Finance Division Revenue Cycle Operational Policy Page 1 of 6. Financial Assistance Program

Transcription

1 Finance Division Revenue Cycle Operational Policy Page 1 of 6 Financial Assistance Program I. POLICY STATEMENT Origination Date: Revision Date: 2/4/09 4/15/09, 8/3/09, 2/15/11, 3/14, 1/16, 11/16 Grady offers financial assistance to eligible patients for emergency and medically necessary healthcare. Grady will provide quality care for emergency medical conditions to all patients regardless of their ability to pay, their eligibility for financial assistance and without discrimination. II. FINANCIAL ASSISTANCE PROGRAM Who is eligible? Patients with incomes less than 400% of the Federal Poverty Level are eligible for financial Where and how to obtain an application? A Financial Assistance Program Application may be obtained as follows: - Financial Counseling Office, Admission, and Clinic Registration at Grady Memorial Hospital, a Neighborhood Health Center, or the Infectious Disease Center at Ponce. - Request an application by calling Request an application by mail at the following address: Grady Memorial Hospital 80 Jesse Hill Jr. Dr. SE PO Box Atlanta, Georgia Attn: Financial Assistance - Download the Financial Assistance Program Application from the Grady Memorial Hospital website as follows:

2 Page 2 of 6 How to apply for financial assistance: Complete, sign and submit the Financial Assistance Program Application as well as required documents as outlined in this policy in order to determine eligibility for financial What is required? When applying for financial assistance, individuals must provide the following documents: Proof of Identity: Provide the original or certified copies of acceptable identification and documentation to verify proof of identity, which includes, but is not limited to the following: a. Driver s License (Georgia), State of Georgia ID Card, Any Consular, Credit Card with Picture or School Picture ID b. Visa or Resident Alien Card or other immigration documents issued by the U.S. Government Proof of Residency: One to three of the following showing your current street address is required to prove residency for at least 30 days from the application date (a PO Box address and junk mail does not demonstrate residency): a. One to three utility bills such as power bill, gas bill, water bill and/or telephone bill b. Lease Contract c. Rent Receipt (showing current address) d. Food Stamps Letter e. Current Issued Voter s Registration Card f. Other business documents that verify your place of residency, such as, credit card statements, IRS, Medicaid letters, student letter from school, cable bill, cell telephone bills, bank statement, mortgage statement, check stubs showing your address, etc. Proof of income: Provide all proof documents that apply: a. One to three current paycheck stubs (patient and spouse) b. Social Security Administration Letter Current Year c. Unemployment Claim, Department of Labor Wage Inquiry, if applicable or recent bank statements, if patient is living off savings d. A letter from employer on company letterhead stating the rate of hourly pay, the total amount paid each pay period and how often the employee is paid e. Any decision letters indicating the patient is receiving unemployment compensation, Medicaid, Social Security disability, General Assistance, workers compensation or retirement plan f. Food Stamps Letter and paycheck stubs (if applicable) g. Verification of homelessness or a letter from a shelter on company letterhead h. Other business documents showing how the patient is being supported I. Last year s tax return statement Proof of number of dependents: One of the following is required as proof of the number of dependents: a. Previous year s Income Tax Return (most recent) b. Any decision letters indicating that the patient has legal responsibility for the child, such as, court ordered guardianship papers or custody papers c. Birth Certificate for each child age 18 and younger Financial Assistance Eligibility Eligibility for financial assistance is based on county of residence, family size, gross income and the Federal Poverty Level. - If a patient has potential payment resources such as, commercial insurance or third party liability, the individual must exhaust these payment sources prior to utilizing Grady s Financial Assistance.

