Munising Memorial Hospital. Administrative/Financial Policy

Transcription

1 Munising Memrial Hspital Administrative/Financial Plicy SUBJECT: Credit and Cllectins & Financial Assistance POLICY NO REVISED: March 26, 2014 Authrized By: The credit and cllectin plicy f Munising Memrial Hspital is designed t preserve a sund financial basis fr peratins f the institutins in rder that vital essential services may be btained. The plicy establishes a respnsibility fr the prmpt cllectin f patient charges. This plicy applies t all individuals wh receive services frm Munising Memrial Hspital, and frm that, establish a financial bligatin, except fr services prvided thrugh Harbur View Assisted Living. Harbur View is a fr prfit service prvided under unrelated business incme guidelines with the expectatin that prfits frm Harbur View services will subsidize Munising Memrial patient care. 1. All charges are due at the time f service. 2. Payment may be made with cash r credit card. MMH accepts Visa and MasterCard. 3. If insurance benefits are nt received within sixty (60) days frm the billing date, the patient must pay the accunt r make credit arrangements with MMH. 4. Mnthly installments are available if MMH s minimum payment is met. The fllwing minimum payments apply t the cmbined hspital/clinic ttal balance per guarantr: Balance: Minimum Mnthly Payment: 0 - $250 $50.00 $ $75.00 $501 - $1,000 $ $ % - max 10 mnths 5. An initial bill will be sent t the respnsible party fr the patient s persnal financial bligatins. 6. MMH will issue subsequent billings at least every 30 days and fr a minimum f 120 days after the initial bill befre referring an accunt t an external cllectin agency. The patient will receive at least 3 billing statements and a final ntice indicating that the accunt will be referred t an external agency when an acceptable payment has nt been received r when an apprpriate payment plan has nt been established. 7. The statement r billing ntices will be accmpanied by telephne calls, cllectin letters, persnal cntact ntices, and any ther ntificatin methd that cnstitutes a genuine and respnsible effrt t cntact the party respnsible fr the bligatin. 1 P a g e

2 8. MMH will dcument alternative effrts t lcate the party respnsible fr the bligatin r the crrect address n billings returned by the pstal ffice service as incrrect address. Alternative effrts may include use f skip tracing methds, use f the internet, pst ffice recrds r ther purchased r widely available means f tracing a patient r guarantrs residence r pint f cntact with the intent f cllecting utstanding debt r ntifying them f ptins and ther prgrams f public assistance that may be available t them. 9. Fr Emergency Care services (services that culd qualify as emergency bad debt) with balances ver $1,000 where ntices have nt been returned as incrrect address r undeliverable, MMH will send a final cllectin ntice by certified mail. In these instances where, after a reasnable effrt, an accunt has been deemed as undeliverable, the accunt shall be referred t an external cllectin agency fr additinal fllw-up prir t the exhaustin f the 120 days frm the attempt f the initial bill. 10. Dcumentatin f cntinuus cllectin actin undertaken n a regular, frequent basis will be maintained by paper and electrnic media. 11. The patient s file will include dcumentatin f cllectin effrt including bills, fllw-up letter, telephne and persnal cntact, and will be maintained until an audit is cmplete. Prmpt Payment Discunt Munising Memrial ffers the fllwing prmpt payment discunt t all patients with a balance as utlined belw. Bay Care patients will nt be eligible fr prmpt pay discunts due t the extensive use f ffice visit deductibles required by almst all payrs. Prmpt pay discunts are exclusively available t hspital patients nly (excluding Harbur View). Balance t Balance Discunt 0 $1,000 10% Over $1,000 20% Discunts are fr current accunts (all patient service charges generated after plicy effective date) nly and must be paid in full within 15 days f the statement date. Patients with persnal balances f ver $1,000 that are unable t pay within 15 days will be apprved fr a 20% discunt if a persnal payment arrangement is made within thse 15 days and the accunt is paid in full within 10 mnths. 2 P a g e

