Why are some patients charged “facility fees” at Sarasota Memorial’s outpatient centers?
Sarasota Memorial follows national guidelines and billing standards mandated by the Center for Medicare & Medicaid Services (CMS) for all patients and all visits – in the hospital setting and in outpatient settings. CMS has defined facility fee insurance codes for outpatient “clinic visits” to reimburse hospitals for the level/intensity of the nursing services and hospital resources used in an outpatient clinic setting. The fees take into account the operating and overhead costs related to the building, service provided by our clinical and support staff, supplies and equipment, as well as administrative costs related to support departments like Patient Financial Services.
Why is there a separate physician fee?
Physicians who treat patients at hospital-owned facilities typically are not owners or employed by those facilities. They use a special code when billing insurance companies and accept lower fees/insurance reimbursement than physicians who use their own equipment, supplies, staff and facilities
Physicians who own their own facility and resources use different insurance billing codes that include their facility/overhead costs into a single patient bill for an office visit and are reimbursed at a higher rate by insurance providers.
Do all outpatient services have facility fees?
No, Sarasota Memorial charges a facility fee only when the service provided meets the definition and criteria established by CMS for a “clinic visit.” There are some outpatient services, such as lab, radiology and rehabilitation therapy, that have different codes established by CMS. In those situations, the facility costs are already built in to the reimbursement rate, so patients are not charged a separate fee.