3 Page 3 of 6 - If the patient meets criteria for any Federal or State Assistance Program, e.g., Medicaid, Medicare, Cancer State Aid, Georgia Crime Victims Compensation Program, etc., for some or all of the costs for healthcare services, the individual is expected to apply for such programs prior to utilizing Grady s Financial Assistance Program. Grady will provide assistance to patients when applying for such programs. MEDICARE PATIENTS WHO QUALIFY FOR MEDICAID OR OTHER THIRD PARTY PAYERS - Patients who have Medicare as a primary payer and Medicaid as a secondary payer will have responsibility for the Medicaid copayment only. - Patients with Medicare coverage as a primary and other third party payer coverage as a secondary will have responsibility for the third party payer copayment or the financial assistance discount cost whichever is the lesser amount. Automated Financial Assistance Eligibility Screening Patients may also qualify for financial assistance through an automated third party software. Financial assistance does not cover the following: Cosmetic/Plastic Elective Surgery Elective Services Fetal Anomalies International Patients - - Care provided to out-of-country patients with Visitor Visas Grady will determine if a service is eligible for financial Financial Discount Levels: Benefit levels are available for Fulton County, DeKalb County and other Georgia county residents. These levels include free and discounted patient financial responsibility for care. Who participates? Facility: Grady Providers of Care: Grady, Emory School of Medicine, and Morehouse School of Medicine. Although Emory School of Medicine and Morehouse School of Medicine acknowledges, the patient s eligibility for financial assistance and will apply free or discounted costs, the patient may receive a separate bill from the treating physician as well as for professional services provided by Radiologists, Pathologists, or other treating physicians. III. FINANCIAL ASSISTANCE TIME PERIOD Application Period: Individuals may apply for financial assistance prior to healthcare being provided and up to the 240 th day after the first billing statement is provided. During this Application Period, the patient or the patient s representative may apply for financial During the Application Period, Grady will accept and process all applications submitted. Processing the application will also take place even if the case is allowed to or has taken one or more Extraordinary Collection Actions (ECA) as described in this policy during this period.

4 Page 4 of 6 Extraordinary Collection Actions (ECA): ECA is actions taken by a hospital facility against an individual related to obtaining payment of a bill for care, service or treatment. This may include the following actions: - Selling an individual s debt for hospital care, service or treatment to a third party - Reporting adverse information about an individual to consumer credit reporting agencies or credit bureaus (collectively, credit agencies). - Commence a civil action against an individual. When an application is received during this 240 day Application Period, all ECA will be suspended, pending the determination of the individual s eligibility for financial If the patient is determined to be eligible for financial assistance as described in this policy, steps will be taken to reverse the ECA even if the actions were appropriate and permissible. IV. WHERE TO RETURN COMPLETED APPLICATIONS AND REQUIRED DOCUMENTS: The completed Financial Assistance Program Application and required documents may be delivered to: - Financial Counseling Department - Hospital Admission - Clinic Registration - Mail to: Grady Memorial Hospital 80 Jesse Hill Jr. Dr. SE PO Box Atlanta, Georgia Attn: Financial Assistance V. AVAILABLE HELP TO COMPLETE AND/OR SUBMIT THE APPLICATION Grady will provide help to individuals with obtaining, completing, and/or submitting the Financial Assistance Program Application by contacting the address above, presenting to a Financial Counseling Office or by calling the telephone number listed below: For questions regarding the Financial Assistance Program, please contact the Financial Counseling Department at VI. NOTIFICATION FOR FINANCIAL ASSISTANCE ELIGIBILITY APPROVAL Individuals will be notified in writing of the eligibility determination under the FAP policy and the basis for the determination. If eligibility cannot be determined due to missing information or documents, the individual will also be notified in writing. NOTE: Incomplete Financial Assistance Applications must be resolved within 30 days of being notified by a Financial Counselor. VII. ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE The amount of financial assistance for an individual will depend on several factors when determining eligibility for assistance as follows:

