RRMC Policy #25
Financial Assistance Policy for Patients
Rapides Regional Medical Center
Financial Assistance Policy for Patients
|Department Affected: Hospital-Wide and HPL clinic locations||Effective: 01/01/19|
|Reviewed by: Policy & Procedure Committee & RHS Executive Committee||Reviewed Dates: 3/09, 3/11, 3/12, 3/13, 3/15, 11/18|
Revisions Approved by:
Chief Financial Officer - Nathan Crabdree
Administration - Jason Cobb
Quality Management - Sheryl Ireson
(Signatures on file)
|Revision Dates: 1/14, 10/15, 11/18|
Rapides Regional Medical Center (RRMC) is committed to providing financial assistance to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care based on their individual financial situation. Consistent with its mission to deliver compassionate, high quality, affordable healthcare services, RRMC strives to insure that the financial capacity of people who need healthcare services does not prevent them from seeking or receiving care. RRMC will provide, without discrimination, medically necessary care for individuals regardless of their eligibility for financial assistance or for government assistance.
Accordingly, this written financial assistance policy (FAP):
- Describes what services are eligible for assistance and what medical providers participate in the FAP,
- Includes patient eligibility criteria for financial assistance,
- Describes the method by which patients may apply for financial assistance, and
- Describes the basis for calculating amounts charged to patients.
Financial assistance is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with RRMC’s procedures for obtaining assistance or other forms of payment and to contribute to the cost of their care based on their individual ability to pay. Individuals with the financial capacity to purchase health insurance shall be encouraged to do so, as a means of assuring access to healthcare services, for their overall personal health, and for the protection of their individual assets.
In order to manage its resources responsibility and to allow RRMC to provide the appropriate level of assistance to the greatest number of persons in need, the Board of Directors of Rapides Healthcare System LLC establishes the following guidelines for the provisions of financial assistance.
A. Financial assistance may only be provided to patients receiving non-elective, or medically necessary care. This includes care received in the hospital, emergency room, and HPLong clinics.
B. This policy is applied to charges for care provided by the hospital, HPLong Clinics and other medical providers with which RRMC has contracted to provide care under this FAP. Those providers include the companies that provide radiology, laboratory, emergency and hospitalist services, as well as, other independent physicians. The current listing of FAP Providers is available from RRMC’s business office: First floor, main hospital, Phone (318) 769-3225; email: firstname.lastname@example.org, or 211 4th St., Alexandria, LA 71301. The office is open from 8:00 am to 5:00 pm, central time, Monday through Friday. The list is also available on RRMC’s website at: http://rapidesregional.com/patients-and-visitors.
Patients eligible for RRMC financial assistance may receive bills for services provided by medical professionals who are not on the FAP Providers list.
C. The eligibility determination for financial assistance shall be based on an individualized determination of financial need and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation.
The following levels of financial assistance are available depending on a patient’s annual income compared to the Federal Poverty Levels (FPL) updated annually in the Federal Register by the U.S. Department of Health and Human Services:
|Annual Income (% of FPL)||Maximum Financial Obligation|
|Up to 250%||None|
|251% to 300%||3% of Annual Income|
|301% to 400%||4% of Annual Income|
|401% to 600%||10% of Annual Income|
|601% to 800%||12% of Annual Income|
|Over 800%||15% of Annual Income|
Amounts billed for emergency and other medically necessary care provided to FAP-eligible individuals will be no more than amounts generally billed to patients with Medicare fee for service, Medicaid fee for service or private insurance during the 12-month period ending September 30 of each calendar year, updated on an annual basis. This look-back method of determining allowed bill amounts is described in the Internal Revenue Service regulations. Patients may request information on this calculation by submitting a request to RRMC’s Business Office at 211 4th St., Alexandria, LA 71301.
D. Patients apply for financial assistance by completing an Application for Financial Assistance and providing all necessary supporting documents to confirm income. All patients shall receive a copy of a Plain Language Summary of the Financial Assistance Policy (FAP), and an Application upon registration.
E. The FAP, a Plain Language Summary of the FAP and an Application is available on the hospital’s website at: http://rapidesregional.com/patients-and-visitors. Spanish language versions of all documents are available at the same site.
The FAP and Application are also available upon request from the hospital’s business office: First floor, main hospital, Phone (318) 769-3225; email: email@example.com, or 211 4th St., Alexandria, LA 71301. The office is open from 8:00 am to 5:00 pm, central time, Monday through Friday. Spanish language versions of all documents are available upon request.
F. Assistance with completing the FAP Application and answers to questions about the application process can be found by contacting the hospital’s business office: First floor, main hospital, Phone (318) 769-3225; email: firstname.lastname@example.org, or in person at the main hospital admitting office, 211 4th St., Alexandria, LA 71301. The office is open from 8:00 am to 5:00 pm, central time, Monday through Friday.
G. For Medicare beneficiaries, in addition to thorough completion of the Medicare FAP Application, the preferred income documentation will be the most current year’s Federal Tax Return. Any patient/responsible party unable to provide his/her most recent Federal Tax Return may provide two pieces of supporting documentation from the following list to meet this income verification requirement:
- State Income Tax Return for the most current year
- Supporting W-2
- Supporting 1099’s
- Most recent bank and broker statements listed in the Federal Tax Return
- Current credit report
- Qualified Medicare Benefits (QMB for inpatients only)
H. Documentation acceptable for Non-Medicare patients:
- Signed, witnessed FAP Application
- W-2 withholding forms
- Most Recent Employer Pay Stubs
- Copies of all bank statements for last 3 months
- Written documentation from income sources such as verification of wages from employer, verification from public welfare agencies or any governmental agency which can attest to the patient’s income status for the last twelve (12) months.
