Financial Assistance Program For the Uninsured & Underinsured

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1 Our Call to Action Together we promise: Healthcare that works. Healthcare that is safe. Healthcare that leaves no one behind. Version Date: 05/18/2011

2 Table of Contents Mission Statement, Our Call to Action and Core Values Policy Statement Accounting for the for the Uninsured & Underinsured Screening Patients for Gov t Eligibility, Charity Care, and Financial Assistance Financial Counselor Patient Interview Process Flow Medicaid Eligibility Charity Care Eligibility (FAP) Means to Pay and Prompt Payment of Uninsured Amounts Appeal Process for Patients HHS Poverty & SVH Income Guidelines Evaluation of Applications Repayment of Patient Liability Collection of Unpaid Balances St. Vincent Health Payment Options Appendix: Definitions Ascension Health Policy #9 Ascension Health Policy #16 Ascension Health Procedure M-1 Version Date: 05/18/2011 Page 2 of 25

3 St. Vincent Health Mission Statement St.Vincent Health is a nonprofit, spiritually-centered health care system sponsored by Ascension Health. We are dedicated to the mission of improving the lives and health status of residents of Indiana through the provision of a continuum of holistic and high-quality healthcare services. St.Vincent Health is compelled to make a positive and healing difference for those serviced by living the mission, vision and Core Values of Ascension Health while supporting the respective cultures and values of Network participants who share compatible but different core values. St. Vincent Health supports this mission by providing its participants with an improved access and ability to strengthen the quality of care and service coordination across the continuum in a values-focused environment with special concern for the sick and the poor. St.Vincent Health will provide integrated healthcare services that prevent disease, promote wellness, and care for the sick and suffering. This will be carried out in a manner that is costeffective and consistent with the Ethical and Religious Directives for Catholic Health Care Services approved by the National Conference of Catholic Bishops. Our Call to Action Together we promise: Healthcare that works. Healthcare that is safe. Healthcare that leaves no one behind. Core Values The core values of St.Vincent Health are those of Ascension Health, namely: Service of the Poor generosity of spirit for persons most in need Reverence respect and compassion for the dignity and diversity of life Integrity inspiring trust through personal leadership Wisdom integrating excellence and stewardship Creativity courageous innovation Dedication affirming the hope and joy of our ministry Version Date: 05/18/2011 Page 3 of 25

4 Policy Statement In accordance with our mission statement and Core Value of Service to the Poor and Ascension Health s (AH) Policy #9, Policy #16 and Procedure #M-1, it is the policy of St. Vincent Health (SVH) to establish and maintain a program whereby patients requiring medically necessary care with no insurance (uninsured) and with limited insurance (underinsured) are provided an opportunity to apply and be considered for financial assistance for their total charges or unpaid portion of their bill. SVH will create and maintain a process for effectively evaluating a patient s need for financial assistance without regard to race, color, religion, sex, age, national origin, citizenship or disability. As stated in Policy #16, there are three types of patients as part of the uninsured population. These three patient types are as follows: 1. Charity Care (CC): Those who qualify as indigent under the HHS Poverty Guidelines; 2. (FAP): Those who do not qualify as indigent, but have a demonstrated inability to pay for all of their services; 3. Means to Pay: Those with a demonstrated ability to pay for services. Using AH Policy #9, #16 and # M-1 as a basis, the for the Uninsured and Underinsured at SVH will be comprised of the following: A. Eligibility for governmental and local assistance programs: Medicaid, Medicaid/Medicare Disability, and Federal, State and local grants or other healthcare assistance programs. B. Charity care consideration based on household or family unit income level; C. A sliding scale for those with incomes between 200% and 400% of the HHS Poverty Guidelines; D. A discount for services for uninsured patients with income greater than 400% of the HHS Poverty Guidelines (Means to Pay) (AH Policy #16); and E. Repayment terms for the unpaid, uninsured or underinsured portion of the bill. Notification to the patient of this program will be conducted through signage in key waiting areas and access points, through patient statements/letters and telephone communication through all revenue cycle contact points and the St. Vincent Health Website. Financial assistance will be provided by assessing the patient s household or family unit for their ability to pay. The income basis used for determining ability to pay will be the Federal HHS Poverty Guidelines (FPG) as published annually in the Federal Register. Version Date: 05/18/2011 Page 4 of 25

