Patient Friendly Billing Procedures

 

Grant Memorial Hospital (GMH) is committed to minimizing the expenses associated with the recovery of patient account balances. It is the intent of GMH to identify and collect all patient account balances, preferably prior to or at time of treatment or immediately following. Prompt identification and collection of these balances will increase cash flow, while minimizing the cost of collections, statements, and postage.

The following information includes a detailed overview of the financial obligation and responsibility processes for patients. It includes these key terms:

  • Co-insurance is a percentage of the total charge that is due from the patient for each service event. These amounts are deducted from the hospital’s contracted rate of payment with the expectation that the hospital will recover this portion from the patient.
  • Co-payment is typically a flat amount or fixed fee due from the patient, based upon their medical plan, for specific medical services covered by the plan. Co-payments typically apply to each date of service.
  • Deductible is typically a flat amount due from the patient, as required by the insurance carrier, based on the provisions of the patient’s insurance policy. This amount may apply to each date of service or on an annual basis. Note: This amount may not always be satisfied within one visit.
  • Insured is any person who is recognized by the federal government as being covered by any health insurance policy.
  • Non-covered charges refer to hospital charges that will not be reimbursed by a third-party payer due to the type of charge, place of service, diagnosis, limits of coverage, and effective dates of coverage based upon the provisions of the patient’s insurance policy.
  • Non-urgent refers to patients who do not require expedited care.
  • Normal business hours are Monday – Friday between the hours of 9 am and 4 pm.
  • Resident refers to a person who resides at GMH with no specific moving date.
  • Underinsured are patients who have insurance that does not completely cover the fees for medical services.
  • Uninsured are patients who do not have any insurance coverage for medical services.
  • Urgent refers to patients who require expedited care (within one business day or the same day) for medical reasons or the physician’s request.

Scheduling of Patient Services

Scheduled patient services at Grant Memorial Hospital, including inpatient, outpatient surgery, and all applicable outpatient services, should be scheduled at least one week in advance when possible.

Preauthorization/certification as defined by the patient’s insurance policy for non-urgent patient services must be obtained before a patient is put on the schedule. Any uninsured patient requiring non-urgent services should be referred to a financial counselor for financial clearance prior to scheduling hospital services. Urgent uninsured patients who are put on the schedule after hours and come in the next day will be referred to the financial counselor after services are provided.

Data collected at the point of scheduling must include:

  • Applicable authorization/referral numbers
  • Copy of physician’s order
  • Essential medical insurance information
  • Key patient data
  • Ordering physician
  • Supporting diagnosis codes for scheduled test/procedure

Pre-registration of Patient Services

Scheduled patients should be pre-registered 2-3 days prior to the expected date of service, with the understanding that add-ons will occur on a daily basis.

The pre-registration process should include:

  • Performing insurance verification on all insurances on the account. The insurance verification process should include confirmation and documentation of applicable patient deductibles, co-pays, and non-covered amounts; authorization and referral requirements; coverage for specific services provided; effective dates of coverage; insurance ID/group number; running price estimator; and scanning all applicable paperwork.
  • Checking for medical necessity for Medicare and Medicare Advantage outpatients. If medical necessity requirements are not met, contact ordering physician in an effort to resolve this issue and/or patient signs verifying that they understand it is their responsibility if insurance will not pay.
  • Contacting patient regarding:
    • Any Medicare/Medicare Advantage medical necessity issues where an Advanced Beneficiary Notice (ABN) may be required.
    • For urgent patients, any insurance pre-certification/pre- authorization requirements related to their policy should be communicated. Inform patient that their ordering doctor must obtain pre-certification/pre-authorization for their test and/or procedure prior to scheduling the patient at GMH.
    • Collection of any definitive patient responsibility (co-pay, co-insurance, deductible, deposit, or amount identified by financial counselor).
    • If payment cannot be collected at the time of pre-registration, inform the patient of the amount due at the time of service and their payment options.
    • Urgent uninsured patients who are put on the schedule after hours and come in the next day will be referred to the financial counselor after services are provided.
  • Verifying state Medicaid for any patients identified as uninsured or underinsured. If no coverage exists, the patient should be referred to a financial counselor for exploration of other potential payment options prior to the scheduled date of service.

Financial Counseling

Patients referred to a financial counselor prior to or at the time of scheduling or pre-registration should be followed up on the same day or the following business day to determine a means for payment or assistance. Patients will be referred to the financial counselor via the GMH clinics or scheduling and pre-registration. Uninsured walk-in patients during normal business hours should be referred to the financial counselor.

The financial counselor should make every effort to collect any payments.

For uninsured/underinsured financially capable patients, see the “Patient Discounts, Deposits, and Payment Arrangements” section below for payment options and also utilize the price estimator and/or refer the patient to the financial counselor.

