Financial Application Process
- The FAP application may be initiated by Patient Access Services (PAS) personnel on admission, or retrospectively by Business Services personnel. FAP approval up to $50,000 may be approved by the Manager of Business Services, $50,001 to $99,999 may be approved by the Director of Business Services, and greater than $99,999 may be approved by the CFO or CEO.
- The patient may contact PAS or Business Services for an application, if the patient cannot locate the original.
- The patient should complete the application with supporting documentation and return the application to the hospital.
- Incomplete applications may result in the hospital requesting additional information or denying the application.
All reasonable efforts will be made to assist patients to qualify for appropriate County, State, and/or Federal or Health Assistance Programs, and if not qualified, may be eligible for HMNH FAP program.
- The hospital may consider income and monetary assets which will not include retirement or deferred compensation plans qualified under the Internal Revenue Code, or non-qualified deferred compensation plans. The first $10,000.00 of a patient’s monetary assets will not be counted, nor will 50% of the patient’s monetary assets over the first $10,000.00. The hospital may require waivers or releases from the patient or patient’s family authorizing the hospital to obtain account information from financial or commercial institutions, or other entities that hold or maintain the monetary assets of the patient or patient’s family to verify their value. Information obtained pursuant to this clause regarding the assets of the patient or patient’s family will not be used for collection activities.
- For FAP free care, annual family income (inclusive of applicable monetary assets) at or below 200% of the FPL may qualify for 100% write off of the HMNH account(s). For FAP Discount Payment Program, annual family income between 200.1% and 400% of FPL may qualify HMNH accounts in accordance with the discount sliding scale, based upon Medicare rates (DRG, CMG, APC, fee schedules).
- The patient or the patient’s legal representative shall make every reasonable effort to provide the Hospital with documentation of health benefits coverage at time of service or within thirty days of service.
- The patient or the patient’s legal representative shall provide the hospital with documentation of income within 30 days of receipt of application. Documentation of income will be limited to three recent pay stubs and/or most current income tax return. If a commission or bonus has been received, the hospital may require tax returns.
- The information the hospital uses to determine eligibility obtained from sources other than the individual seeking financial assistance may be accepted, including written documentation of person or person’s assisting the patient financially.
- Failing to provide information that is reasonable and necessary to make a determination under this program, may result in the denial of the application.
- The hospital will provide patients with a written notice that contains information about availability of the hospital’s FAP process including information about eligibility as well as contact information for hospital employee or office from which the person may obtain further information about this policy. The notice will be provided to patients who receive emergency or outpatient care, and who may be billed for that care, but who were not admitted. The notice will be provided in English and Spanish.
- The hospital will provide uninsured patients upon request, with an estimate of the amount the hospital will require the patient to pay for the healthcare services, procedures, and supplies that are reasonably expected to be provided to the person by the hospital, based upon an average length of stay and services provided for the person’s diagnosis. The hospital may provide this estimate during normal business hours.
- A notice of this policy will be clearly and conspicuously posted in locations that are visible to the public, including, but not limited to: the emergency department, billing office, admission’s office, other outpatient settings and hospital web site.
- The hospital will make all reasonable efforts to obtain from the patient or his or her representative information about whether private or public health insurance or sponsorship may fully or partially cover the charges for care rendered by the hospital to a patient, including but not limited to: private health insurance, Medicare, Medi-Cal, the California Childrens’ Services Program (CCS), or other state/county funded programs designed to provide health coverage.
- If the Hospital bills a patient or the patient’s legal representative who has not provided proof of coverage by a third party at the time the care is provided, or upon discharge, as a part of that billing, the hospital will provide the patient or legal representative with a clear and conspicuous notice that includes all of the following: a statement of charges for services rendered, a request that the patient inform the hospital if the patient has health insurance coverage, Medicare, Medi-Cal, or other coverage; a statement that if the consumer does not have health insurance coverage, the consumer may be eligible for Medicare, Medi-Cal, CCS, Healthcare Exchange or FAP; a statement indicating how the patient may obtain applications for the Medi-Cal program, CCS, Medicare and that the hospital will provide these applications.
- If the patient does not indicate coverage by a third party payer and requests a discounted price or FAP, then the hospital will provide an application for Medi-Cal, CCS, Medicare, or other governmental program to the patient, and/or discount or FAP application. This application will be provided prior to discharge if the patient has been admitted or to the patient receiving emergency or outpatient care. Information regarding the financially qualified patient and discount application includes the following: a statement that indicates that if the patient lacks or has insufficient insurance and meets certain low and moderate income requirements, the patient may qualify for discounted payment; the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about the hospital’s FAP care policy and how to apply for that assistance.
Application Review Process
Upon receipt of completed application, documentation of income, and asset verification, if applicable, the hospital will review and make a determination of the application within 30 days to determine if eligibility requirements are met.
- The patient is notified via system-generated letter of acceptance or denial. If the patient is in-house, the letter will be hand delivered; otherwise the letter will be delivered through the U.S. Postal Service.
- If the patient disagrees with the determination, he/she may follow the dispute process detailed below.
- If the patient documentation is not received within 30 days, the hospital may consider the patient not eligible
- Approval is granted for one year unless the patient’s financial situation changes.
FAP (Free Care)
Upon approval, HMNH’s approved free care account(s) will be adjusted to patient responsibility of zero. If the patient account reflects a prior payment, a patient refund, if appropriate (inclusive of applicable interest) will be issued to the patient and/or payer.
FAP (Discount Payment)
HMNH will utilize Amounts Generally Billed (AGB) via the Prospective Medicare Method when determining patient liability. Upon approval, the patient will not be charged more for emergency or other medically necessary care than the amounts generally billed (AGB) to individuals who have insurance covering such care. The patient responsibility will be based upon Medicare allowable rates: DRG, APC, Fee Schedule. The sliding scale for patient income is directly related to the established Federal Poverty Level (FPL). The reduced patient liability is a % of the Medicare allowable as noted below:
- Up to 200% of FPL, 0% of Medicare allowable
- 200.01-250% of FPL, 25% of Medicare allowable
- 250.01-300% of FPL, 50% of Medicare allowable
- 300.01-350% of FPL, 75% of Medicare allowable
- 350.01 -400% of FPL, 100% of Medicare allowable
Upon approval, HMNH patient account(s) will be adjusted to the patient responsibility. A reasonable payment plan without interest will be offered. If the patient’s account(s) reflects a prior payment which exceeds the total patient dollar responsibility, a patient refund (inclusive of applicable interest) will be issued to the patient and/or payer based upon HSC 127440 related to reimbursing said patients for excess amounts paid, including interest, as set forth in Section 685.010 of the Code of Civil Procedure.
- The patient has the right to appeal the denial to the Business Services Manager.
- The patient or legal representative may submit additional supporting documentation within 30 days, to support their financial eligibility.
- Review of the additional documentation will be completed and patient notified of the outcome no later than 30 - 60 calendar days. A system-generated letter will be delivered through the U.S. Postal Service, and if the denial is overturned, the procedures in “Application Review Process” will be followed.
Hospital Provider List
Emergency physicians who provide emergency medical services in the hospital that provide emergency care is also required by law to provide discounts to uninsured patient or patients with high medical costs who are at or below 350% of the FPL.
The HMNH FAP does not include professional services provided by our Medical Staff. The listing below is effective immediately and will be updated quarterly beginning 10/1/16.
For complete provider list please refer to Attachment - FAP Policy Physician List
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