Facility fees are taking many patients by surprise

Due to an obscure change in Medicare rules that occurred nearly a decade ago, "provider-based billing" allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Consumer advocates across the country say patients increasingly are being charged the fees, and a consultant has estimated that the fees could generate an additional $30,000 annually per physician for hospitals.