Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual Subject: HealthCare Financial Assistance Plicy Purpse: T establish guidelines fr financial assistance respnsive t the needs f the cmmunity, regardless f race, age, gender, ethnic backgrund, natinal rigin, citizenship, primary language, religin, educatin, emplyment r student status, dispsitin, relatinship, insurance cverage, cmmunity standing, r any ther discriminatry differentiating factr. Scpe: Manager Finance & Business Office Administrative Directr (AD) Chief Nursing Officer (CNO) Designated staff Definitin: Uninsured is defined as, thse withut cmmercial r private insurance cverage, Medicare r Medicaid; including thse whse benefits have exhausted. AGB Amunts generally billed fr emergency r ther medically necessary care t individuals wh have insurance cverage. FPG U.S. Department f Health & Human Services Federal Pverty Guidelines. HCAP Ohi Hspital Care Assurance Prgram. HFA Healthcare Financial Assistance. PFS Patient Financial Services Department. SNF Skilled Nursing Facility. Plicy: 1. Healthcare Financial Assistance ( HFA ) is a prgram that cvers patients withut health insurance and thse with nly partial insurance cverage (i.e. the uninsured and underinsured) wh meet the incme and ther eligibility criteria described herein 2. HFA plicy applies t all emergency and ther medically necessary care prvided by IOS. 3. HFA plicy des nt apply t certain ther prviders delivering emergency r ther medically necessary care in IOS facilities. The list f prviders is maintained in a separate dcument and nline. Members f the public may readily btain it free f charge via the cntact list at the end f this plicy. Prcedure: HFA Eligibility Criteria: Incme T apply fr HFA, a patient r family member must cmplete an applicatin including grss incme fr a minimum f 3 mnths (up t 12 mnths) prir t the date f applicatin r date f service. Prf f incme is required with the exceptins f patients discharged t a SNF, patients wh are deceased with n estate, and patients wh have dcumented hmelessness. Third party incme scring may be used t verify incme in situatins where incme verificatin is unable t be btained thrugh ther methds. Assets There are situatins where individuals may nt have reprted incme but have significant assets available t pay fr healthcare services. In these situatins, IOS may evaluate these assets as cash available t meet essential living expenses, which includes healthcare expenses. Health Savings Accunts Reviewed and Apprved By Hspital Administratin Crp Resp. Plicy #: Page 1 f 5
Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual IOS requires prf that Health Savings Accunt and/r Medical Savings Accunt funds be depleted prir t prviding healthcare financial assistance. Federal Pverty Guidelines HFA eligibility is based upn expanded incme levels f up t 200% f FPG. Apprval is based upn the number f family members and family incme. If a dependent is disabled and ver the age f eighteen, he/she will be included in family size. The FPGs in effect n the date f service are in effect fr the applicatin prcess. They are issued each year in the Federal Register by the Department f Health and Human Services (HHS). The current and histrical FPGs are available at http://aspe.hhs.gv/pverty/index.cfm. Individuals with an incme level at 200% FPG r belw receive 100% discunt n healthcare services. Health Insurance Marketplace (Exchange) Participatin If a patient has elected nt t purchase health insurance cverage r enter the marketplace/exchange, financial assistance may nt be extended until they d s. Exceptins t this plicy include patients discharged t a SNF, patients wh are deceased with n estate, and patients wh have dcumented hmelessness. The patient will be cnsidered self-pay and receive the self-pay discunt in accrdance with 127 Payment Plicy fr Uninsured Patients, be ffered a payment plan, etc. Healthcare financial assistance may be ffered nce the patient meets the requirement fr insurance. Gegraphic Area Deductibles Patients wh live in the cmmunity served by IOS (Allen cunty and cunties cntiguus t Allen cunty) will be ffered healthcare financial assistance. Fr thse patients living utside f the gegraphic area, extenuating circumstances must be dcumented and apprved by the Administrative Directr. Fr patients wh dn t qualify fr HFA and have self-pay balances after insurance, balances attributed t the patients deductible will require payment. Upn receipt f the signed applicatin, the infrmatin will be reviewed, incme verified, and an eligibility determinatin will be made. The patient will be ntified in writing f the determinatin. Presumptive Eligibility Patients are presumed t be eligible fr financial assistance n the basis f individual life circumstances including but nt limited t Patient discharged t a SNF Patient is deceased with n knwn estate. State-funded prescriptin prgrams; Hmeless r received care frm a hmeless clinic; Reviewed and Apprved By Hspital Administratin Crp Resp. Plicy #: Page 2 f 5
Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual Participatin in Wmen, Infants and Children prgrams (WIC); Fd stamp eligibility; Subsidized schl lunch prgram eligibility; Eligibility fr ther state r lcal assistance prgrams that are unfunded (e.g., Medicaid spend-dwn); and Lw incme/subsidized husing is prvided as a valid address. Patients determined t have presumptive financial assistance eligibility will be prvided 100% financial assistance. IOS shall utilize available resurces (e.g. technlgy slutins, service rganizatins, etc.) t btain such infrmatin as credit scre in rder t assist in determining whether a patient is presumed eligible fr financial assistance Cperatin Patients/guarantrs shall cperate in supplying all third party infrmatin including Mtr Vehicle r ther accident infrmatin, requests fr Crdinatin f Benefits, pre-existing infrmatin, r ther infrmatin necessary t adjudicate claims, etc. While the applicatin is being prcessed, IOS will request that patients wh may be Medicaideligible apply fr Medicaid. In rder t receive healthcare financial assistance, the patient must apply fr Medicaid and be denied fr any reasn ther than the fllwing: Did nt apply; Did nt fllw thrugh with the applicatin prcess; Did nt prvide requested verificatins. Accuracy f Applicatin Financial assistance may be denied under this HFA plicy if there is reasnable suspicin f the accuracy f an applicatin. If the patient/guarantr supplies the needed dcumentatin and/r infrmatin requested t clarify the applicatin, the financial assistance request may be recnsidered. Recnsideratin will be reviewed and handled n a case-by-case basis. Applicatin Prcess fr HFA: Applicatin frms are made available in Pre-Admissin and Admissin / Registratin sites t facilitate early identificatin and initiatin f the applicatin prcess. Applicatin frms may als be btained by cntacting IOS via the cntact list at the end f this plicy. IOS may accept verbal clarificatins f incme, family size r any infrmatin that may be unclear n an applicatin. Inpatients will be required t cmplete an applicatin fr each admissin unless the patient is readmitted within 45 days f discharge fr the same underlying cnditin. Apprved utpatient applicatins are effective fr 90 days frm initial date f service. An inpatient applicatin can als be used t cver utpatient services fr the patient in the 90-day perid immediately fllwing the first day f the inpatient admissin. Reviewed and Apprved By Hspital Administratin Crp Resp. Plicy #: Page 3 f 5
Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual Financial Assistance fr Catastrphic Situatins: Financial assistance fr a catastrphic situatin is available under this plicy. Catastrphic financial assistance is defined as a patient that has medical r hspital bills after payment by all third parties that exceed 25% f the patient's ttal reprted incme and the patient is unable t pay the remaining bill. Basis fr Calculating Amunts Charged t Patients: Fllwing a determinatin f eligibility under this plicy, a patient eligible fr financial assistance will nt be charged mre fr emergency r ther medically necessary care than AGB. IOS will set the AGB fr, thse patients wh qualify fr the Financial Assistance Prgram, at the amunt Medicare wuld allw fr the care (including bth the amunt that wuld be reimbursed by Medicare and the amunt the beneficiary wuld be persnally respnsible fr paying in the frm f c-payments, cinsurance and deductibles). IOS des nt bill r expect payment f grss charges frm individuals wh qualify fr financial assistance under this plicy. Uninsured patients are required t make a dwn payment that will nt exceed AGB as defined abve. Actins Taken in the Event f Nnpayment: The actins that IOS may take in the event f nnpayment are described in Plicy 109, Billing and Payment: General Statements. Members f the public may btain a free cpy f this separate plicy by cntacting IOS via the cntact list at the end f this plicy. Measures t Widely Publicize the HFA Plicy: IOS makes this HFA plicy, applicatin frm, and plain language summary f the plicy widely available n its website, and implements additinal measures t widely publicize the plicy in the cmmunities served. IOS als accmmdates all significant ppulatins that have limited English prficiency by translating this HFA plicy, applicatin frm, and plain language summary f the plicy int the primary language(s) spken by such ppulatins. Ntice t Ohi Residents Ohi Hspital Care Assurance Prgram (HCAP): IOS prvides, withut charge t the individual, basic, medically necessary hspital-level services t individuals wh are residents f Ohi, are nt Medicaid recipients, and whse incme is at r belw the federal pverty line. Cvered services are inpatient and utpatient services cvered under the Ohi Medicaid Prgram, with the exceptin f transplantatin services and services assciated with transplantatin. Recipients f Disability Financial Assistance qualify fr assistance. Ohi residency is established by a persn wh is living in Ohi vluntarily and wh is nt receiving public assistance in anther state. Requests fr financial assistance fr Ohi residents are prcessed fr HCAP first, and then are therwise subject t the prvisins f this HFA plicy. Reviewed and Apprved By Hspital Administratin Crp Resp. Plicy #: Page 4 f 5
Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual Crrespndence cncerning IOS HFA plicies shuld be sent t the fllwing: Institute fr Orthpaedic Surgery Attn: Billing Department 801 Medical Drive Lima, Ohi 45804 Questins cncerning IOS HFA plicies shuld be directed t: (567) 940-3263 Additinal infrmatin is available at: www.ishspital.cm / Hspital Billing & Financial Assistance. Reviewed and Apprved By Hspital Administratin Crp Resp. Plicy #: Page 5 f 5