5 Sisters and Priests with the Catholic Church who are uninsured and have taken a vow of poverty automatically qualify for Charity Care under this program and are not required to complete the Financial Evaluation Form. Any balance due after insurance has paid or if the patient is uninsured will be written off as Charity Care. The basis of this program is the truthful and accurate provision and/or submission of financial information from the patient and/or responsible party(ies). Patients and/or responsible party(ies) that intentionally misrepresent their household financial information will be automatically disqualified from any consideration whatsoever with regard to this program. Intentional misrepresentation determination is the sole right of SVH. SVH reserves the right and authority to update, change or discontinue this program without any form of prior notification. Accounting for the for the Uninsured & Underinsured The financial impact of this program will be monitored and accounted for using a minimum of three specific transaction codes for the application of discounts and/or adjustments to the account. These transaction codes are as follows: Description G/L Account Charity Care-Category (Up to 200% FPG) Charity Care FAP Adjust-Category (200% to 400% FPG) Charity Care Uninsured Discount (Greater than 400% FPG) Administrative Adjustment Screening Patients for Federal, State and Local Program Eligibility, Charity Care and Financial Assistance An uninsured patient and/or the responsible party will be screened for financial assistance in the following manner: 1. Eligibility for Medicaid, Medicaid disability, Social Security disability and other Federal, State, Cobra or local healthcare programs and/or grants. 2. Charity Care adjustment for those patients with income levels less than or equal to 400% of the HHS Poverty Guidelines (see chart on Page 9). 3. Uninsured discounts provided to those patients greater than 400% of HHS Poverty Guidelines. The criteria used for A in the Policy Statement section above will be the established guidelines and policies provided by the governmental offices. Patients will be assisted to apply for any available form of assistance. In some situations, insured patients may be eligible for the programs outlined in A, B and C above for the patient s liability portion of their bill and may be screened and assisted upon request. Version Date: 05/18/2011 Page 5 of 25

6 Medicaid Eligibility If the patient appears to meet criteria for Medicaid, Medicaid disability, Social Security disability and other Federal, State or local healthcare programs, associates from the SVH ministry Financial Assistance Office (FAO) or their designee will: Inpatient - contact the patient and assist with the application process and ensure compliance with program requirements. Outpatient contact the patient in person or by telephone when possible and refer the patient to the appropriate program and provide a telephone number for assistance whenever possible. All hospital statements will also inform the patients of our program and how they may contact us to apply for the program. If an inpatient case is denied coverage and we believe the denial of coverage was inappropriate, we will assist the patient in filing an appeal. If an outpatient is denied coverage and we believe the denial of coverage was inappropriate, at our discretion, we will assist the patient in filing an appeal. Account balances for patients who receive services prior to the effective date of their Medicaid coverage will be written off as Charity Care. Account balances for services to a Medicaid recipient whose coverage ceases, is exhausted, or receives medically necessary services that are determined to be non-covered services by Medicaid will be written off as Charity Care. Account balances for patient accounts in a Deceased with No Estate status will also be considered charity care. International patients requesting charity care will be considered on a case by case basis. Charity Care Eligibility If the patient appears to meet criteria for Medicaid, Medicaid disability, Social Security disability and other Federal, State or local healthcare programs assistance will be provided to the patient to apply for the program. For non-elective (medically necessary) procedures, if the patient s income level is less than 400% of the HHS Poverty Guidelines and does not meet criteria for Medicaid, Medicaid disability, Social Security disability and other Federal, State or local healthcare programs, they can be considered for Charity Care assistance. Charity care write-offs or financial assistance adjustments will be made according to the HHS Poverty Guidelines Calculation Table (FAP Table) Patients requesting assistance who qualify for assistance will receive written notification of the charity award. Retirement funds, the principal residence and ordinary automobiles are excluded from consideration when evaluating the patient s income and ability to pay unless they are determined to be an extraordinary asset (see definitions). Version Date: 05/18/2011 Page 6 of 25

7 (FAP) Patients who meet the criteria of income between 200% and less than or equal to 400% of the HHS Poverty Guidelines will be eligible for a discount from total charges. They will also have a cap on their total patient liability for a single visit at 10% of their gross annual (calculated or anticipated) income. Income is based on the total available or anticipated gross income for the household or family unit. Patients falling under 200% of federal poverty guideline who are eligible for group health insurance but who choose not to pay will be required to pay $ of their hospital bill. Patients requesting assistance who qualify for assistance will receive written notification of the charity award. Discounts for FAP approved services are considered part of SVH s Charity Care program as Category I and are adjusted as partial Charity Care. Means to Pay and Prompt Payment of Uninsured Amounts Uninsured patients will receive a discount from total charges in the amount of 40% at the time of final billing. The 40% rate became effective 07/01/12. The hospital may choose to provide an additional discount over the minimum required discount. Assistance may be awarded in cases where the amount of medical bills compared to gross income creates a high likelihood that the patient will be unable to pay their medical claim. Insured patients with income determination greater than 400% may be eligible for assistance for their patient liability or non-covered services in cases where medical bills or circumstances indicate patients medical bills compared to gross income creates a high likelihood of inability to pay. Appeal Process for Patients Patients will be notified of the appeal process through the approval and denial notification process. If a patient wishes to appeal a determination with regard to Charity Care, Financial Assistance or Means to Pay, their written request and reason for an appeal should be directed to St. Vincent Health or his/her designee with all pertinent forms and documentation. The Vice President of Revenue Cycle or his/her designee will review the case and supporting documentation, discuss any and all pertinent issues with the patient, the responsible party and the locally sponsored ministry. A final decision with regard to the appeal will be issued in writing within 30 days of receipt of the written appeal. Version Date: 05/18/2011 Page 7 of 25

