Financial Assistance Policy

It is our commitment to provide quality health care services with compassion, dignity, and respect for those we serve, especially the poor and underserved. We will provide low-income individuals with financial assistance based upon established guidelines.

Definitions
Scope of Policy
Financial Eligibility
Special Areas
Presumptive Circumstances
Recording of Financial Assistance

Definitions

Financial Assistance — Free or discounted health services provided to persons who cannot afford to pay. It may include those persons who are uninsured or underinsured and/or not eligible for any private or public underwritten health care coverage program based on government or internal determination. Individuals qualifying for Financial Assistance must meet pre-established criteria.

Family — A household that resides in a defined residence or has no residence but operates together as a unit. The family unit may include parents or other elderly relatives of those in the family unit that are defined as dependents on the Federal Tax return.

Family Income — Family income may include all income attributable to all members of the family in the defined residence, other than minimal amounts earned by minors.

Earned and Unearned Income — Earned income includes salary, wages, self-employment income, and tips earned by the patient, spouse, or parent. Also included is unearned income received from Social Security, disability payments, retirement benefits, child support, alimony, interest earnings, dividends, and income from other sources (unemployment, workers compensation, etc.).

Assets — Assets that will be considered liquid include those that could be converted to cash within one year. These include checking accounts, saving accounts, trust funds, and other investments. Additionally, countable assets include the liquidated value of luxury items, i.e., recreational vehicles, second homes, etc. In lieu of liquidating the assets, they may count as current years income when determining what level of financial assistance should be provided.

Scope of Policy

A. Financial assistance applies to all patients regardless of race, creed, sex, age, or payor.

B. Eligibility for financial assistance will be determined on an individual basis and evaluated on an assessment of the patient's and/or family's need, financial resources, and obligations.

C. Financial assistance applies to all types of medically necessary services.

D. Services not provided or billed by the hospital are not covered by this policy.

E. Trauma/emergency care will be provided to all patients, regardless of their ability to pay. Stabilization of the patient will occur prior to any determination of payment arrangements.

F. Cosmetic services and other elective procedures should not be underwritten by financial assistance.

G. In general, financial assistance should not be provided to residents out of the service area unless the patient presents with an urgent, emergent, or life-threatening condition.

Financial Eligibility

A. A financial assistance determination will be made once the application (see attachment I) has been completed and approvals have been received. A completed application will serve as the basis for documenting the patient's eligibility for assistance in accordance with pre-established criteria.

B. A financial assistance process will be utilized for evaluating the patient's financial resources and obligations. The assessment process requires that the patient provide the following information as considered appropriate:

• Earned income including monthly gross wages, salary, and self-employment income.
  
• Unearned income including dividends, interest and income from any other source such as unemployment or workers compensation.
  
• Number of dependents in the household.
  
• Information to determine the patient's financial status, including assets and liabilities.
  
  (Note: Supporting documents will be requested and will be filed with the application.)

C. Proxy Information — It is appropriate to use proxy information to determine financial assistance eligibility. For example, the fact that the applicant "stays with friends" or works "occasionally" are good proxies for determining income levels.

D. Offsets to Income — Out-of-pocket outlays of income required to meet a family's health and medical care needs may be subtracted from the patient's income. These may include out-of-pocket prescription drugs, health care coverage premiums, caregiver services, and the like. In addition, tuition and education fees may also be subtracted.

E. Efforts should be taken to determine a patient's eligibility for financial assistance at or before the time of admission or service; however, determinations can be made after service and should be considered prior to taking legal action to collect.

F. Reasonable measures will be taken to ensure that any language or hearing barriers are addressed.

G. In general, a multiple of federal poverty guidelines, minimum of 100% maximum of 200%, is the appropriate basis for the initial determination of a patient's eligibility for financial assistance. However, other factors stemming from the patient's financial application will also be taken into consideration. It should be assumed that individuals in families with income at or below the poverty level do not have the ability to underwrite their health care needs.

H. Income will be re-verified every six (6) months — one (1) year based on need. It will be appropriate to retroactively determine financial assistance eligibility based on this re-verification.

I. Patients may also be eligible for financial assistance for a portion of their account. A sliding scale will be used to determine the percentage of financial assistance available to the patient. Financial assistance may be used for co-pays and deductibles, and when the patient is not able to pay for the entire amount of their account.

J. Approval levels for financial assistance will be as follows:

• $0 - $4,999 — Manager of Patient Accounts
  
• $5,000 - $9,999 — Director of Patient Administration Services
  
• $10,000 plus — Chief Financial Officer

K. Financial assistance should be made in accordance with the predetermined criteria. However, it is recognized that occasionally there will be a need for granting financial assistance to a patient who may otherwise not meet the criteria established within the procedure. In such cases, the Manager of Patient Accounts and/or the Director of Patient Administration Services will review the case and document why the assistance was granted. This documentation will be maintained in the financial folder.

L. Documentation of financial assistance must be kept on file for a minimum of seven (7) years. Documentation of financial assistance should also be noted in the patient's account.

Special Areas

A. The following areas will be considered as eligible for financial assistance classification within the financial statements.

• Unreimbursed medically necessary services provided to patients qualifying for federal, state or county federal assistance programs.
  
• Denied Medicaid (or other publicly sponsored program) services when there is no other coverage source (non-covered charges/services).
  
• Medicare deductible and co-insurance dollars otherwise not paid by Medicaid and not reimbursed by Medicare through the cost report.
  
• Settlement arrangements with patients at less than full amount due because of patient's inability to pay full balance (amount forgiven would be classified as charity).
  
• Patient bankruptcies
  
• Sexual assaults/victims of crime.
  
• Accounts initially written off to bad debt and subsequently returned from collection agencies where the patient was determined to have met the financial assistance criteria based on information obtained by the collection agency.
  
• Returns from a collection agency requested by the hospital where charity guidelines are met within six (6) months of bad debt turnover date.

Presumptive Circumstances

It is recognized that not all patients will be willing or able to provide complete financial and/or social information. Therefore, some charity cases may be determined based on available resources.

• Patient is deceased with no known estate.
  
• Patient is homeless or unemployed
  
• Family/friend provides undocumented information establishing the patient's inability to pay.
  
• Members of religious organizations who have taken the vow of poverty.
  
• Patients with current eligibility under county or state medical indigent services administered by county or state facilities or private sector entities.

Recording of Financial Assistance

A. Financial assistance must be valued at the cost of providing the care, in accordance with the Healthcare Audit Guide and Trinity Health Policy.

B. Financial assistance must be systematically accounted for so that the community benefit component is accurately recorded.

If you are a Mercy Hospital Grayling patient and have a compliment, concern, or complaint, please contact one of our Patient Liaisons.

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