Provider Based Billing

On September 1, 2015 Brattleboro Memorial Hospital will be joining hospitals across Vermont and the rest of New England in transitioning its medical practices to Medicare and Medicaid Provider Based Clinics. This new system, approved by the Center for Medicare and Medicaid Services (CMS) will affect most BMH Medical Group practices.

The important thing we want you to know is this: You can expect the same great health care from your existing provider; only if you have Medicaid or Medicare will the way you are billed be changing. From September 1, 2015 onward, every time you receive care from a BMH Medical Group practice, you will receive two statements; one from the Brattleboro Memorial Hospital (BMH) Medical Group for the professional care, and one from Brattleboro Memorial Hospital for the clinic service.

The new system will require adjustments for all of us, and we expect that you may have questions. Please take a few minutes to review the list of commonly asked questions below, and make particular note of the contact information for our Community Resource Liaison who will be available to all affected patients to answer questions and address any concerns about the new system.

We look forward to continuing to care for you, and expect that after a short transitional period, the new billing system will feel very familiar to us all. Please don’t hesitate to be in touch if you need assistance in any way.

Commonly Asked Questions About Provider-Based Status

What does Provider Based Billing mean?: “Provider-Based” or “Hospital-Based Outpatient” refers to the billing process for services rendered in a hospital owned medical practice that is clinically integrated into a hospital. This is the national model of practice for healthcare organizations that provide both hospital and physician clinic services to their patients.

What will be different?: You will still receive the exact same medical care from your regular provider. Scheduling appointments and lab work will be handled as they always have been. BUT: From September 1st onward, every time you receive services from a BMH Medical Group practice you will receive two statements; one from the Brattleboro Memorial Hospital (BMH) Medical Group for the professional care and one from Brattleboro Memorial Hospital for the clinic charge.

Why is this necessary?: Brattleboro Memorial Hospital views your ability to access local physicians as critical to our mission. In order to support our continued ability to provide these services, we are adopting the same type of billing process in our practices as we do for outpatient care in all of the hospital departments, ensuring more appropriate payment for services provided by hospital staff and physicians.

Will this affect my co-pays, co-insurance or deductibles?: Depending on which clinical service is provided, there may be additional out-of-pocket expenses for which you will be responsible.

What if I have secondary insurance coverage?: Co-insurance and deductibles may be covered by a secondary insurance policy. We recommend that you consult directly with your insurance company to find out which portions of your charges will be covered under the new system.

Which Brattleboro Memorial Hospital locations will be affected by this change?: Departments of Brattleboro Memorial Hospital include:

  • BMH Orthopaedics & Sports Medicine
  • BMH Urology
  • Brattleboro Family Medicine
  • Brattleboro General Surgery
  • Brattleboro Internal Medicine
  • Brattleboro Obstetrics and Gynecology
  • Center for Cardiovascular Health
  • Just So Pediatrics
  • Maplewood Family Practice
  • Putney Family Healthcare
  • Windham Family Practice