Patient Assistance Program (Charity Care) Program Overview This procedure addresses Northeastern Vermont Regional Hospital s (NVRH) Patient Assistance or Charity Care Program. Charity Care is defined as the desire, but not the ability to pay for health care services. Bad Debt is defined as the ability, but not the desire to pay for rendered health care services. The policies and procedures outlined in this procedure will assist NVRH in correctly identifying Charity Care and will eliminate the potential for Charity Care being unidentified and/or incorrectly classified as Bad Debt. Charity Care will be provided for Northeastern Vermont Regional Hospital patients from Vermont and New Hampshire. Signs are posted in the Access Area indicating Northeastern Vermont Regional Hospital s participation in a Patient Assistance Program. All self pay guarantors will be provided a grid for determining eligibility for the Patient Assistance Program in a letter from the self pay Patient Account Specialist. Guarantors, other than those with the Medicaid program as identified above, who request financial assistance, will be screened against eligibility criteria. Eligibility for Patient Assistance involves the evaluation of household income as a percentage of the Federal Poverty Guidelines. Patient Assistance will be granted only after exhausting other resources of payment. Representatives from Patient Business Services or Community Connections staff will assist guarantors with the financial assistance application process. All open accounts with the applicable guarantor and or family members will have the insurance mnemonic of PA.APPL assigned to the account to indicate that a Patient Assistance Application is on file. This is an internal designation only. This insurance mnemonic will be updated in demo recall and not removed by the registration staff on new registrations until a determination has been made. In mutual respect for our patients, NVRH and other Vermont and New Hampshire hospitals have an unwritten agreement to honor each facility Patient Assistance approvals, eliminating the need for the patient from having to complete duplicate applications. Patient Assistance (Uncompensated Care) may be provided to patients who, at the discretion of the management of NVRH, have not filed a formal application. These allowances can be authorized based on extenuating circumstances. This provision is not intended to be used as an alternative to the application process, but to provide the necessary administrative flexibility, in certain situations. Patient Assistance (Charity Care) Page 1
Persons applying for patient assistance must make a minimum good faith payment of $10.00 monthly until the application is finalized. Medicare and self Pay applications will require approval of the Director of Patient Business Services or designee. Applications require disclosure of assets, income (with documentation) and proof of Medicaid denial. Patient Assistance may be approved either prior to or post services being rendered. Once a guarantor has been approved, it will be valid for all open debit accounts and encounters and future services for a one year period. After this one year period patients must reapply. Policies Northeastern Vermont Regional Hospital will provide Charity Care services for medically necessary inpatient, outpatient and affiliated Physician Practice(s) service except for the following services: hearing aids and Independent Physician Therapy training. These services are rendered without expectation of payment except for the good faith payments made during the application process from or on behalf of the individual and/or individual s guarantor receiving the services. Once approved the Patient Assistance will be applied to any residue amounts outstanding providing the accounts have not been placed with an outside agency. Charity Allowances If a guarantor appears to be financially indigent, Patient Business Services staff or designee will assist the patient/guarantor in applying for both Medicaid and other state sponsored programs for the State of Vermont. Patient Business Services staff or designee will direct New Hampshire guarantors to apply for Medicaid in New Hampshire. If no source of financial assistance is available, Northeastern Vermont Regional Hospital will review the account for a charity allowance. The sliding scale guidelines are updated annually by the Chief Financial Officer based on the poverty guidelines as established by the Federal Government Services Agency (GSA) and published annually in the Federal Register. The accounts receivable will be relieved (written-off) in adherence to the Northeastern Vermont Regional Hospital s adjustment policy. The write off will indicate the expiration date of the charity care approval in the adjustment transaction. The same indigent/charity care policy guidelines will be applied for Medicare accounts and applied toward any unpaid coinsurances and deductibles. Guidelines for Processing Indigent/Charity Care Accounts Apply the following guidelines when processing indigent/charity care accounts: Patient Business Services Designee will process all inquiries and applications for Patient Patient Assistance (Charity Care) Page 2
