SOUTHEASTERN REGIONAL MEDICAL CENTER PATIENT FINANCIAL SERVICES

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Noreen Powell
6 years ago
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1 SOUTHEASTERN REGIONAL MEDICAL CENTER PATIENT FINANCIAL SERVICES TITLE OF PROCEDURE: ORGANIZATION CHARITY POLICY PURPOSE: To establish a policy to provide relief for medical expenses incurred by patients and families of patients who do not have the financial resources to pay for their medical care. PROCEDURE: 1. The Patient Financial Services will be responsible for adhering to this procedure during the normal course of daily work activities. 2. The Director of PFS or designee will be responsible for communicating with the staff any and all changes made to this policy. 3. Southeastern Regional Medical Center will offer Financial Assistance adjustments to families who meet the Charity Care Guidelines (see attached) as approved by the Board of Directors. 4. Family size and the Income Poverty Guidelines, published annually by the Department of Health and Human Services, will be used as Financial Assistance Guidelines by Southeastern Regional Medical Center to determine eligibility. 5. Applications for Financial Assistance should be complete and accurate and include verifiable proof of household income and/or assets (i.e. W-2 forms, tax returns, payroll check stubs, statements from employers, deeds, tax records, etc). 6. The household will be designated as any person living in the same residence for the purpose of shelter, Regardless of relationship status. 7. All other avenues to obtain financial assistance (Medicaid and third party payments) must be exhausted prior to receiving SRMC Financial Assistance consideration. 8. Financial Assistance adjustments will only apply to the remaining balance after all insurance and third party payments have been applied. 9. Financial Assistance applications may be accepted and considered for inpatient and outpatient services only, elective and cosmetic services will not be considered. CHARITY CARE 2009 PP (2).doc 1

2 10. The following sliding scale will be used in determining the eligibility of an applicant for Financial Assistance: FINANCIAL ASSISTANCE ADJUSTMENT CHART FOR INCOMES OVER 100% of Federal Poverty Guidelines ACTUAL % PATIENT LIABILITY OF POVERTY % OF CHARGES % 0% % 5% % 10% % 15% % 20% 11. Patients are expected to pay the remaining balance on their account that would not be eligible for Financial Assistance adjustment(s). Patients who fail to pay their remaining balance will become delinquent and be subject to normal collection procedures. The patient responsibility portion must be remitted before the Financial Assistance deduction will be posted to the patient s account. 12. Any applicant that has been denied either partially or fully may provide additional information and have their application reconsidered. 13. Once an applicant has been approved for Financial Assistance, all accounts held by the patient within the past three (3) years may be included in the charity care determination. 14. Any patient, approved for a Financial Assistance adjustment, who requires future services, will be re-evaluated for eligibility at the time services are rendered. 15. Financial Assistance applications and documentation will be kept on file for ninety (90) days after Financial Assistance adjustment approval. 16. The applicant s home site (including house and one (1) acre of land) may be exempt from inclusion of assets. Any additional real and personal property may be used in the evaluation to determine the adjustment. 17. The patient s assets and unusual expenses, and the dollar amount of any additional medical bills, will also be taken into consideration. 18. The balance of all liquid assets will also be factored in when determining the amount of the Financial Assistance adjustment. It is the responsibility of the applicant to provide adequate documentation of such liquid assets to include checking account(s), savings account(s), stocks, bonds, I.R.A., etc. 19. Southeastern Regional Medical Center reserves the right to reverse any and all adjustments for uncompensated services provided by the Financial Assistance Policy if the information provided on the application is CHARITY CARE 2009 PP (2).doc 2

3 determined to be falsified or if proof that the applicant has received compensation for services from another source is obtained. 20. Any applicant who is denied Medicaid due to personal asset limits ($ per household) will be denied indigent. 21. The amount of the patient account(s) may be considered in relation to all other criteria outlined above, when eligibility relates to patient meeting criteria at the time of service is rendered. The history of service and the need for future services may be considered. Patients with catastrophic hospitalization charges, including verifiable debts with other medical providers and above average net worth, may be considered for Charity Care adjustments. (Amended 07/15/10) If the patient s liability exceeds 50% of the prior year s annual family income and/or assets, the following guidelines will be used for catastrophic charity care determination. Income Payment Required Up to $50K 15% of Annual Gross Income $50K to $75K 20% of Annual Gross Income $75K to $100K 25% of Annual Gross Income Over $100K 30% of Annual Gross Income 22. If there is no income a notarized statement will be required from the person who pays the household bills or helps the applicant financially. A UIB is required for all applicants receiving unemployment. 23. Medicare accounts are under special requirements regarding Charity Care applications and adjustments. A Medicare account cannot be written off to bad debt prior to one hundred twenty (120) days from bill date. Income documentation, verifying medically indigent status and compliance with the stated Charity Care Guidelines in this policy, must be obtained and made a part of the Charity Care documentation package if the account is to be written off prior to one hundred twenty (120) days from bill date. 24. Southeastern Regional Medical Center reserves the right to reverse any and all uncompensated services provided by the Charity Care Policy if the information provided on the application is determined to be falsified or if proof that the applicant has received compensation for services from another source is obtained. 25. Southeastern Regional Medical Center reserves the right to request any and all documentation deemed necessary to support any application for Charity Care. 26. A designated employee will meet with the patient, either in office, by telephone or via U.S. Mail and review qualifications for eligibility for Charity Care Guidelines and determine the amount/percentage applicable and other SRMC debts. 27. The designated employee will prepare the Charity Care application and attach all required documentation as outlined above. 28. The employee may send a standardized letter to the patient as needed in the case where a patient is denied or only partial approval is given. 29. Complete adjustment form and submit to appropriate Manager for approval. CHARITY CARE 2009 PP (2).doc 3

4 30. Verify adjustment has been completed and file application and attached documentation for the length of time specified above.. APPROVED BY: Director Patient Financial Services C. Thomas Johnson, III Vice President, Finance Date Implemented: _03/01/06 07/12/07 _ _ _ 03/22/11 CHARITY CARE 2009 PP (2).doc 4

Policy Name: Financial Assistance and Emergency Medical Care Policy

Policy Name: Financial Assistance and Emergency Medical Care Policy Key Points EFFECTIVE DATE: Revision Dates: 2/14/08; 8/1/08; 10/1/08; 1/23/09; 5/5/09; 11/22/2010, 12/21/2010; 1/20/11, 5/16/11; 1/26/12; 3/13/12; 1/24/13; 2/26/13; 3/7/13; 1/22/14, 5/28/14, 6/25/14, 1/27/15,