For uninsured/underinsured indigent applicable patients, a Financial Assistance application should be completed if the patient:

  • Does not meet the requirements for Medicaid eligibility
  • Has insurance but also has a high patient responsibility and cannot afford identified patient liabilities
  • Is a Medicare primary patient with a fixed income that qualifies for financial assistance
  • Is an extraordinary case identified by the state or hospital (see the Financial Assistance Policy for additional information). For uninsured/underinsured patients, the financial counselor should document in the patient account the expected payment methodology (discount, deposit, payment plan, medical assistance, or Financial Assistance application status). Hospital-approved payment plans should be handled as noted in the “Prompt Payment” section below.
  • Is uninsured and refuses to obtain insurance

Patient Discounts, Deposits, and Payment Arrangements

DISCOUNTS

The following payment discounts are available:

  • Uninsured patient – Once identified, total charges will discount 20 percent automatically.
  • Employee – Upon request and following the guidelines in the “Employee Discount” section below, the remaining balance after primary insurance, secondary insurance, and co-pays have been applied will be discounted 25 percent.
  • Prompt payment – Any patient obligation, either self-pay, patient co-pay, patient co- insurance, or patient deductible, will be subject to a prompt pay discount of 20 percent if the patient pays the net patient obligation (less the 20 percent prompt pay discount) in full at either preauthorization/scheduling or time of service. If a patient received an estimated patient obligation that they paid in full (less the 20 percent prompt pay discount) at either preauthorization/scheduling or time of service, subsequently their patient obligation is more than originally quoted, or patient was not provided an estimate, the hospital will honor the 20 percent prompt pay discount on the remaining balance if paid within 14 days of notification from the hospital to the patient. If, however, the patient obligation is less than originally quoted, the hospital will refund the patient the balance between the payment made, less the revised net patient obligation (less the 20 percent prompt pay discount). For uninsured patients and employees, this is an additional discount over those granted above.

DEPOSITS

For uninsured patients who are scheduled for non-urgent care, if payment in full cannot be made, a 30 percent deposit based on estimated charges is required as calculated from the price estimator. If the patient has bad debt with GMH, a 100 percent deposit may be required if the patient refuses to meet with the financial counselor and cannot produce proof of identification.

PAYMENT ARRANGEMENTS

If necessary, remaining balances can be paid monthly in adherence with the following schedule:

  • Any account with a balance due of $24.99 or less is to be paid in full within 30 days.
  • Any account balance between $25.00 and $249.99 is to be paid in full within six months; minimum payment per month of $25.00.
  • Any account balance between $250.00 and $1,199.99 is to be paid in full within 12 months; minimum payment per month of $50.00.
  • Any account balance between $1,200.00 and $4,799.99 is to be paid in full within two years; minimum payment per month of $100.00.
  • Any account balance above $4,800.00 is to be paid in full within five years; minimum payment per month of $200.00.

Employee Discount

An “employee” is anyone who receives a W-2 from Grant Memorial Hospital. Employees will receive a 25 percent discount on their account balances. The employee may be required to provide proof of the required co-pay amount.

Employees are responsible for requesting their employee discount. A request may be done by contacting the Billing Department.

An employee’s family members’ accounts will receive the employee discount if the family member is claimed as a dependent on the employee’s Federal 1040 tax return, and only by request of the employee. This includes the employee’s spouse, as well as dependent children up to the age of 26 and covered by the hospital’s insurance (otherwise, dependent children up to the age of 21 without the hospital’s insurance), and any other dependent family members.

An individual must have been an employee on the date of service for the account to be considered for the employee discount.

No refunds will be given to any employees for their failure to request the employee discount. An employee has 60 days from the date of the first patient statement to request the employee discount; otherwise, the employee forfeits the discount.

Registration/Sign-in

Notices are posted throughout the admissions and registration areas to alert patients that payment for insurance deductibles, co-insurance, co-pays, and non-covered charges are expected prior to or at the time of service. All acceptable forms of payment are included as part of this notice.

Emergency Room payments should be collected following physician screening.

At the point of registration/check-in, staff will:

  • Ensure patient’s identity (e.g. patient/guarantor name, mailing address, and birth date match driver’s license) and scan all physician orders and applicable authorizations/referrals. Additionally, update existing scanned information with any new or additional information, such as patient/guarantor driver’s licenses and insurance cards. For emergent, urgent, and walk-in patients who did not go through the pre-registration process, verify the insurance, run the price estimator, and collect all applicable patient responsibilities.
  • If the patient is a Medicare or Medicare Advantage patient and was not pre-registered, check to ensure medical necessity (contact physician office if medical necessity is not met). If physician provides updated diagnosis information, an updated order must be obtained. If medical necessity cannot be obtained, have the patient sign an Advanced Beneficiary Notice (ABN).
  • For pre-registered patients, review and follow up on any outstanding items from pre- registration and collect any applicable patient liability identified via the insurance verification process and price estimator that was not collected previously.

During normal business hours, emergent, urgent, and walk-In patients identified as uninsured or underinsured should be referred to a financial counselor prior to departing from the hospital. After hours, for any patient identified as uninsured or underinsured, the registration representative should print a fact sheet for the patient for referral to the financial counselor for follow-up within 1-2 business days.

 

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