Assistance utilizing the sliding scale guidelines established in this policy & procedure. Applicants will be requested to furnish information concerning assets and to substantiate income and eligibility, or lack of, insurance, state or federal Medical Assistance. Perform a financial analysis identifying eligibility resources for Medicaid, State funding, disability, etc. on all self-pay and under-insured patient accounts. Types/Location of Services Criteria The Northeastern Vermont Regional Hospital may offer Charity Care services for all services provided within the hospital or affiliated facilities as deemed medically necessary by the medical staff. Once approval has been granted it will remain valid for one (1) year. Approval will be indicated in shared (on a need to know basis) file under the Patient Assistance cabinet. All open accounts excluding accounts that have been referred to outside third party for collections will be considered for charity write-off upon approval. Patients qualifying for Medicaid are required to apply for Patient Assistance to cover the remaining co-payments and deductibles. Household Defined Household is defined as a group of two or more persons related by birth, marriage, civil union from Vermont Act 91, adoption, who reside together and among whom there are legal responsibilities for support; all such related persons are considered one household. Household further includes persons living together who present themselves and live as a married couple. Asset Guidelines Assets will be considered in each application. Ability to satisfy the obligation through these assets will be determined. Assets such as Bank Accounts, Real Estate, Stock, Bonds and other will be considered to be available resources Equity in the primary residence will be excluded from the consideration, as will assets which are part of federally qualified retirement programs. Patient Assistance (Charity Care) Page 3
Income Guidelines Income is defined as total annual cash receipts before taxes from all sources except as identified below. Income includes: money from wages and salaries before any deductions; net receipts from non-farm or farm self-employment (receipts from a person s own business or from an owned or rented farm after deductions for business or farm expenses; regular payments from social security, railroad retirement, unemployment compensation, worker s compensation, strikes benefits from union funds, disability benefits, veteran s benefits; public assistance including aid from the Department of Children & Families, Supplemental Security Income and General Assistance money payments. training stipends; alimony, child support, and military family allotments or other regular support from an absent family member or someone not living in the household; private pensions, government employee pensions, and regular insurance or annuity payments; dividends, interest, rents, royalties, or periodic receipts from estates or trusts; and Net gambling or lottery winnings. Income does not include the following: capital gains; any liquid assets, including withdrawals from a bank or proceeds from the sale of property; tax refunds; gifts, loans and lump-sum inheritances; one-time insurance payment or other one-time compensation for injury; non-cash benefits such as the employer-paid or union-paid portion of health insurance or other employee fringe benefits; the value of food and fuel produced and consumed on farms and the imputed value of rent from owner occupied non-farm or farm housing; and Federal non-cash benefit programs, including food stamps, school lunches and housing assistance. Although one-time insurance payments are excluded from income, one-time insurance payments made for coverage of hospital services would limit the availability of the free care to bills on amounts not covered by such payments. Income may be documented by: copy of most recent tax form; copy of most recent pay stub(s); Signed statement of income from employers; Patient Assistance (Charity Care) Page 4