5 Page 5 of 6 1. Whether the patient received medically necessary healthcare, non-elective medical care and/or treatment. 2. Annual gross family income for the patient, spouse, or partner responsible for the patient s bill. 3. The county where the patient lives. 4. The patient s family size or the responsible party for the bill. 5. Other financial resources that are potentially available to pay for the health care services provided, including, but not limited to, commercial, government or other third party coverage. 6. Availability of health insurance. 7. The Federal Poverty Income Level. 8. Whether free and/or discounted care, service, and/or treatment is available through government programs or at other designated healthcare facilities. VIII. INCOME GUIDELINES USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE Free Care: Homelessness - Federal Definition of Homeless Individuals with an income of zero. Discounted Benefit Levels: Tier 1: Patients with an Annual Gross Family Income up to 250% of the current Federal Poverty Income Level will be eligible for discounts assuming they meet criteria for financial Tier 2: Patients with an Annual Gross Family Income 251% to 400% of the Federal Poverty Income Level will be eligible for discounts assuming they meet criteria for financial IX. FINANCIAL COUNSELING ASSISTANCE PROGRAM POLICY, REQUIREMENTS & PLAIN LANGUAGE SUMMARY Individuals may receive a copy of the Financial Assistance Program (FAP) policy, a Plain Language Summary, the FAP Application, and requirements as follows: - Grady Health System Website: - Financial Counseling Office - Hospital Outpatient Clinics - Neighborhood Health Centers - Emergency Department - Admissions Office - Billing Customer Service - Individuals may request the policy, application and the program requirement sheet to be mailed to his/her address by submitting a request to FAPpolicyapplication@gmh.edu, by calling or by mailing a request to the following address to include a return address and a contact telephone number: Grady Memorial Hospital 80 Jesse Hill Jr. Dr. SE PO Box Atlanta, Georgia Attn: Financial Assistance - The FAP policy, application and program requirements are available in English and Spanish.

6 Page 6 of 6 X. RIGHT TO REASSESS FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA AND ELIGIBILITY STATUS - Grady reserves the right to reassess an individual s eligibility at a later date in the event of changes in financial circumstances and/or upon receiving new or different information. - Grady s governing body, i.e., Grady, may adjust the eligibility criteria for the Financial Assistance Program periodically based upon: 1) the Community Health Needs Assessment (CHNA) conducted for the hospital; 2) as necessary to comply with applicable laws and regulations. XI. THE FINANCIAL ASSISTANCE PROGRAM POLICY (FAP) BROADLY PUBLICIZED The Financial Assistance Program Policy (FAP), Application, and Plain Language Summary and translations of these documents into several languages other than English are made available free of charge to the public as follows: - Financial Counselors will provide the FAP Application, program requirements and the FAP Plain Language Summary to all self-pay patients during their hospitalization. - The FAP is displayed for review and available electronically for printing and downloading from the Grady Memorial Hospital website at In addition, it is made available system-wide as indicated in XI. FINANCIAL COUNSELING ASSISTANCE PROGRAM POLICY, REQUIREMENTS & PLAIN LANGUAGE SUMMARY - FAP Newspaper Publication - Financial Counseling Office - Emergency Department - Clinic Registration - Admissions & Discharge XII. NON-DISCRIMINATION - Healthcare will be provided to all patients presenting for care without regard to race, creed, color, national orgin, or other characteristics covered by law, including immigration status. - Grady will not discriminate in providing emergent/urgent medical treatment or other medically necessary care or deny care, treatment, or service to those eligible for either financial assistance under FAP or Government Assistance Programs.

7 Financial Assistance Program Summary Grady Health System offers discounted care under a financial assistance program for medically necessary services. Eligible patients will not be charged more than amounts generally billed to those with insurance. Who is Eligible? The amount of financial assistance you may receive depends on your income, family size and county of residence. Patients with a family income at 400% of the Federal Poverty Level (FPL) or below may be eligible for a discount. What Services are Covered? Emergency and medically necessary care provided within the Grady Health System. The program covers services provided by all physicians and advanced practice providers associated with your care. The program does not cover cosmetic services. How to Apply? You will need to provide the following: Proof of identity: - Government issued ID Proof of county of residence: - Lease contract or rent receipt - Utility/Cable/Phone bill Proof of income: - Current pay stub - Social Security letter - Unemployment claim Proof of family size: - Most recent tax return - Dependents birth certificates Call to schedule an appointment with a Financial Counselor. Additional Information On the web - By phone In person Grady Memorial Hospital, Ground floor, Room GA026 Monday Friday, 7:00 AM 4:30 PM Grady Neighborhood Health Centers Monday Friday, 8:00 AM 4:30 PM