The provider will then report the revenue received on Line 10 (Line 11 for Ambulatory Surgery Centers) of their PGP report and pay the surcharge from the revenue received and reported. ![]() Patient: Submits their percentage of the total due, including the billed surcharge, to the provider.The provider will then report the revenue received on Line 12 (a or b) (Line 13 for Ambulatory Surgery Centers) of their PGP report and pay the surcharge from the revenue received and reported. Non-electors submit their percentage of the total due, including their share of the billed surcharge, to the provider. Non-electing payor: Provider assesses non-elector surcharge percentage rate on bill to non-electing payor (plus, if applicable, an additional GME percentage on inpatient services).The provider will report the revenue received from the patient on line 10 (line 11 for Ambulatory Surgical Centers) of their PGP report. ![]()
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