3 Uninsured Payment Discunt Michigan Medicaid Expansin requires that Munising Memrial Hspital accept as payment in full 115% f ur Medicare rate frm UNINSURED patients whse husehld incme is less than 250% f the Federal Pverty Guidelines. T receive the current payment discunt, patients must cmplete a brief applicatin frm t verify their husehld incme. The current discunt rate and federal pverty guidelines are shwn n the applicatin. Prmpt payment discunts and financial assistance will be applied t the balance due fllwing the deductin f the uninsured payment discunt. POLICY Financial Assistance and Charity Care Plicy Munising Memrial Hspital is cmmitted t the prvisin f health care services t all persns in need f medically necessary care regardless f ability t pay. In rder t prtect the integrity f peratins and fulfill this cmmitment, the fllwing criteria fr the prvisin f financial assistance and charity care are established. These criteria will assist staff in making cnsistent bjective decisins regarding eligibility fr financial assistance and charity care while ensuring the maintenance f a sund financial base. This plicy applies t all individuals wh receive services frm Munising Memrial Hspital, and frm that, establish a financial bligatin, except fr services prvided thrugh Harbur View Assisted Living. Harbur View is a fr prfit service prvided under unrelated business incme guidelines with the expectatin that prfits frm Harbur View services will subsidize Munising Memrial patient care. COMMUNICATIONS TO THE PUBLIC Infrmatin abut the MMH s financial assistance and charity care plicy shall be made publicly available as fllws: A ntice advising patients that MMH prvides financial assistance and charity care shall be psted in key public areas f MMH, including Admissins, the Emergency Department, Clinic Office, and the Business Office. MMH will distribute a written ntice abut the availability f financial assistance and charity care t all patients. This will be dne at the time that MMH requests infrmatin pertaining t third party cverage. The written ntice als shall be verbally explained at this time. If fr sme reasn, fr example in an emergency situatin, the patient is nt ntified f the existence f financial assistance and charity care befre receiving treatment, he/she shall be ntified in writing as sn as pssible thereafter. Bth written ntice and verbal explanatin shall be available in any language spken by mre than 10% f the ppulatin in the Hspital s service area, and interpreted fr ther nn-english speaking r limited-english speaking patients and fr ther patients wh cannt understand the writing and/r explanatin. 3 P a g e

4 MMH shall train frnt-line staff t answer financial assistance and charity care questins effectively r direct such inquiries t the apprpriate department in a timely manner. Written ntice abut MMH s financial assistance and charity care plicy shall be made available t any persn wh requests the infrmatin, either by mail, by telephne r in persn. MMH s sliding fee schedule, if applicable, shall als be made available upn request. ELIGIBILITY CRITERIA Financial assistance and charity care are generally secndary t ALL ther financial resurces available t the patient, including grup r individual medical plans, wrker s cmpensatin, Medicare, Medicaid r medical assistance prgrams, ther state, federal, r military prgrams, third party liability situatins (e.g. aut accidents r persnal injuries), r any ther situatin in which anther persn r entity may have a legal respnsibility t pay fr the csts f medical services. Patients will be granted financial assistance and charity care regardless f race, creed, clr, natinal rigin, sex, sexual rientatin, r the presence f any sensry, mental, r physical disability r the use f a trained dg guide r service animal by a disabled persn. Financial assistance and charity care shall be limited t thse residing within the hspital s designated service area. Services eligible under this plicy: Fr the purpses f this plicy financial assistance refers t healthcare services prvided withut charge r at a discunt t qualifying patients. The fllwing healthcare services are eligible fr financial assistance: 1. Emergency medical services prvided in an emergency rm setting; 2. Nn-elective services prvided in respnse t life-threatening circumstances in a nnemergency rm setting; and 3. Medically necessary services, evaluated n a case-by-case basis at MMH s discretin. In thse situatins where apprpriate primary payment surces are nt available, patients shall be cnsidered fr financial assistance and charity care under this plicy based n the fllwing criteria: The full amunt f uncvered hspital charges will be determined t be charity care fr a patient whse grss family incme is at r belw 100% f the current federal pverty level and whse net assets are less than $100,000. The respnsible party s financial bligatin which remains after the applicatin f any sliding fee schedule shall be payable as negtiated between MMH and the respnsible party. The respnsible party s accunt shall nt be turned ver t a cllectin agency unless payments are missed r there is sme perid f inactivity n the accunt, and there is nt satisfactry cntact with the patient. MMH shall nt require a disclsure f the existence and availability f family assets frm financial assistance and charity care applicants whse incme is less than 100% f the current federal pverty level but may require a disclsure f the existence and availability f family assets frm financial assistance and charity care applicants whse incme is at r abve 100% f the current federal pverty level. 4 P a g e

