1. Identification of Potentially Eligible Patients.
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3 B. Approved financial assistance applications will be considered in force for 12 months (after which they expire), or until a change in patient financial status is determined. PROCEDURE 1. Identification of Potentially Eligible Patients. A. Whenever possible, prior to the service of the patient, Patient Financial Services staff will conduct a pre-admission interview with the patient, the guarantor, and/or his/her legal representative. If a pre-admission interview is not possible, this interview should be conducted at the time of the scheduled appointment or as soon as possible thereafter. In the case of an emergency, Tidelands Health evaluation of payment alternatives will not take place until after the required medical care has been provided. At the time of the initial patient interview, the following information should be gathered: 1. Routine and comprehensive demographic data. 2. Complete information regarding all existing third party coverage, may also include household family size and income. B. Identification of potentially eligible patients can take place at any time during the rendering of services or during the collection process. Patient Financial Services staff will review all applications submitted. Applicants that fail to respond to statements for services rendered or that do not request consideration for financial assistance within 30 days of their initial statement may continue to receive collection efforts as noted in the Tidelands Health collections policy. Applications for financial assistance will be reviewed with a retro look back period not to extend greater than 240 days. Applications submitted for services greater than 240 days of age will not be eligible for financial assistance review. C. Those patients who may qualify for financial assistance from a governmental program should be referred to the appropriate program, such as Medicaid, prior to consideration for financial assistance. Patients who refuse such referrals will not be eligible for the financial assistance program also includes failure to provide all required documentation. 2. Determination of Eligibility A. All patients identified as potential financial assistance recipients should be offered the opportunity to apply for financial assistance. If this evaluation is not conducted until after the patient leaves the facility, a Patient Financial Services representative will mail a financial assistance application to the patient for completion. The patient should receive and complete a written application and provide all supporting data required to verify eligibility. B. In the evaluation of an application for financial assistance, a patient s total resources will be taken into account which will include, but not be limited to, analysis of assets (identified as those convertible to cash and unnecessary for the patient s daily living expenses), family income. If a patient has available and sufficient resources, the patient is not eligible for financial assistance. The program will utilize collectability scoring to aid with the evaluation of the application.
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5 FINANCIAL ASSISTANCE GUIDELINES GROSS ANNUAL PATIENT INCOME LESS THAN RESPONSIBLE FAMILY SIZE (200% OF POVERTY) FOR 0% OF CHARGES ,280 32,920 41,560 50,200 58, , , ,760 EACH ADTL FAMILY MEMBER: 8,640 Effective Date: 02/01/2018
6 AMOUNTS GENERALLY BILLED (AGB) TEMPLATE Look-back Method Georgetown Waccamaw Sum of claims for emergency and medically 68,482, necessary care allowed by health insurers during 93,730, divided by 12 divided by 226,113, equals Sum of associated gross charges for those claims 303,475, equals 30% AGB percentage 31%
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8 Follows Financial Assistance Policy: Provider: Yes No Associated Pathology Associates in Surgery Atlantic Eye LLC Atlantic Urology Clinics Beach Medicine Carolina Coastal Plastic Surgery Carolina Kidney & Hypertension Specialists, PC Carolina OB/GYN Carolina Orthopedic Specialists Carolina Orthotics & Prosthetics Carolina Regional Cancer Center Carolina Rheumatology & Neurology Associates Carollina Health Specialists Coastal Cancer Center Coastal Carolina Infectious Disease Coastal Ear, Nose & Throat Coastal Eye Group Coastal Orthopedic Associates Coastal Psychological Consulting Diagnostic Pathology DMH Telepsychiatry Consultation Program Dunes Podiatry East Coast Retina Eastern Carolina Eye Center Emergency Room Physicians & Midlevels Executive Court Medical Specialists Floyd Brace Georgetown Anesthesia Consultants Georgetown Podiatry Georgetown Radiology LLC Grand Strand Psychological Services Grand Strand Urology Inlet Anesthesia Consultants, PC Inlet Pediatrics Inlet Pulmonary, Critical Care and Sleep Medicine Island Women's Care Low Country Foot Specialist Low Country Plastic Surgery Low Country Surgical Associates Murrells Inlet Heart & Vascular MUSC Department of Cardiology MUSC Department of Neurosciences MUSC Department of Orthopaedics MUSC Department of Radiation Oncology MUSC Tidelands MUSC Pediatric Hematology Nirvana Plastic Surgery Ocean Cardiology Palmetto Oral & Maxillofacial Surgery Pawleys Pediatrics and Adult Medicine Revolution Monitoring
9 Follows Financial Assistance Policy: Provider: Yes No Southeast Medical Associates Strand Infectious Diseases The Doc House The Pain and Rehab Institute Tidelands Coastal Carolina Breast Center Tidelands Georgetown Orthopedics Tidelands Heart and Vascular Tidelands Hospitalist Group Tidelands NextStep Pain Management Services Georgetown Tidelands NextStep Pain Management Services Murrells Inlet Tidelands NextStep Wound Healing & Infusion Center Tidelands Surgical Specialists of Waccamaw Tidelands Waccamaw Community Care Tidelands Waccamaw Family Medicine Tidelands Waccamaw Gastroenterology Tidelands Waccamaw Oncology Tidelands Waccamaw Orthopaedics Tidelands Winyah Women's Center Vision Radiology Waccamaw Kidney & Hypertension Specialists Waccamaw Oral Maxillofacial Surgery Waccamaw Surgical Associates Waccamaw Urology Winyah Surgical Specialists W Joye Counseling Services, LLC EKG Professional Interpretation Added Vascular Professional Interpretation Added Tidelands Waccamaw Community Hospital Added Tidelands Georgetown Memorial Hospital Added
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