Provider-Based Billing

Saint Francis Healthcare System (Medical Center) strives to provide our patients with information to help them make the most informed decisions possible related to their healthcare. The information contained on this page is being provided to help you better understand what provider-based billing is and which Saint Francis Medical Center clinics are Provider-Based Billing locations.

What is a provider-based physician practice?

The Center for Medicare and Medicaid Services (CMS) permits physician office clinics to operate as “provider-based” when certain conditions are met. These physician office clinics are integrated into the hospital and are therefore permitted to bill services as a hospital outpatient department to government operated insurance plans. These charges often show up on a statement as “facility charges” which help cover the additional expenses of operating an outpatient department of a hospital compared to a free standing physician office.

Which Saint Francis Medical Center clinics operate as hospital outpatient departments and bill charges as a provider-based location?

  • Cape Physician Associates
    3250 Gordonville Road
    Cape Girardeau, MO 63703
  • Cape Cardiology Group
    211 Saint Francis Drive Suite 15
    Cape Girardeau, MO 63703
  • Cape Medical Oncology
    211 Saint Francis Drive Entrance #6
    Cape Girardeau, MO 63703
  • Cape Cardiovascular and Thoracic Surgery
    3250 Gordonville Road #358
    Cape Girardeau, MO 63703
  • Cape Gynecological Oncology
    211 Saint Francis Drive Entrance #7
    Cape Girardeau, MO 63703
  • Cape Neurology Specialists
    3004 Gordonville Road
    Cape Girardeau, MO 63703

Will I experience higher out of pocket costs for being seen in a provider-based billing clinic?

It is possible for a patient to have higher out of pockets costs when obtaining services from a provider-based billing clinic. Patients that do not have a secondary or supplemental payer are more likely to experience higher out of pockets costs at these locations.

Who can I call if I have more questions about Provider-Based Clinics or my bill?

The Saint Francis Customer Service Department can be reached by calling 573-331-5217 option #4.

Who can I speak to if I need to discuss payment arrangements or payment plan?

The Saint Francis Customer Service Department can be reached by calling 573-331-5217 option #4.

Who can I speak to if I am having difficulty paying for my bills received by Saint Francis?

The Saint Francis Financial Counselor can be reached by calling 573-331-5217 option #2.

How much can I expect to pay out of pocket for services at a provider-based clinic?

Patients who have a Medicare supplemental payer typically do not get billed out of pocket for any out of pocket expenses for Medicare covered visits at a provider-based billing department. This is never guaranteed and is subject to each patient’s specific policy and benefits.

Medicare requires hospitals that bill as provider-based clinic locations to provide estimates for what services could cost a patient who has traditional Medicare and who does not have a supplemental insurance policy. The amounts noted below are effective for 2018 and would be subject to a patients Medicare Part A deductible, Part A coinsurance, Part B deductible, and Part B coinsurance. For patients who have met their deductibles and/or coinsurances, out of pocket amounts would be lower than the figures stated below. For more information on deductibles and coinsurances please see your Medicare Handbook or consult our insurance page. If you have questions, would like additional procedure estimates, or would like a personal estimate specific to a certain service please call our financial counselors at 573-331-5217 option #2 or click here to request an estimate.

Service DescriptionHospital Services, no deductibles metHospital Services after deductible metProfessional Services, no deductibles metProfessional Services after deductibles metTotal Out of Pocket Cost if no deductible metTotal Out of Pocket after deductible met
New Patient,
Level 1
$102.08$20.42$26.21$5.25$128.29$25.67
New Patient,
Level 3
$102.08$20.42$75.12$15.02$177.20$35.44
New Patient,
Level 5
$102.08$20.42$165.49$33.10$199.91*$53.52
Established Patient,
Level 1
$102.08$20.42$9.01$1.80$111.09$22.22
Established Patient,
Level 3
$102.08$20.42$50.16$10.03$152.24$30.45
Established Patient,
Level 5
$102.08$20.42$108.66$21.73$188.55*$42.15
EKG$50.25$10.05$8.34$1.67$58.59$11.72
Chest X-Ray$55.77$11.16$10.76$2.15$66.53$13.31
Skin Tag Removal$151.70$30.34$70.11$14.02$190.76*$44.36

*2018 Medicare Part B Deductible = $183 (20% coinsurance applies to allowed amounts after deductible has been met)

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