Copy of benefits statements: i.e. Social Security, AFDC; Workers Compensation; Pensions, Unemployment, etc.: Advising Guarantors of Patient Assistance Program The Patient Access Specialist will advise all patients (guarantor s) presenting without insurance of the Patient Assistance Program. The Patient Access Specialist will provide all patients who have no insurance listed with Business Card of the Patient Accounts Specialist handling Patient Assistance and instructed to call for an application. Patient Account Specialist staff will screen for all un-insured and under-insured guarantors and provide assistance with both the Medicaid Application and/or Patient Assistance application. The first letter the self pay guarantor receives will advise the guarantor of the Patient Assistance Program and provide a grid indicating income and allowance amounts. Upon receipt of the Patient Assistance Application or phone call concerning the the process the insurance mnemonic of PA.APPL will be added to every open debit balance claim in a UB or FB status as the last payer by the Patient Account Specialist staff. Any patient applying for Patient Assistance will not be referred to an outside collection Agency during the processing period. Acknowledgment of Patients meeting criteria for Patient Assistance Guarantors having met the criteria for Patient assistance will have the demo recall data base identified with the insurance mnemonic that reflects applicable sliding scale amount by the Patient Business Services staff. FIN.AS100 FIN.AS75 FIN.AS50 FIN.AS25 Patients will be issued a Patient Assistance Program Identification card with Patient s Name, Effective Dates and Patient Business Services staff s Signature for presentation when receiving services at any NVRH facilities. Patient Assistance (Charity Care) Page 5
Guarantors will be instructed to present this card for services at the affiliated practices and hospital. The Patient Business Services staff or Designee will maintain a file, which is accessible to NVRH and affiliates office staff, with a listing of Patient Assistance approved applicants. The applicants will be listed in this library for a minimum of three months post final effective date. Adjustment of Patient Accounts meeting criteria for Patient Assistance Guarantors having met the criteria for Patient assistance will require approval for adjustment in adherence to NVRH Finance Policy. The Patient Business Services staff or Designee will review the accounts meeting criteria with the Director of Patient Business Services and/or Chief Financial Officer. Once approval has been obtained the Patient Business Services staff or Designee will remove the PA.APPL insurance mnemonic and replace it with the applicable Insurance mnemonic for assistance: i.e.: FIN.AS100 FINANCIAL ASST 100 FIN.AS75 FINANCIAL ASST 75 FIN.AS50 FINANCIAL ASST 50 FIN.AS25 FINANCIAL ASST 25 The policy information will be recorded in the following manner: Policy Data Policy # 022810 (this is the expiration date without the / s) Status On Off Date Exp Date 02/28/10 Ben Plan Coverage # Subscriber's Policy # Group # Group Name (Director s Use only!) No other information other than the above will be listed! All NVRH Charity Allowances requires the approval of Director Patient Business Services for claims in the amount of $19,999 or less and the Vice President of Finance for all claims greater than $19,999. After approval Hospital claims amounts will be adjusted using the following guidelines by the Patient Account Specialist for Self Pay Collections or the Director of Patient Business Services using the following adjustment codes that correspond with the amount of financial assistance granted. [Type text] Page 6
AFIN.AS25 for FINANCIAL ASST 25% AFIN.AS50 for FINANCIAL ASST 50% AFIN.AS75 for FINANCIAL ASST 75% AFIN.AS100 for FINANCIAL ASST 100% Each of these are routed to 01.5520.5300 The expiration date will be indicated with each adjustment. The Patient Business Services staff or Designee will advise the patient of eligibility determination via a letter. Statement Generation for Patient Assistance Applicants The PA.APPL insurance mnemonic will prompt a special series of statements to remind the patient of the obligations during the application process. It is imperative that the PA.APPL be listed on each open account of the Patient Assistance applicant for patients with Medicare/ Self Pay applications. Separate applications for Patients having Primary Commercial insurance. Patients presenting with primary commercial insurance will not qualify for Medicaid and therefore will not be required to complete the State applications. A separate application package (with separate instructions) is available for those individuals who have commercial primary insurance. These applications will not have the PA.APPL insurance mnemonic. Patient Assistance (Charity Care) Page 7
Patient Assistance Program (Charity Care) Acknowledgment of Patients meeting criteria for Patient Assistance... 7 Adjustment of Patient Accounts... 8 Advising Guarantors of Patient Assistance Program... 6 Charity Allowances... 3 Guidelines for Processing Indigent/Charity Care Accounts... 3 Household Defined... 4 Income documentation... 6 Income does not include... 6 Income Guidelines... 5 Income Includes... 5 Income does not include... 6 Overview... 1 Policies... 2 Patient Assistance (Charity Care) Page 8