- Income tax returns
- Forms providing or denying unemployment compensation or worker’s compensation
- A Medicaid remittance voucher which reflects that the patient’s Medicaid benefits for that Medicaid fiscal year have been exhausted.
I. Financial Assistance Processing based on Extenuating Circumstances:
There may be occurrences of extenuating circumstances where the patient/responsible party is not able to complete the FAP Application and/or provide supporting documentation and resource testing cannot be completed or where the medical indigence of the patient is determined by the medical debt outweighing 25% of the patient/responsible party’s annual income as outlined by state requirement/policy. In those circumstances, a manager may make the decision to waive the required documentation provided that all attempts to obtain additional information are documented clearly or may perform additional resource testing to validate the need for charity. Some of the following could be considered extenuating circumstances:
- Undocumented Residents or Homeless - Patients identified as undocumented residents or homeless through:
- Medicaid eligibility screening,
- Registration process,
- Discharge to a shelter,
- Clinical or case management documentation, or
- Attempt to run a credit report
- Patient Expiration - Patients that expire, and research determined through family contact and/or courthouse records that an estate does not exist and was documented, may be considered for financial assistance with the manager’s review and approval for a policy exception.
- Medically Indigent - If based upon state guidelines or requirements, the patient/responsible party meets the medically indigent status, the FAP may be applied after the manager completes a resource testing process for the patient/responsible party.
J. Application Review:
Electronic validation of patient information/income is obtained and, together with family size, will be entered into Onbase (the FAP web tool) to determine eligibility.
Registrars, Financial Counselors, Support Services and Collectors utilize all relevant on- line systems (Passport insurance verification, Artiva collection system, the DHH website, and Transunion online) available to gather correct information. All efforts are be documented in a clear, concise and consistent manner in the Collections/Artiva System. Staff will demonstrate respect and integrity in all internal and external dealings. Confidentiality is considered of utmost importance and will be adhered to by all staff.
After thorough review of the FAP Application and documented Medicaid eligibility attempts or other means, a manager may waive supporting documentation on non- Medicare, non-TRICARE, non-Medicaid, and non-Medicare Secondary Payor accounts only when it is apparent that the patient/responsible party is unable to meet the supporting documentation requirement but clearly meets the FAP guidelines.
Whenever possible, the hospital will consider an electronic validation of patient information/income, especially for non-Medicare accounts where no income verification is obtained.
Review of assets may take place during the application process, where allowed, by law. Under no circumstances will liens be considered on properties less than $300,000 in value.
If an incomplete FAP Application is received, a patient will be advised in writing of what additional information must be submitted to complete the application process and reminded of where they can receive help completing the application process.
If a patient submits a complete FAP Application and is deemed ineligible for assistance, they will be notified in writing concerning the basis for the determination.
K. Refunds on FAP-eligible accounts:
The general expectation is that all patients pay for services rendered if they are not fully covered by a third party. However, if a patient is qualified for the FAP, any amount paid by the patient above that required by the FAP will be refunded.
L. Patient Dispute Process:
In the event a patient wishes to file a dispute and appeal their eligibility for this policy, patient may seek review from the Business Services Director, Hospital Chief Financial Officer or a Hospital Executive.
M. Collection Policies:
RRMC management has developed policies and procedures for internal and external collection practices (including actions the hospital may take in the event of non- payment, including collections action and reporting to credit agencies) that take into account whether the patient qualifies for the FAP, a patient’s good faith effort to apply for a governmental program or for assistance from RRMC, and a patient’s good faith effort to comply with his or her payment agreements with RRMC. RRMC will not impose extraordinary collections actions such as postponement of care, wage garnishments, liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance under this policy. Reasonable efforts shall include:
- Validating that the patient owes the unpaid bills and that all sources of third- party payment have been identified and billed by the hospital.
- Documentation that RRMC has or has attempted to offer the patient the opportunity to apply for financial assistance pursuant to this policy and that the patient has not complied with RRMC’s application requirements.
- Documentation that the patient does not qualify for financial assistance under this policy.
Patients will receive a written notice 30 days before extraordinary collections actions are initiated notifying them of RRMC’s intent to begin such action and of the availability of financial assistance, accompanied by a FAP Plain Language Summary. RRMC will also make all reasonable efforts to notify patients verbally before any actions are taken.
No extraordinary collections actions will be taken prior to 120 days following the issuance of the first patient billing. Patients have a total of 240 days following the first billing to submit an application for financial assistance, and should any extraordinary collection action be in process at the time an application is submitted, such actions will be suspended while the application is processed.
N. Compliance with Regulations:
In implementing this policy, RRMC management and staff shall comply with all federal, state, and local laws, rules and regulations that may apply to activities conducted pursuant to the Policy.
O. Eligibility Expiration:
It is recognized that some patients may have chronic or multiple conditions that may result in frequent visits to RRMC and it may be an undue burden to participate in the full verification process on each visit. For that reason, the FAP may be applied to any account subsequent to the eligibility date for a period of up to 6 months. It is also recognized that patients may have changes in financial circumstances after the eligibility date and if requested should provide the documentation to support their continued eligibility on each visit to RRMC.