transition, we want to inform you of changes being made in our billing policies. Like other medical centers and hospitals across the country, OUMC is taking a more active role in the care delivered within outpatient clinics and, as a result, we are converting SCC clinics to hospital-based outpatient clinics beginning October 1, 2020.

A hospital-based outpatient clinic is the term Medicare uses for locations that meet specific regulations. Hospital-based outpatient clinics are organized to promote increasing collaboration between hospitals and outpatient clinics to better serve your healthcare needs by emphasizing joint attention to quality, coordination of care, and exceptional clinical outcomes.

Starting with services provided on October 1, 2020, patients with government coverage (Medicare, Medicare Advantage, TRICARE, Medicaid) coverage and self-pay patients visiting SCC clinics will begin receiving two bills for their visits—one for services provided by the physician or other provider and another for facility charges, representing the resources required to support provider services. The amount owed will depend on the actual services provided. Previously you would have seen both of these items on the same bill.

The source of the billing will depend on which organization delivered the service—for example, lab services are provided by the hospital and will thus be billed by OUMC as “hospital-based services” even though they are delivered in an outpatient clinic environment, and professional services for care pro-vided by your doctor will be billed as “physician services” by OU Health Physicians.

With these changes, patients may also receive two explanations of benefits (EOBs) from their insurance carrier. Patients might owe an additional copayment for the hospital-based outpatient clinic visit, though many patients have a supplemental policy that may cover any additional expenses incurred. As your healthcare provider, we are committed to offering you the best care possible. We are also com-mitted to helping you understand our financial and billing policies, so this letter includes answers to frequently asked questions about hospital-based outpatient clinics and changes to the billing policy. How-ever, if you have additional questions regarding these billing policy changes, please feel free to call our financial navigation team at (405) 271-3863.

As always, we look forward to assisting you with your healthcare needs.

Sincerely,

Robert Mannel, MD
Rainbolt Family Endowed Chair in Cancer
Director, OU Health Stephenson Cancer Center
Associate Vice Provost for Cancer Programs
Professor, Department of Obstetrics and Gynecology
University of Oklahoma Health Sciences Center

Kris Gose, RN, MBA
President, University of Oklahoma Medical Center

Provider-Based Billing Implementation Assistance - Frequently Asked Questions

Provider-Based Billing General Questions

What does “hospital-based” outpatient mean?
Medicare has designated SCC clinics as “hospital-based” outpatient departments of University of Oklahoma Medical Center (OUMC)—a term they use for locations that meet certain regulations. Basically, it means that our clinics are now considered to be departments of OUMC. It is a common model of practice for integrated healthcare systems and is found in many hospitals and facilities, both locally and around the nation. Hospital-based outpatient clinics are organized to better serve your healthcare needs by emphasizing joint attention to quality, coordination of care, and exceptional clinical outcomes.

Why are SCC clinics changing to hospital-based outpatient clinics?
Hospital-based outpatient clinics have become the national standard for academic medical centers. OUMC continually tries to find ways to provide the highest quality of care. The care provided at SCC has always met a very high standard of patient care, as evidenced by our designation by the National Cancer Institute, and will continue to do so. However, our hospital-based outpatient clinics will now also participate in the Joint Commission accreditation process, which works to improve healthcare for the public and helps organizations provide a safe and effective quality of care. OUMC already takes these extra steps to ensure we meet these high standards for our patients, and now our hospital-based outpatient clinics will be a part of this review.

What are the benefits of being cared for at a hospital-based outpatient clinic?
Medicare acknowledges the value of providing care in an integrated, collaborative environment. Hospital-based outpatient clinics are held to nationally recognized service and patient care standards, leading to high-quality care for patients.

Billing Questions

How does hospital-based outpatient billing affect patients?
Patients receiving outpatient services at SCC may notice a change in the way they are billed. Depending on the insurance coverage, patients may now receive two separate bills for services provided in the hospital-based clinics—one bill for the services provided by the physician and one for the services provided by the facility. It is possible that patients’ co-payments may change for certain outpatient services and procedures at our hospital outpatient locations. We recommend that patients review their insurance benefits to determine what their policy will pay and what out-of-pocket expenses may be incurred.

What if the patient has secondary or supplemental insurance coverage?
Coinsurance and deductibles may be covered by a secondary or supplementary insurance policy. The patient should check with their benefits or insurance company for detailed answers related to secondary insurance.

Where can patients call with questions or concerns?
Patients with questions may call our financial navigation team at (405) 271-3863.