PATIENT ACCOUNTING DEPARTMENT CHARITY CARE POLICY

Transcription

1 PATIENT ACCOUNTING DEPARTMENT CHARITY CARE POLICY SCOPE: As part of our commitment to the health care needs of our community BMH has instituted this program designed to provide financial assistance to our patients who may not be able to pay for part or all of their care. Butler Memorial Hospital will treat all patients equitably, with dignity, respect, compassion and will not discriminate based on sex, age, color, race, religious creed, ancestry, national origin, disability, veteran s status or lifestyle. POLICY: Butler Memorial Hospital will extend presumptive charity care/financial assistance to medically indigent patients. The determination of medical indigent status will be consistent for all patients. Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with Butler Memorial Hospital's procedures for obtaining charity or other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay. PURPOSE: This policy establishes the process and requirements for applying for Charity Care the hospital will offer financial aid to patients that will consist of charity care, presumptive eligibility, and extended-payment arrangements. DEFINITION: 1. Charity Care: Healthcare services that have been or will be provided free or at a discount to individuals who meet the established criteria. 2. Family: A group of two or more people who reside together and who are related by birth, marriage, or adoption. 3. Family Income: Includes earnings, unemployment, worker's compensation, Social Security benefits, child support, etc. 4. Uninsured: The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations. 5. Underinsured: The patient has some level of insurance but still has out-of-pocket expenses that exceed his/her financial abilities. 6. Medically Necessary: As defined by Medicare (services or items that are reasonable and necessary for the diagnosis or treatment of illness or injury)

2 7. Hospital Courtesy Discount: The adjustment given to the uninsured patient granted by the hospital to decrease the patient's obligation from the hospital charge amount. 6. Charity Care Discount: An adjustment to the patient responsibility granted by the hospital based on the patient's income, and financial need. The patient may be eligible for 100%, 75%, or 50% charity care. 7. Presumptive Eligibility: A determination that a patient is presumed eligible for Charity Care when adequate information is provided by the patient or through other sources with allows Butler Memorial Hospital to determine that the patient qualifies for Charity Care. ESSENTIAL INFORMATION: 1. The policy will apply to all services provided at Butler Memorial hospital. All patients selecting BMH as their health care provider may be eligible to receive financial assistance under this policy. 2. The hospital will bill all insurance coverage on behalf of the patient to obtain benefit payments. The patient has an obligation to provide all the required insurance information and assignment of benefits; this does not relieve the patient from his/her obligation. 3. Payment in advance of the service may be required for asymptomatic services (routine physicals etc.) and for services that are generally considered as non-covered (cosmetic surgery, reversals for sterilizations, dental procedures.) 4. The hospital will provide financial counseling services to all patients who have a patient responsibility. The financial aid described in this policy will be considered the payment of last resort. The Patient Financial Services Representative will assist the patient in applying for Medical Assistance. 5. The method for applying or inquiring about our Charity Care Policy is to contact our office at between the hours of 8:00 am to 4:00 pm Monday through Friday or visit our office location at Butler Memorial Hospital, One Hospital Way, Butler, Pa 16001, 2nd floor Cashiers Office to apply in person. You also have the availability to request an application by ing [email protected] or visiting our website on the About BHS Page under the policy link ( to obtain an application. 6. Any patient seeking financial aid shall comply with all financial aid application requirements, including the production of documents within 30 days of receipt of application. BMH will treat such information confidentially and will only use the information for the purposes of determining the patient's eligibility for financial aid. 7. The Chief Executive Officer will make periodic reports to the Board of Directors on the Hospital's provision of charity care.

