DMH seeks to justify facility fee
In September, DMH started charging a
According to DMH officials, the fee is part of its outpatient facilities' switch to provider-based billing, a national model of billing regulated by
Fees associated with provider-based billing have been allowed by CMS since 2000. While national data on facility fees doesn't exist, the
DMH President and CEO
"Carle assigns a level-of-care technical fee that best reflects the intensity of services provided by staff and resources consumed during an office visit," Carle public relations coordinator
"
Justifying the fee
"When a patient comes to the hospital, if they go to the lab or radiology, they see a physician's fee and a facility fee," Anderson said. "If someone is at our facility using our supplies and equipment, there's a charge. That's how hospitals have billed forever and ever.
"This is us extending that same billing model outside our four walls to our employed physicians and express care locations."
"Saying the federal government is making them impose the fees sounds good, and for these locations prescribing drugs under this program to establish themselves as child entities, it makes sense that they'd define the relationship using provider-based billing," Miller said. "But that's separate from charging a fee."
Anderson, though, said CMS rules state provider-based billing has to come with a "legitimate charge."
"If you're really going to do provider-based billing for 340B, it has to be a legitimate charge," Anderson said. "We try to align our charge with what we know
"I think their excuse -- the provider-based billing for 340B -- is a cop out," Petry said. "Go back and look at the explanation when Carle started doing it a couple years ago. It's the same verbiage. They're charging an extra
DMH insisted the 340B program was the reason it switched to provider-based billing. "We did not get into provider-based billing to generate revenue," Anderson said. "That was not our goal."
Stone said at this point DMH is reimbursed by
Stone said provider status is recognition that a hospital provides a lot of vital services to the indigent for which it isn't reimbursed.
"The government allows you to recover some of those large capital investment costs in charging a facility fee," Stone said. "And the 340B program will result in money coming back to the hospital from the federal government, via the drug manufacturers.
"There are people out there who think: That's not right. I work. Why should I subsidize these people?
"Well, what are you going to do -- throw these people out on the street? If we don't get these drugs to them, then they show up inside the hospital and they're real sick, and they consume even more resources."
Who pays?
Anderson said as of
"We've worked with insurance companies to reduce the out of pocket responsibility to patients," Anderson said. "We've worked very hard to minimize the impact on patients."
Insurance coverage for the facility fee depends on the individual insurance company and plan. Some private insurance companies will negotiate a discounted fee, usually
The fee is covered under
Anderson said any patient having trouble paying a bill should call the DMH Business Office (217) 876-3785.
"When you're talking about 20 patients a day at a doctor's office at an extra
DMH used to be just the hospital. Now it has offices and clinics all over
"These places like
"I don't understand it -- it's their decision to put these other facilities in the community. It was their decision to take on that load," Perkins said. "Why are they trying to pass it off on the patients?"
Anderson said in early December that no one had reported to DMH they were changing doctors because of the fee, and by late January calls to the office asking about the fee had stopped.
Both Barnett and Perkins said though they're not happy with the fee, they'll likely not switch.
"When I get a doctor broken in, I hate to change," Barnett said. But she said she'll consider it if the costs become too great.
Perkins said she can afford to pay the fee, but doesn't like the principle of an extra
"It's just upsetting at my age to be thrown into this," Perkins said. "I don't know any doctors at HSHS."
"I'll have to be really sick to go to the doctor -- it's going to have to be pretty serious," Brown said "But sometimes your life is worth more than money. If it came down to that, I'd go."
The original version of this story has been altered to clarify the impact on
***
Subscribe to the Herald & Review
Reporting like this is brought to you by a staff of experienced local journalists committed to telling the stories of your community. Support from subscribers is vital to continue our mission.
Become a subscriber?
Get breaking news right in your inbox.
___
(c)2017 the Herald & Review (Decatur, Ill.)
Visit the Herald & Review (Decatur, Ill.) at www.herald-review.com
Distributed by Tribune Content Agency, LLC.
Elderly couple displaced by South Shores house fire
Joseph D. Flynn, 63, an insurance broker
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News