5 FINANCIAL ASSISTANCE AND THE AFFORDABLE CARE ACT Effective April 1, 2014, financial assistance fr uninsured patients, nce apprved, will remain in effect until then end f the calendar year in which it was granted. Patients will be encuraged t purchase an affrdable insurance plan during the next pen enrllment perid. If a patient chses nt t purchase affrdable cverage, they will nt be eligible fr financial assistance in subsequent calendar years. Patients wh have purchased insurance under the Affrdable Care Act will be eligible t apply fr financial assistance t aid in payment f plan deductibles, c-pays, and ther nn-cvered, medically necessary charges. PROCESS FOR ELIGIBILITY DETERMINATION Initial Determinatin: MMH shall use an applicatin prcess fr determining eligibility fr financial assistance and charity care. Requests t prvide financial assistance and charity care will be accepted frm surces such as physicians, cmmunity r religius grups, scial services, financial services persnnel, and the patient, prvided that any further use r disclsure f the infrmatin cntained in the request shall be subject t the Health Insurance Prtability and Accuntability Act privacy regulatins and MMH s privacy plicies. All requests shall identify the party that is financially respnsible fr the patient ( respnsible party ). The initial determinatin f eligibility fr financial assistance and charity care shall be cmpleted at the time f admissin r as sn as pssible fllwing initiatin f services t the patient. Pending final eligibility determinatin, MMH will nt initiate cllectin effrts r request depsits, prvided that the respnsible party is cperative with MMH s effrts t reach a final determinatin f spnsrship status. If MMH becmes aware f factrs which might qualify the patient fr financial assistance r charity care under this plicy, it shall advise the patient f this ptential and make an initial determinatin that such accunt is t be treated as qualified t receive financial assistance r charity care. Final Determinatin Prima Facie Write-Offs. In the event that the respnsible party s identificatin as an indigent persn is bvius t Hspital s persnnel, and MMH can establish that the applicant s incme is clearly within the range f eligibility, MMH will grant charity care based slely n this initial determinatin. In these cases, MMH is nt required t cmplete full verificatin r dcumentatin. Financial assistance and charity care frms, instructins, and written applicatins shall be furnished t the respnsible party when financial assistance r charity care is requested, when need is indicated, r when financial screening indicates ptential need. All applicatins, whether initiated by the patient r MMH, shuld be accmpanied by dcumentatin t verify infrmatin indicated n the applicatin frm. The fllwing types f dcuments shall be used as evidence upn which t base the final determinatin f charity care eligibility: 5 P a g e

6 A W-2 withhlding statement; Pay stubs frm all emplyment during the relevant time perid; An incme tax return frm the mst recently filed calendar year; Frms apprving r denying eligibility fr Medicaid and/r state-funded medical assistance; Frms apprving r denying unemplyment cmpensatin; r Written statements frm emplyers r DHS emplyees. A determinatin f net assets less than $100,000. During the initial request perid, the patient and MMH may pursue ther surces f funding, including Medical Assistance and Medicare. The respnsible party will be required t prvide written verificatin f ineligibility fr all ther surces f funding. MMH may nt require that a patient applying fr a determinatin f indigent status seek bank r ther lan surce funding. Usually, the relevant time perid fr which dcumentatin will be requested will be 3 mnths prir t the date f applicatin. Hwever, if such dcumentatin des nt accurately reflect the applicant s current financial situatin, dcumentatin will nly be requested fr the perid f time after the patient s financial situatin changed. In the event that the respnsible party is nt able t prvide any f the dcumentatin described abve, MMH shall rely upn written and signed statements frm the respnsible party fr making a final determinatin f eligibility fr classificatin as an indigent persn. MMH will allw a patient t apply fr charity care at any pint frm preadmissin t the time the bill becmes delinquent, recgnizing that a patient s ability t pay ver an extended perid may be substantially altered due t illness r financial hardship, resulting in a need fr financial assistance r charity care services. If the change in financial status is temprary, MMH may chse t suspend payments temprarily rather than initiate charity care. Time Frame fr Final Determinatin and Appeals Each financial assistance applicant wh has been initially determined eligible fr charity care shall be prvided with at least 14 calendar days, r such time as may reasnably be necessary, t secure and present dcumentatin in supprt f his r her financial assistance applicatin prir t receiving a final determinatin f spnsrship status. MMH shall ntify the applicant f its final determinatin within 14 days f receipt f all applicatin and dcumentatin material. The respnsible party may appeal a denial f eligibility fr charity care by prviding additinal verificatin f incme r family size t the Chief Financial Officer within 30 days f receipt f ntificatin. The timing f reaching a final determinatin f charity care status shall have n bearing n the identificatin f charity care deductins frm revenue as distinct frm bad debts If the patient r respnsible party has paid sme, r all f the bill, fr medical services and is later fund t have been eligible fr financial assistance r charity care at the time services were prvided, he/she shall be reimbursed fr any amunts in excess f what is 6 P a g e