3 PROCEDURE: DISCOUNTS OFFERED: A. Charity Care Discount will be determined based on income and size of the family. We will follow the federal poverty guidelines when determining the patient eligibility. Patients will receive charity care in a range of 100% with income less than 200% of the Federal Poverty Guidelines, 75% with income less that 250% of the Federal Poverty Guidelines, or 50% with income less than 300% of the Federal Poverty Guidelines. (see appendix A for grid) B. To be eligible for a Charity Care discount, the patient or their representative must complete the Medical Assistance application and Charity Care Application. C. The Hospital Courtesy Discount will be offered to patients with no insurance coverage, and who do not qualify or choose not to apply for a Charity Care Discount. Patients who are responsible for the entire balance will have their charges reduced by 69%. This percentage will be calculated at the beginning of each fiscal year based on the amounts generally billed to patients who have insurance coverage. The discount based on the average discount negotiated with the commercial insurance plans. The discount based on this provision will be labeled Hospital Courtesy Discount. PROCEDURE: 1. Presumptive Eligibility for Charity Care: A. Eligibility will be considered in instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to a lack of supporting documentation. In the event there is no evidence to support a patient's eligibility for charity care, Butler Memorial Hospital will base their determination on the below criteria. 1. Homeless or received care from a homeless clinic. 2. Food Stamp eligibility 3. Patient is deceased with no known estate 4. Family or friends of a patient that provide information establishing the patient's inability to pay. 5. Patients who qualify for section 8 housing B. Financial need will be determined in accordance with procedures that involve an individual assessment of financial need determined by the Patient Financial services program policy.

4 1. Include an application process, in which the patient or the patient's guarantor are required to cooperate and supply personal, financial and other information and documentation to make a determination of financial need and eligibility for alternative sources of coverage from public assistance programs. 2. The required documents to apply for charity care require the patient to provide the following documents to verify income. A Tax return for the current year B. Social Security Benefits for the current year C. Unemployment Benefits D. Child Support Payments E. Paystub(s) listing year-to-date income F. Pension (copy of bank statement if directly deposited) G. Disability/Workers compensation H. Alimony I. Proof of any other sources of income J. Medical Assistance determination letter K. Number of dependents claimed for tax purposes 3. If eligibility is determined by Patient Financial Services representative that an applicant may be eligible, it will be required by Butler Memorial Hospital to explore appropriate alternative sources of payment and coverage from public and private payment programs and to assist patients to apply for such programs. 4. Take into account the patient's available assets and all other financial resources available to the patient. 5. Patient Financial Service Representative will review the patient's outstanding accounts for prior services. Once the application has been approved it will be in effect for six months before and after the approval date. C. Upon completion of presumptive charity care process, approvals will cover all services from date of service and up to (60) days after the application date. Presumptive charity care application approvals will be determined by Patient Financial Representative or at the discretion of the Director, Network Business Services. 1. After sixty day period, patient will be required to renew their application with Patient Financial Services.

5 D. Communication: Notification about charity care will be available from Butler Memorial Hospital which shall include the following: 1. A contact telephone number will be provided to all patients 2. Posting on all patient bills 3. Posting in all Patient Registration Areas 4. Posting on Butler Memorial Hospital's website 5. Posting in the Emergency Room areas 6. Posting in all outreach locations 7. Posting in the patient's hospital handbook 8. Patient's who have applied for Charity care will be notified within 30 days of their application whether they have been approved or denied by telephone or in writing. E. Regulatory Requirements: In implementing this policy Butler Memorial Hospital management and facilities shall comply with all other federal, state, and local laws, rules, and regulations that may apply to activities conducted pursuant to this policy.

6 APPENDIX A Dependants BUTLER MEMORIAL HOSPITAL CHARITY CARE GUIDELINES 100% Charity 75% Charity Annual Income Annual Income Less Than 200% of Less Than 250% of Federal Poverty Federal Poverty Guidelines Guidelines 50% Charity Annual Income Less Than 300% of Federal Poverty Guidelines Annual Income Annual Income Annual Income 1 $22,980 $28,725 $34,470 2 $31,020 $38,775 $46,530 3 $39,060 $48,825 $58,590 4 $47,100 $58,875 $70,650 5 $55,140 $68,925 $82,710 6 $63,180 $78,975 $94,770 7 $71,220 $89,025 $106,830 8 $77,260 $99,075 $118,890 75% PFA..... MINIMUM PAYMENT..... $24.00 PER MONTH 50% PFA..... MINIMUM PAYMENT..... $39.00 PER MONTH 2013 PUBLISHED FEDERAL POVERTY GUIDELINES For families/households with more than 8 persons, add $4,020 for each additional person. PERSONS IN FAMILY POVERTY GUIDELINE 1 $11,490 2 $15,510 3 $19,530 4 $23,550 5 $27,570 6 $31,590 7 $35,610 8 $39,630