|Approved By:||Jason Bonner, CFO|
|Department:||Patient Financial Services||Category:||Financial|
|Policy Level:||Departmental||Policy Start Date:||10/01/2017|
|Review Interval:||12 months||Next Review Date:||6/30/2021|
|Reviewed:||Vicki Hammack, PFS Director||Revised:||10/01/2017|
|Reviewed:||Marian Sweet, PFS Director||Revised:||7/1/2020|
The hospital shall contribute appropriate resources, advocacy, and community support to promote the health status of the community, which it serves, within its economic ability to do so. Financial assistance will be provided to patients with a demonstrated inability to pay. The purpose of this policy is to establish criteria for determining if a patient’s account qualifies for financial assistance. The amount of financial assistance to be made available, as well as any other changes to this policy, shall be assessed and determined by the hospital’s Chief Executive Officer or Chief Financial Officer on an annual basis, and will adhere to federal and state guidelines for tax-exempt and non-profit facilities, as applicable. The amount of financial assistance as well as the other terms of this policy may be changed by the hospital’s CEO or CFO.
The hospital is a non-profit corporation offering financial assistance to qualified patients. The hospital will not discriminate on the basis of race, ancestry, religion, national origin, citizenship status, age, disability, or gender in its consideration of a patient’s qualification for financial assistance.
The classification of a patient as being eligible for financial assistance shall occur at the time sufficient information has been obtained to verify the patient’s inability to pay for needed medical services, and as soon as possible after the patient first presents for services or indicates an inability to pay for services. It is ultimately the patient’s responsibility to provide the necessary information to qualify for financial assistance.
Other Payor Sources
Patients must fully cooperate and comply with eligibility requirements for any other healthcare program(s) for which they may be qualified prior to their evaluation for financial assistance. Federal and/or state assistance may be available for those who meet qualifications. Before financial assistance is provided, all available avenues of assistance from third-party payors must be exhausted.
This policy applies to all emergency and other medically necessary care provided in this hospital or any substantially related entity of the hospital. All services must be medically necessary in order to qualify for financial assistance (e.g., elective services such as cosmetic surgery do not qualify for financial assistance). Eligible services will be based on those services for which Medicare provides coverage.
All patients may apply for financial assistance at any time during the continuum of care or after care is received. Each patient’s situation will be evaluated according to relevant circumstances, such as income, assets, or other resources available to the patient or patient’s family when determining the ability to pay the outstanding patient account balance. Taking this information into consideration, the attached Financial Assistance Eligibility Discount Guidelines (Attachment A) are utilized to determine what amount, if any, of the outstanding patient account balance (based on gross charges) will be discounted after payment by all third parties. PLEASE NOTE: The financial assistance offered under this policy does not apply to physician or other professional fees billed separately from the hospital’s fees. The hospital reserves the right to further limit the services covered by this policy.
Allowable Types of Charity Care Charges
Most hospital and outpatient charges are charity eligible except for the following which are not permissible charity charges:
- Professional fees
- Cosmetic procedures – includes all charges on the encounter.
- Excludes denials from medical necessity transaction codes 993 and 685.
Deductibles, copays, and coinsurance are all included when hospital has a contractual arrangement with the payers are eligible for insured patients.
Non covered services provided to Medicaid eligible and indigent care program patients.
Non covered charges for days exceeding length of stay limits for patients who are Medicaid eligible patients.
Balances after insurance payments for patients with exhausted benefits, and high deductible plans that may result in patient qualification.
Exclusions for Charity
Exclude from charity any deductibles and copays that are claimed on the Medicare Bad Debt report.
Method for Applying for or Obtaining Financial Assistance
Applying for financial assistance can be initiated by a patient requesting assistance in person, over the phone at 318-283-3710, through the mail at P.O. Box 1060 Bastrop, La. 71221, or via the hospital’s website. Additionally, the hospital can initiate a financial assistance application (refer to LAW004.6 – Financial Assistance Application) on behalf of the patient.
Presumptive Eligibility for Financial Assistance
The hospital may review credit reports and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation. Hospital uses presumptive information to determine qualification for charity care and may assign charity adjustments to an account without the authorization of the patient. If a charity eligible patient has other outstanding balances during the eligibility period, the accounts are also eligible for charity adjustments.
Assistance with Application Process
The hospital’s financial counselors are available to answer questions and provide information about this policy and to assist with the financial assistance application process. The hospital’s financial counselors may be reached between the hours of 8:30 a.m. and 3:30 p.m. Monday through Friday by calling 318-283-3710.
