REFERENCE NUMBER: PFS.PDS.115. TITLE: Patient Billing and Collections CURRENT EFFECTIVE DATE: 01/01/2018. PAGE 1 of 8 SCOPE:

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1 PAGE 1 f 8 SCOPE: This Patient Billing and Cllectins Plicy applies t all Presbyterian Healthcare Services (Presbyterian) hspital facilities, including inpatient, utpatient, hme health care services and ambulatry care clinics. PURPOSE: The purpse f this plicy is t define cllectin activities s that Presbyterian billing and cllectin practices are effective, reasnable and cnsistent, in accrdance with all applicable regulatry requirements. Presbyterian will nt engage in any extrardinary cllectin actins (as defined herein) against an individual t btain payment fr care befre reasnable effrts have been made t determine whether the individual is eligible fr assistance fr the care under ur Financial Assistance Plicy. POLICY: Presbyterian will use reasnable and cnsistent methds t cllect patient balances. Cntracted cllectin agencies will als fllw the requirements f this plicy. Presbyterian and its cntracted cllectin agencies will nt discriminate between Medicare and nn- Medicare accunts, either in their cllectin effrts r in their determinatin f cllectability. Except in the case f an emergency, it is the plicy f Presbyterian t cllect payment at the time f service based n the patient s insurance cverage and/r the patient s eligibility fr financial assistance. PROCEDURE: A. Pint f Service Cllectins Nte: The fllwing sectin des nt apply t emergency services r Medical Screening Exams (MSEs) which are always prvided regardless f the patient s ability t pay. Presbyterian will make a reasnable effrt t prvide patients with an estimated ut-fpcket cst fr the care prvided by Presbyterian after verifying their insurance benefits and eligibility fr financial assistance. A written estimate will be prvided upn request. Patients will be advised that services that are nt prvided by Presbyterian (even if in a Presbyterian facility) will nt be included in this estimate. It is the respnsibility f the patient t pay any deductible, cpayment r cinsurance amunt specified by their insurance plan at the time f service. Fr patients cvered under highdeductible health plans, if an estimate cannt be prvided at the time f service then a depsit will be required. Depsit and payment amunts may vary depending n qualificatin fr financial assistance.

2 PAGE 2 f 8 Any services nt cvered r authrized by the patient s insurance plan will be the respnsibility f the patient. Patients cvered by insurance that des nt include Presbyterian in its prvider netwrk, r des nt include ut-f-netwrk benefits fr services prvided by Presbyterian, will be cnsidered self-pay; these patients will be respnsible fr payment in full at the time f service unless satisfactry arrangements, including financial assistance, are apprved in advance. Patients wh are unable t make the expected payment at the pint f service will be asked t meet with a Presbyterian Financial Advcate and make apprpriate payment r have their services rescheduled fr a later date. Financial assistance and/r payment ptins are available fr patients wh qualify. See Payment Plans belw. B. Self-Pay Discunts Uninsured patients are eligible t receive a discunt f 30% fr all services, except fr lab services prvided by Presbyterian, which are eligible fr a 50% discunt frm billed charges. These discunts will be autmatically applied prir t the initial billing statement and will be reviewed n an annual basis t assure apprpriateness. Uninsured patients that have been navigated frm a Presbyterian Emergency Department t a Presbyterian Clinic will receive ne urgent care visit at n charge within 72 hurs f the riginal emergency department visit. All fllw up care will fllw the plicy as it applies t nn-emergent care. Clinics that participate in the Natinal Health Service Crps (NHSC) prgram may charge a flat fee t uninsured patients per clinic plicy. C. Payment Plans Presbyterian ffers ur patients the pprtunity t pay balances due in mnthly installments. Balances eligible fr payment plans: Balances greater than r equal t $ Nn-cvered services Self-pay balances fr uninsured patients Balances nt eligible fr payment plans: Balances less than $ Balances that have been previusly referred t bad debt Balances that have been previusly authrized fr a payment plan n which the patient defaulted