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9 Repayment of Patient Liability In exchange for consideration and application of the FAP and Means to Pay program, patients are expected to pay their portion of discounted services at time of service or shortly thereafter. It may not be possible for patients to repay SVH providers within the designated timeframe. Therefore, provisions will be made with lending institutions to provide interest free monthly payment arrangements for patients who qualify for the FAP or Means to Pay. Upon request by patient, payment arrangements will be established through our financing partner. Collection of Unpaid Balances When a patient and/or responsible party fail to pay their portion of the amount due, the account will be referred to an agency for collection. The amount of dollars due will be the amount of the debt as calculated under this program. Patients will receive a minimum of four statements and multiple phone calls asking them to establish arrangements prior to referral to a collection agency. Legal action may be initiated against those patients and/or responsible party(ies) who default on payment to SVH and have the Means to Pay (income greater than 400% of the HHS Poverty Guidelines) or those patients whom have already been provided partial financial assistance because it has been determined that they have the means to pay the remaining balance. This legal action may include lawsuit, judgment, interest applied to the balance due as allowed by Indiana statute, property or estate lien(s) and garnishment of wages. Body attachments and foreclosure will not be used as a means to collect a debt regardless of the patient s income category. Presumed Prior to referral to a collection agency, patient accounts with large balances are reviewed to determine if they would have qualified for assistance had they made the effort to request assistance. This Presumed uses a scoring algorithm to place the patient into a federal poverty level. Based upon that level the patient is given Financial Assistance even though it was not requested. Under this Presumed Financial Assistance Program patients who fall under the 200% of federal poverty guidelines are provided 90% (85% for CAH facilities) financial assistance and billed for the remaining 10% (15% for CAH facilities). Patients with extremely large balances remaining after that adjustment are reviewed again to determine if additional assistance is required and adjustments are made by Management Level if appropriate. Version Date: 05/18/2011 Page 9 of 25

10 St Vincent Health Payment Options Objective: Programs offered must be viewed as a positive by our patients and lead to an increase in customer satisfaction. To reduce the amount of patient responsibility accounts receivable, the hospital offers an interest free financing option for our customers. Charge Card payments are promoted for payment in full and may be offered in conjunction with a discount. All patient statements must include reference to our financial assistance program and the basic charity guidelines. At least one statement must include an insert that specifically identifies current federal poverty guidelines and family size in both English and Spanish language. Concept: Patients will be encouraged to pay their accounts in full by selecting from one of the following options. The intent of the overall program is to remove obstacles for payment in full: Option 1: Payment in full using Check, Money Order, Credit or FSA Card. Option 2: Internal Payment Plans for those patients wishing short term payment arrangements of four months or less. Option 3: Revolving Credit Program: A recourse program that finances any patient balances $50 or greater. This program is interest free to our patients with fees and interest paid by the hospital. The program also allows the patient to add additional account balances to the account for any hospital within St. Vincent Health while sending one statement per month. The program is also very easy to implement: 1) The patient indicates they wish to pay their bill using this program. 2) The account information is sent to Program partner on a daily basis. 3) Program partner funds the hospital electronically on a weekly basis. 4) Once the account is processed, the program partner sends a welcome packet to the patient notifying them of their account information. 5) The Banking Institution of the program partner sends a monthly statement to the patient. 6) When the patient wishes to add additional accounts to their account, the hospital needs to verify that the account is still in good standing. 7) If the account is still in good standing, the above process is repeated. Version Date: 05/18/2011 Page 10 of 25

11 Appendix Definitions: Assets Personal property and items of value including savings accounts owned by the patient and/or responsible party. Elective Care Healthcare provided in non-urgent, non emergency situations that benefits the patient and is not considered to be medically necessary, i.e. cosmetic or plastic surgery. Emergency A life threatening condition that requires immediate care from a licensed physician and nurses under the direction of a licensed physician. Extraordinary Assets - Those items over and above the basic needs of housing and transportation required for self-sufficiency. Examples of extraordinary assets would be: Savings Accounts with value in excess of estimated annual expenses Personal property considered recreational, such as vacation homes Non-Income generating land Multiple vehicles per adult in the family Family Unit Family unit consists of parent(s) with minor children residing at the current address listed on the registration form or adult child supporting a parent(s) within a single household. Household Income The total amount earned by all household members residing at one residential location. If there are multiple family units living in the household, then the family unit itself is to be counted for income and the other family units are excluded from total income calculations. Income- Any and all dollars that assist the patient in self-sufficiency is income. Income can be the result of wages, investment income, rental income and other sources of cash for daily living expenses. Support If an applicant receives partial or full financial support from another individual within the residence, then that individual s income is to be included in the total gross income. If an applicant receives partial or full financial support from another individual outside the residence, then only the support amount is to be included in total gross income. Uninsured A patient and/or responsible party who, through no fault of their own, does not have third party coverage or access to third party coverage for healthcare services through their employer, their spouse s employer, their parent s employer, or their significant other s employer. Underinsured A patient and/or responsible party with third party coverage for healthcare services who may have an extraordinary amount due that they cannot pay due to household or family unit income. Urgent Care Care that is not determined to be an emergency situation, but does require some level of attention to avoid further harm or deterioration of health in the near future. Version Date: 05/18/2011 Page 11 of 25

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