7 determined t be wed. The patient will be reimbursed within 30 days f receiving the financial assistance r charity care designatin. Adequate ntice f denial: When an applicatin fr financial assistance and charity care is denied, the respnsible party shall receive a written ntice f denial which includes: The reasn r reasns fr the denial; The date f the decisin; and Instructins fr appeal r recnsideratin. When the applicant des nt prvide infrmatin and there is nt enugh infrmatin available fr MMH t determine eligibility, the denial ntice als includes: A descriptin f the infrmatin that was requested and nt prvided, including the date the infrmatin was requested; A statement that eligibility fr charity care cannt be established based n infrmatin available t MMH; and That eligibility will be determined if, within thirty days frm the date f the denial ntice, the applicant prvides all specified infrmatin previusly requested but nt prvided. The Chief Financial Officer and/r Administratr will review all appeals. If this review affirms the previus denial f financial assistance and charity care, written ntificatin will be sent t the respnsible party and the Department f Health in accrdance with state law. If a patient has been fund eligible fr financial assistance r charity care and cntinues receiving services fr an extended perid f time withut cmpleting a new applicatin, MMH shall re-evaluate the patient s eligibility fr financial assistance and charity care at least semi-annually t cnfirm that the patient remains eligible. MMH may require the respnsible party t submit a new financial assistance and charity care applicatin and dcumentatin. DOCUMENTATION AND RECORDS Cnfidentiality: All infrmatin relating t the applicatin will be kept cnfidential. Cpies f dcuments that supprt the applicatin will be kept with the applicatin frm. Dcuments pertaining t financial assistance and charity care shall be retained fr 5 years. This plicy will be reviewed and updated annually. Attachments: Patient/Guarantr Accunt Statement Timeline Financial Assistance Applicatin Patient/Guarantr Accunt Statement Timeline Patient registers with insurance cverage: 1. Bill sent t insurer 2. After insurance determines level f cverage, patient is sent the first statement identifying the amunt they are respnsible fr, if any. 7 P a g e

8 First Statement (apprximately days fllwing date that bill is sent t insurer. Patient/Guarantr chse ne f the fllwing actins: A. Pay balance within 15 days f date f statement and qualify fr a prmpt pay discunt. B. Arrange payment schedule accrding t the Credit and Cllectins Plicy. C. Apply fr Financial Assistance within 15 days f date f statement (pssible qualificatin fr payment discunt). Secnd Statement (apprximately 30 days fllwing riginal statement): A. Arrange payment schedule accrding t the Credit and Cllectins Plicy B. Apply fr Financial Assistance Third Statement (apprximately 60 days fllwing riginal statement): A. Arrange payment schedule accrding t the Credit and Cllectins Plicy B. Apply fr Financial Assistance Furth Statement (apprximately 90 days fllwing riginal statement): Patient/Guarantr ntified that if they have nt arranged a payment schedule r qualified fr Financial Assistance within 30 days f the date f this ntice, the accunt is turned ver t a cllectin agency. Patient registers withut insurance cverage: 1. Patient is infrmed f Financial Assistance Plicy at the time f registratin. 2. Within 15 days f registratin the patient/guarantr is sent the 1 st statement. First Statement: Patient/Guarantr chse ne f the fllwing actins: A. Pay balance within 15 days f date f statement and qualify fr prmpt pay discunt. B. Arrange payment schedule accrding t the Credit and Cllectins Plicy. C. Apply fr Financial Assistance within 15 days f date f statement (pssible qualificatin fr payment discunt). Secnd Statement (apprximately 30 days fllwing riginal statement): A. Arrange payment schedule accrding t the Credit and Cllectins Plicy B. Apply fr Financial Assistance Third Statement (apprximately 60 days fllwing riginal statement): A. Arrange payment schedule accrding t the Credit and Cllectins Plicy B. Apply fr Financial Assistance Furth Statement (apprximately 90 days fllwing riginal statement): Patient/Guarantr ntified that if they have nt arranged a payment schedule r qualified fr Financial Assistance within 30 days f the date f this ntice, the accunt is turned ver t a cllectin agency. 8 P a g e