3 PAGE 3 f 8 Payment plan terms must adhere t the fllwing guidelines: Accunt Maximum Terms f Payment Plan Balance $100 - $500 4 mnthly payments $501 - $1,000 6 mnthly payments $1001 $2, mnthly payments $2,501 $5, mnthly payments $5,001 $10, mnthly payments >$10,001 > 36 mnths (minimum $150 / mnth) Request fr payment terms that fall utside f these guidelines must be apprved by the Directr f Patient Accunting r his designee. D. Cmmunicatin f the Presbyterian Financial Assistance Prgram Presbyterian ffers financial assistance fr patients wh meet the qualificatins set frth in the Presbyterian Financial Assistance Plicy (FAP) (PFS.PDS.116). Patients may btain a cpy f the FAP, FAP applicatin, and a plain language summary f the FAP thrugh the fllwing ways: Online at By cntacting a custmer service representative at By cntacting a financial cunselr at a Presbyterian clinic r facility By mail, free f charge, upn request t a custmer service representative r a financial cunselr. Patients may submit cmpleted FAP applicatins during a 240-day Applicatin Perid (as defined herein). Presbyterian will nt engage in any extrardinary cllectin actin (ECA) against the patient r guarantr withut making reasnable effrts t determine the patient s eligibility under the FAP plicy. Specifically: Presbyterian will ntify individuals abut its FAP befre initiating any ECAs t btain payment fr care and will refrain frm initiating any ECA fr at least 120 days frm the first pst-discharge r pst-visit billing statement fr the care. If Presbyterian intends t pursue ECAs, the fllwing will ccur at least 30 days befre first initiating ne r mre ECAs:

4 PAGE 4 f 8 Presbyterian will ntify the patient in writing that financial assistance is available fr eligible individuals and will identify the ECAs that may be initiated t btain payment. This written ntice will include a deadline after which such ECAs may be initiated that is n earlier than 30 days after the date that the ntice is prvided; The abve ntice will include a plain language summary f the FAP; Presbyterian will make a reasnable effrt t ntify the patient verbally abut the FAP and hw the individual may btain assistance with the applicatin prcess. If Presbyterian cmbines a patient s utstanding bills fr multiple episdes f care befre initiating ne r mre ECAs, it will refrain frm initiating the ECAs until 120 days after it prvided the first pst-discharge billing statement fr the mst recent episde f care. E. Pre-Cllectin Billing Statement Prcess Uninsured patients will be sent a billing statement within 30 days after the date f service and apprximately every 30 days thrughut the Applicatin Perid. Insured patients will receive a statement nly if there is a balance due after their insurance has paid the claim. Patients will be sent a billing statement prmptly, and will receive billing statements apprximately every 30 days thrughut the Applicatin Perid. Nte: Presbyterian utilizes a pre-cllectin letter series administered by a third party fr hspital patient balances. The patient will receive three written ntices f the balance due. If the balance remains unpaid at the cnclusin f the letter series, the accunt will be returned t Presbyterian, at which time it may be referred t a cllectin agency. F. Extrardinary Cllectin Actins It is the plicy f Presbyterian nt t engage in ECAs against an individual t btain payment fr care befre making reasnable effrts t determine whether the individual is eligible fr assistance under its FAP. ECAs include reprting adverse infrmatin abut the individual t cnsumer credit reprting agencies r credit bureaus.

5 PAGE 5 f 8 G. Prcessing FAP Applicatins If an individual submits an incmplete FAP applicatin during the Applicatin Perid, Presbyterian will: Suspend any ECAs; and Prvide the individual with a written ntice that describes the additinal infrmatin and/r dcumentatin required under the FAP r FAP applicatin frm that must be submitted t cmplete the applicatin. This ntice will include the Presbyterian cntact infrmatin set frth in this plicy. If an individual submits a cmplete FAP applicatin during the Applicatin Perid, Presbyterian will: Suspend any ECA previusly initiated; Make an eligibility determinatin as t whether the individual is FAP-eligible fr the care and ntify the individual in writing f the eligibility determinatin (including, if applicable, the assistance fr which the individual is eligible) and the basis fr this determinatin. If the individual is determined t be FAP-eligible fr the care, Presbyterian will: Prvide the individual with a written ntificatin that indicates the amunt the individual wes fr the care under the FAP, hw that amunt was determined and hw the individual can get infrmatin regarding the AGB fr the care. Refund t the individual any amunt he r she paid fr the care that exceeds the amunt he r she is determined t be persnally respnsible fr paying under the FAP, unless such excess amunt is less than $5 (r such ther amunt published in the Internal Revenue Bulletin). Take all reasnably available measures t reverse any ECA (with the exceptin f a sale f debt) taken against the individual t btain payment fr the care. In the event n FAP applicatin has been submitted during the Applicatin Perid, Presbyterian may initiate ECAs t btain payment fr the care nce it has ntified the individual abut the FAP as described in sectin D f this plicy.