Length of Eligibility
Once financial assistance has been approved, it is effective for all outstanding patient accounts and for all services provided within twelve (12) months after the financial assistance application is signed by the patient or responsible party or the hospital employee (“Date of Completion”). Financial assistance may be extended for an additional six (6) months with affirmation of the patient’s income or estimated income and household size. All patients must reapply after the initial twelve (12) month period is over. Approval under Section 6(b) above will only apply to the date(s) of service on the patient account balance being evaluated. Eligibility will not apply to accounts for future dates of service.
Basis for Calculating Amounts Charged; Amounts Generally Billed
The level of financial assistance will be based on a classification as “Financially Indigent” or “Medically Indigent” or “Catastrophically Medically Indigent,” as defined below. Patients may qualify for 50%. 75% and 100% charity care adjustments based on Annual Poverty levels. In all situations, once the patient is determined to qualify for financial assistance that individual will not be charged more for emergency or other medically necessary care than the amounts generally billed to individuals who have insurance covering such care (“AGB”). In determining AGB, the hospital has initially elected to use the “look-back method” in which the AGB percentages are based on Medicare fee for service and all private care insurers as the primary payer, as outlined in Internal Revenue Code (IRC) Section 501(r). The hospital, in accordance with applicable regulations, may change the methodology for calculating AGB in the future. Information regarding the hospital’s calculation of AGB can be obtained free of charge by contacting 318-283-3710.
“Financially Indigent” means a patient whose Yearly Household Income (as defined below) is less than or equal to 200% of the Federal Poverty Guidelines (“FPG”). These Financially Indigent patients are eligible for a 100% discount on outstanding patient account balances as set forth in the Financial Assistance Eligibility Discount Guidelines (Attachment A).
“Medically Indigent” means a patient who’s medical or hospital bills from all related or unrelated providers, after payment by all third parties, exceed 10% of such patient’s Yearly Household Income, whose Yearly Household Income is greater than 200% but less than or equal to 400% of the FPG, and who is unable to pay the outstanding patient account balance. These Medically Indigent patients are eligible for a discount on outstanding patient account balances as set forth in of the Financial Assistance Eligibility Discount Guidelines (Attachment A).
Catastrophically Medically Indigent
“Catastrophically Medically Indigent” means a patient who’s medical or hospital bills from all related or unrelated providers, after payment by all third parties, exceed 10% of such patient’s Yearly Household Income, whose Yearly Household Income is greater than 400% of the FPG, and who is unable to pay the outstanding patient account balance. These Catastrophically Medically Indigent patients are eligible for a discount on outstanding patient account balances as set forth in Part 3 of the Financial Assistance Eligibility Discount Guidelines (Attachment A).
Financial Assistance Eligibility Discount Guidelines
The Financial Assistance Eligibility Discount Guidelines are attached to and are made a part of this policy (Attachment A). The method for determining appropriate discount percentages will be reviewed annually to ensure patients’ outstanding account balances after discount are no more than AGB. Patient qualification is based on the Federal Poverty levels provided annually by the Federal Government.
Determination of Eligibility for Financial Assistance
Determination of eligibility for financial assistance will be in accordance with procedures that may involve (a) an application process, in which the patient or the patient’s guarantor is required to supply information and documentation relevant to making a determination of financial need; and/or (b) the use of credit reports and other publicly available information that provide information on a patient’s or a patient’s guarantor’s ability to pay.
Yearly Household Income and Household Size
If the patient is an adult, “Yearly Household Income” means the sum of the total yearly gross income or estimated yearly income of the patient and the patient’s spouse, and “Household Size” includes the patient, the patient’s spouse, and any dependents (as defined by the IRC). If the patient is a minor, “Yearly Household Income” means the sum of the total yearly gross income or estimated yearly income of the patient, the patient’s mother, and the patient’s father, and “Household Size” includes the patient, the patient’s mother, the patient’s father, dependents of the patient’s mother, and dependents of the patient’s father.
Household income will be documented through any of the following mechanisms:
Third Party Documentation
By the provision of third party financial documentation including IRS Form W-2 (Wages and Tax Statement); pay check remittance; individual tax return; telephone verification by employer; bank statements; Social Security payment remittance; worker’s compensation payment remittance; unemployment insurance payment notice; unemployment compensation determination letters; response from a credit inquiry and other publicly available information; or other appropriate indicators of the patient’s income. Third party documentation provided under this subsection will be handled in accordance with the hospital’s information security procedures and the requirements of securing protected health information.
