FLOYD MEDICAL CENTER POLICY AND PROCEDURE MANUAL PATIENT FINANCIAL SERVICES
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1 FLOYD MEDICAL CENTER POLICY AND PROCEDURE MANUAL PATIENT FINANCIAL SERVICES Page 1 of 5 TITLE: Billing and Collection Policy Purpose: To set forth the process Floyd Medical Center uses in obtaining payment for medical care, including the reasonable efforts it makes to determine whether an individual is eligible for financial assistance before engaging in Extraordinary Collection Actions (as defined in this Policy), and to set forth the actions Floyd Medical Center may take relating to obtaining payment for medical care. Policy No.: Developed Date: 03/25/2013 Review Date: Revised Date: Review Responsibility: Director and Assistant Director Patient Financial Services Reference Standards: IRC 501(r) Policy: Floyd Medical Center will not engage in Extraordinary Collection Actions against an individual before it has made reasonable efforts to determine whether the individual is eligible for assistance under Floyd Medical Center s Financial Assistance Policy. As set forth in more detail below, this Billing and Collection Policy: 1. Describes the process and time frames Floyd Medical Center uses in obtaining payment for medical care, including the reasonable efforts it makes to determine whether an individual is eligible for financial assistance before engaging in any Extraordinary Collection Actions. 2. Describes the actions Floyd Medical Center may take relating to obtaining payment for medical care, including Extraordinary Collection Actions. 3. Identifies the department with final authority or responsibility for determining that Floyd Medical Center has made reasonable efforts to determine whether an individual is eligible for financial assistance and, therefore, whether Floyd Medical Center may engage in Extraordinary Collection Actions against the individual. DEFINITIONS Application Period The period during which Floyd Medical Center will accept and process an application for assistance under its Financial Assistance Policy. With respect to each episode of care that Floyd Medical Center provides to an individual, the Application Period begins on the date care is provided to the individual and ends on the 240 th day after Floyd Medical Center provides the individual the first billing statement for the care.
2 Page 2 of 5 Extraordinary Collection Actions Actions taken by Floyd Medical Center (or its agent) against an individual related to obtaining payment of a bill for care covered under Floyd Medical Center s Financial Assistance Policy that require a legal or judicial process, or involve reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus. Actions that require a legal or judicial process include, without limitation, actions taken to: Place a lien on an individual s property; Foreclose on an individual s real property; Attach or seize an individual s bank account or any other personal property; Commence a civil action against an individual; Cause an individual s arrest; Cause an individual to be subject to a writ of body attachment; or Garnish an individual s wages. Notification Period The period during which Floyd Medical Center will notify an individual about its Financial Assistance Policy. With respect to each episode of care that Floyd Medical Center provides to an individual, the Notification Period begins on the first date care is provided to the individual and ends on earlier of (i) the 120 th day after Floyd Medical Center provides the individual the first billing statement for the care or (ii) the date on which the individual submits a complete or incomplete Financial Assistance Application. REASONABLE EFFORTS TO DETERMINE IF AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE A. Notification. In connection with its provision of medical care to an individual, Floyd Medical Center will notify the individual of its Financial Assistance Policy in the manner set forth in this Section. In particular, Floyd Medical Center will: i. Distribute a plain language summary of the Financial Assistance Policy and offer a Financial Assistance Application form to the individual before discharge; Include a plain language summary of the Financial Assistance Policy with all (and at least three) billing statements for the care and all other written communications regarding the bill provided to the individual during the Notification Period; Inform the individual about the Financial Assistance Policy in all oral communications with the individual during the Notification Period regarding the amount due for the care; and