6 PAGE 6 f 8 H. Returned Mail Statements returned with n frwarding address will be dcumented in the patient accunt. Accunts with returned mail will be flagged and statements suppressed fr the duratin f the Applicatin Perid. Patients with returned mail will receive n additinal written cmmunicatins frm Presbyterian unless they initiate actins t update their demgraphic infrmatin. Patient Financial Services will attempt t cntact patients using available phne numbers in the billing recrd. Cntact attempts will be dcumented in the patient accunt. In the event Presbyterian is unable t establish cntact with the patient, the balance may be referred t an external cllectin agency as prvided herein. I. Billing Dispute / Reslutin Cllectin activity will be suspended when a patient disputes the balance. Presbyterian will review, dcument and research the accunt fr prmpt reslutin. Any crrectins will be made immediately, accunts will be returned frm cllectins, and adverse reprting remved as apprpriate. Cllectin activities will resume n utstanding balances that are determined t be valid in accrdance with the Fair Debt and Cllectin Practices Act. Patients may dispute their balance by calling r tll free at , r by written cmmunicatin t: Presbyterian Patient Accunting Attn: Directr, Patient Accunting PO Bx Albuquerque, NM J. Overpayment / Credit Balance Reslutin Presbyterian will refund verpayments in the event Presbyterian receives patient payments in excess f the patient balance due. (PFS.PDS.117) In the event a patient believes his r her accunt has been verpaid, he r she may cntact Presbyterian fr review and determinatin by calling r tll free at

7 PAGE 7 f 8 K. Miscellaneus Prvisins Anti-Abuse Rule Presbyterian will nt base its determinatin that an individual is nt FAP-eligible n infrmatin that Presbyterian has reasn t believe is unreliable r incrrect r n infrmatin btained frm the individual under duress r thrugh the use f cercive practices. Determining Medicaid Eligibility Presbyterian will nt fail t have made reasnable effrts t determine whether an individual is FAP-eligible fr care if, upn receiving a cmplete FAP applicatin frm an individual wh Presbyterian believes may qualify fr Medicaid, Presbyterian pstpnes determining whether the individual is FAP-eligible fr the care until after the individual s Medicaid applicatin has been submitted and a determinatin as t the individual s Medicaid eligibility has been made. Final Authrity fr Determining FAP Eligibility Final authrity fr determining that Presbyterian has made reasnable effrts t determine whether an individual is FAP-eligible and may therefre engage in ECAs against the individual rests with the Directr f Patient Accunting r his designee. DEFINITIONS: AGB: Amunts generally billed fr emergency r ther medically necessary care t individuals wh have insurance cverage r amunts therwise determined in accrdance with regulatins that define methdlgies fr determining AGB. Applicatin Perid: The perid during which Presbyterian must accept and prcess an applicatin fr financial assistance under its FAP. The Applicatin Perid begins n the date the care is prvided and ends n the later f the 240 th day after the date f the first pstdischarge billing statement fr the care r at least 30 days after Presbyterian prvides the individual with a written ntice that sets a deadline after which ECAs may be initiated. Cllectin Agency: An utside, nn-hspital agency engaging in extrardinary cllectin actins. Extrardinary Cllectin Actin (ECA): includes any actin taken by Presbyterian against an individual related t btaining payment f a bill fr care cvered under Presbyterian s FAP that requires a legal r judicial prcess r invlves selling an individual s debt t anther party r reprting adverse infrmatin abut the individual t cnsumer credit reprting agencies r credit bureaus. FAP: Presbyterian s Financial Assistance Plicy.

8 PAGE 8 f 8 FAP-Eligible Individual: An individual eligible fr financial assistance under Presbyterian s FAP (withut regard t whether the individual has applied fr assistance under the FAP). REFERENCES: Financial Assistance Plicy and Prcedures (PFS.PHS.116) Credit Balance Management (PFS.PHS.117) Fair Debt and Cllectin Practices Act Internal Revenue Cde Sectin 501(r)