Financial Policy
Key Index Title: Indigent Care
Distribution: Admissions, PFS, Finance, Administration
Formulated By: Finance, Administration
Effective Date: June, 2011
Supersedes: January, 2010
Attachments: 2010 FPG
Purpose:
The purpose of this policy is to provide formal criteria for determining the eligibility of patients being considered for the Piedmont Henry Hospital (PHH) Indigent Care Program.
Policy:
It is the policy of PHH to provide the same standard of care for all patients, regardless of ability to pay. Recognizing that some patients may not possess adequate insurance coverage or financial resources to pay for medically necessary services, PHH will actively promote an Indigent Care Program designed to assist such patients. All uninsured patients will be given the opportunity to apply for assistance in resolving eligible hospital expenses.
Pursuant to the Indigent Care Program, PHH will write off 100% of medically necessary charges for qualified patients who meet the eligibility standards outlined below. Please note that this program is for medically necessary health care and will not cover cosmetic or elective services, or the monitoring or management of chronic conditions.
Definitions:
Eligible patient:
An uninsured patient/guarantor whose gross household income falls below 200% of the following Federal Poverty Guidelines (FPG). Source: U.S. Department of Health and Human Services.
| Persons in family | 2011 FPG (100%) | 2011 FPG (200%) |
|---|---|---|
| 1 | $10,890 | $21,780 |
| 2 | $14,710 | $29,420 |
| 3 | $18,530 | $37,060 |
| 4 | $22,350 | $45,060 |
| 5 | $26,170 | $52,340 |
| 6 | $29,990 | $59,980 |
| 7 | $33,810 | $67,620 |
| 8 | $37,630 | $75,260 |
Gross Income:
Federal adjusted gross income, to include wages, salaries, tips, interest & dividends, unemployment compensation, and other taxable income.
Catastrophic Assistance:
Patients whose household incomes exceed 200% of FPG may be eligible for PHH’s Indigent Care Program if the out-of-pocket expenses for their PHH hospital stay exceed 25% of their annual income.
Eligible Charges:
All PHH charges are eligible for write-off pursuant the Indigent Care Program, except for elective procedures and any other service that does not meet medical necessity standards, as described above.
Procedure:
Medical & Disability Resources:
(1) MDR will conduct initial screening interviews with all uninsured Inpatients. In addition, MDR will interview and screen uninsured Outpatients with balances exceeding $3,000.
(2) As a routine part of these initial interviews, MDR will have the patient complete and sign a provisional IC application and will deliver all completed applications to the Indigent Care Coordinator.
(3) The IC Coordinator will keep all applications on file until it has been determined that the patient is not eligible for government assistance.
Uninsured Coordinator:
(1) Once it has been determined that no government assistance will be forthcoming, the IC Coordinator will “activate” the IC application, contact the patient, and request as much of the following information as is available and applicable:
- Valid identification.
- Most recent W-2 form.
- Prior year’s tax return.
- Last two pay stubs.
- Bank statements.
- Utility bills.
- Written verification of income.
- Proof of food/shelter source.
(2) The Uninsured Coordinator will review the application, income verification, and any other relevant documentation within 10 working days of receipt.
(3) For applicants with balances under $10,000, the Uninsured Coordinator will make the final determination of eligibility and send an approval or denial letter as appropriate.
(4) In cases where no documentation has been received from the patient or responsible party within 10 days, the Uninsured Coordinator will call the patient and/or send a follow-up letter requesting the above-described financial data.
(5) In the event that no documentation can be obtained from the patient, the Uninsured Coordinator will run a credit report and use the information contained therein to make an eligibility determination.
(6) In cases where eligibility has been established, the Uninsured Coordinator will write-off the appropriate amounts during the month in which the patient has been approved for the program.
Executive Director of Revenue Cycle:
(1) For applicants with balances greater than $10,000, the IC Coordinator will review the cases with the Director of Patient Financial Services, who will make the final determination of eligibility.
(2) Shortly following the beginning of each month, the PFS Director will produce a report for the hospital CFO showing how much has been written of to Indigent & Charity for the previous month and year-to-date.
Miscellaneous:
To be considered for PHH’s Indigent Care Program, the patient or responsible party should complete relevant application paperwork and provide the necessary financial information as stipulated.
When it is not possible for the patient to provide all the stipulated documentation, yet there is cause to believe that the patient is eligible, the IC Coordinator may run a credit report and use that information to determine eligibility.
The maximum eligibility duration for the Indigent Care Program will be six months from the date of approval. After that period, the patient must reapply for the program with up-to-date financial information.