3 Page 3 of 5 iv. Provide the individual at least one written notice that informs the individual about the Extraordinary Collection Actions Floyd Medical Center or other authorized persons may take if the individual does not submit a Financial Assistance Application or pay the amount due by a deadline (specified in the notice), which deadline is both at least 30 days after the notice and no earlier than the last day of the Notification Period. B. Incomplete Financial Assistance Applications. i. If an individual submits an incomplete Financial Assistance Application during the Application Period, Floyd Medical Center will: a. Not initiate any Extraordinary Collection Actions, or take further action on any previously-initiated Extraordinary Collection Actions, against the individual after receiving the application and until the completion deadline has passed without the individual having completed the Financial Assistance Application; b. Provide the individual with a written notice that describes the additional information and/or documentation required under the Financial Assistance Policy or Financial Assistance Application that the individual must submit to complete his or her Financial Assistance Application, which notice will include a plain language summary of the Financial Assistance Application; and c. Provide the individual with at least one written notice that informs the individual about the Extraordinary Collection Actions Floyd Medical Center or other authorized persons may initiate or resume if the individual does not complete the Financial Assistance Application or pay the amount due by a completion deadline (specified in the notice), which completion deadline is both at least 30 days after the notice and no earlier than the last day of the Application Period. If an individual who has submitted an incomplete Financial Assistance Application during the Application Period completes the Financial Assistance Application by the completion deadline, the individual will be considered to have submitted a complete Financial Assistance Application during the Application Period, and Floyd Medical Center will comply with the provisions set forth in Section 2.C of this Policy relating to complete Financial Assistance Applications. If an individual who submits an incomplete Financial Assistance Application during the Application Period fails to complete the Financial Assistance Application by the completion deadline, Floyd Medical Center may initiate or resume Extraordinary Collection Actions against the individual after the completion deadline. C. Complete Financial Assistance Applications.
4 Page 4 of 5 i. If an individual submits a complete Financial Assistance Application during the Application Period, Floyd Medical Center will: a. Not initiate any Extraordinary Collection Actions, or take further action on any previously-initiated Extraordinary Collection Actions, against the individual after receiving the application and until a determination is made regarding the individual s qualification for financial assistance under the Financial Assistance Policy; b. Make and document a determination as to whether the individual is eligible for financial assistance under the Financial Assistance Policy; and c. Notify the individual in writing of the eligibility determination (including, if applicable, the assistance for which the individual is eligible) and the basis for this determination. If it is determined that an individual is eligible for financial assistance under the Financial Assistance Policy, Floyd Medical Center will: a. Provide the individual with a billing statement that indicates the amount the individual owes as a person eligible for financial assistance and shows, or describes how the individual can obtain information regarding, the Amount Generally Billed (as defined in the Financial Assistance Policy) for the care and how Floyd Medical Center determined the amount the individual owes as a person eligible for financial assistance; b. If the individual has made payments to Floyd Medical Center (or any other person) for the care in excess of the amount he or she is determined to owe as a person eligible for financial assistance, refund those excess payments; and c. Take all reasonably available measures to reverse Extraordinary Collection Actions, if any (with the exception of a sale of debt), taken against the individual to collection the debt at issue, including, without limitation, measures to vacate any judgment against the individual, lift any lien or levy on the individual s property, and remove from the individual s credit report any adverse information that was reported to a consumer reporting agency or credit bureau. If it is determined that an individual is not eligible for financial assistance under the Financial Assistance Policy, Floyd Medical Center may take Extraordinary Collection Actions against the individual. D. No Financial Assistance Application. If an individual fails to submit a Financial Assistance Application during the Notification Period, Floyd Medical Center may
5 Page 5 of 5 initiate Extraordinary Collection Actions against the individual until and unless the individual subsequently submits a Financial Assistance Application during the remainder of the Application Period. If the individual submits a Financial Assistance Application during the remainder of the Application Period, Extraordinary Collection Actions will be suspended in accordance with the provisions of Section 2.B of this Policy (relating to incomplete applications) or Section 2.C of this Policy (relating to complete applications), as applicable. DEPARTMENT WITH RESPONSIBILITY FOR REASONABLE EFFORTS AND EXTRAORDINARY COLLECTION ACTIONS. Floyd Medical Center s Patient Financial Services Department is responsible for Floyd Medical Center s reasonable efforts to determine whether an individual is eligible for financial assistance and, therefore, for determining whether Floyd Medical Center may engage in Extraordinary Collection Actions against an individual.
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