In cases where third party documentation is unavailable, verification of the patient’s Yearly Household Income can be done (i) by obtaining a financial assistance application signed by the patient or responsible party attesting to the veracity of the patient’s income information provided, or (ii) through the written attestation of the hospital employee completing the financial assistance application that the patient or responsible party verbally verified the patient’s income information provided.
In any instance in which the patient or responsible party is unable to provide the requested third-party verification of patient’s income, the patient or responsible party is required to provide a reasonable explanation of why the patient or responsible party is unable to provide the required third-party verification. Reasonable attempts will be used to verify patient’s attestation and supporting information.
Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of Yearly Household Income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance.
Financial Assistance Disqualification
Disqualification after financial assistance has been granted may be for reasons that include, but are not limited to, one or more of the following:
Financial assistance will be denied to the patient if the patient or responsible party provides false information including information regarding income, household size, assets, or other resources available that might indicate a financial means to pay for care.
Third Party Settlement
Financial assistance will be denied if the patient receives a third-party financial settlement associated with the care rendered by the hospital. The patient is expected to use the settlement amount to satisfy any patient account balances.
Relationship to Collections of Accounts Policy
During the verification process, while information to determine a patient’s income is being collected, the patient may be treated as a private pay patient in accordance with other hospital policies, including the Collections of Accounts Policy. A copy of the hospital’s Collections of Accounts Policy can be obtained free of charge by contacting the Business Office Director or in person at the hospital.
After the patient’s account is reduced by the discounts based on the Financial Assistance Eligibility Discount Guidelines (Attachment A), the patient is responsible for the remainder of the outstanding patient account balance which shall be no more than AGB. Once the patient qualifies for financial assistance, the hospital will not pursue collections on the amount qualified for financial assistance. Patients will be invoiced for any remaining amounts in accordance with the hospital’s Collections of Accounts Policy.
The hospital reserves the right to bill and collect a reasonable copayment for services rendered from patients who qualify for financial assistance.
Relationship to EMTALA and Other Policies
THIS POLICY DOES NOT AFFECT THE HOSPITAL’S OBLIGATION UNDER THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA). THIS POLICY ALSO DOES NOT ALTER OR MODIFY OTHER POLICIES CONCERNING EFFORTS TO OBTAIN PAYMENTS FROM THIRD-PARTY PAYORS.
Providers Covered and Not Covered Under this Policy
A list of providers that are covered under this policy and those that are not maintained at Morehouse General physician credentialing office. Any questions about inclusion or exclusion of providers that are covered under this policy can be directed to CFO.
This policy and procedure shall be periodically reviewed and updated consistent with the requirements and standards established by the Board of Directors and by Morehouse General Hospital management, Federal and State law and regulations, and applicable accrediting and review organizations.
Questions concerning any aspect of this policy should be referred to Administration.
This policy replaces and supersedes all previous policies and is effective immediately.
Effective Date: 10/01/2017
Morehouse General Hospital
Financial Assistance Eligibility Guidelines
Attachment to the MGH Charity Care Policy
Morehouse General Hospital (MGH) has developed criteria for determination of eligibility for financial assistance based on type of indigency and has added tiering for amount of charity care.
- Financially indigent – Yearly household income is less than or equal to 200% of the Federal Poverty Guidelines (FPG) which equates to 100% eligibility with a 100% discount of outstanding MGH balances.
- Medically indigent – Relates to a patient who is related medical bills from all related or unrelated providers after payment from third party payers exceed 10% of the household yearly income whose yearly household income is greater than 200% but less than 400% of the FPG and who is unable to pay the outstanding balance. The patient is eligible for a discount based on the tiering of 200% to 400% amounts.
- Catastrophically Medically indigent – Patient medical expenses from all providers after payment from any third-party payers, exceed 10% of annual household income, annual household income greater than 400% of the FPG, and is unable to pay the balance, are eligible for a tiered discount.
|Charity Care Tier||Family income as % of Federal Poverty Level||Charity Discount %|
|Level 1||</= 200%||100%|
|Level 2||</= 275% – 325%||75%|
|Level 3||</= 326% – 425%||50%|
The Federal Poverty Guidelines are posted annually by the U.S. Federal Government and are used as criteria for tiering discounts.
2020 Federal Poverty Guidelines
For each additional person add $4,480 per person to the income totals