Financial Assistance FAQ
Patient Financial Services
Frequently Asked Questions About Uninsured Patient Billing Collection and Charity Care Policies and Procedures
Why are these policies being implemented/mandated?
To ensure a consistent and uniform method among all Adventist Health facilities for compliance with the California Hospital Association’s “Voluntary Principles and Guidelines on Hospital Billing and Collection Practices for Services Provided to Low-income Uninsured Patients.” These voluntary principles and guidelines are intended to strengthen the hospital’s relationship with the community and to reassure patients, regardless of their ability to pay, of Adventist Health’s commitment to caring.
What is the definition of “Low-Income”?
Low-income is defined as any patient who qualifies for charity care under the hospital’s charity policy. Any patient who has been screened for charity care and receives any charity adjustment is classified as low income.
How should a hospital inform patients of their financial assistance and collection policies?
Hospitals will post signage at key registration areas, adopt the corporate PFS brochure or some similar tool, and utilize the message box on data mailers to further inform patients of the financial assistance and collection policies.
Can an insured patient apply for charity care?
At the discretion of the hospital, any insured patient who indicates an inability to pay their liability after their insurance has paid may be screened for charity care.
Is it necessary to require a Confidential Financial Statement and back-up documentation from every patient applying for charity care?
No. Hospitals may establish an abbreviated application and verification process for service areas where charges are low. Examples of such areas include clinics, rural health clinics, emergency departments, and outpatient ancillary areas. At a minimum, hospitals will document family size and gross family income and secure a credit report.
What is the difference between “statutory” and “non-statutory” charity care?
Statutory charity care is provided to patients for whom you can bill a government program (example: CHPS, or the new Emergency Uninsured federal program for undocumented aliens). Documentation requirements must comply with governmental guidelines and/or state or county regulations. Non-statutory charity care is provided for patients known to meet the general charity care criteria. Every effort should be made to secure a signed application, but this may not be possible in all cases (such as with homeless patients).
Once a patient is approved for charity care, is it necessary for them to apply again for future accounts?
Approved charity adjustments are considered valid for all existing accounts and for an additional 90 days after approval.
Is it okay to send data mailers and/or collection letters to a patient who has applied for financial assistance?
No. Hospitals may not pursue collection from patients while they are in the process of applying for government assistance programs (such as Medicaid) or while they are applying or providing documentation for charity care. Before pursuing payment from the patient, failure to meet eligibility requirements or failure to cooperate must be thoroughly documented in the account notes.
What is “Catastrophic Charity Care”?
When the patient’s liability amount exceeds 50% of the total annual family income, amounts greater than 50% of the income may be written off to charity care.
If a patient is eligible for Medicaid, can they apply for charity care for their Share of Cost (SOC) amount?
No. Shares of Cost are determined by the state to be an amount that the patient must pay before the patient is eligible for Medicaid.
If a patient is eligible for Medicaid, but has restricted coverage, can they apply for charity care for charges not covered by Medicaid?
Yes. If a patient is eligible for Medicaid with restricted coverage, any charges for days or services not covered by the patient’s coverage may be written off to charity without a completed Confidential Financial Statement.
If a patient is eligible for Medicaid, but Medicaid denies, how should the charges be written off?
Patients who qualify for Medicaid are also presumed to qualify for full charity write off. Any charges for days or service written off as a result of a clinical Medicaid denial (such as a TAR denial) should be written off to a specific code and booked as charity. This does not include technical denials, such as untimely billing, eligibility issues, missing invoices or medical records.
Is it permissible to charge interest to low-income patients?
No. Under no circumstance will hospitals (or their contracted vendors including collection agencies) charge interest to low-income patients for any remaining liability under the charity care policy.
Can a patient apply for charity care after they have been assigned to a collection agency?
Yes. Collection agencies must report to the facility when a patient indicates to them that they are financially unable to pay for their services. The hospital can either perform the actual financial screening or delegate the responsibility to the collection agency.
Can lawsuits be filed on low-income patients?
No. Under no circumstances will a collection agency be allowed to file suit against a patient who has received a charity discount but has a remaining patient liability.
Can lawsuits be filed if a patient or guarantor has the ability to pay for their services, but is refusing to do so?
Yes. However, when an agency has determined that a suit is appropriate, they must obtain the CFO’s written approval from the facility prior to actually filing suit.
Can legal assignment approval be delegated by the CFO?
No. The CFO may not delegate this authority.