Financial Assistance Policy | White River Health System

Financial Assistance Policy

Revised: 06.30.2020

Effective: 08.01.2020

 

POLICY & PROCEDURES

Policy

Under these principles, the Board of Directors of White River Health System (WRHS) is committed to the provision of financial assistance to patients who are in need of care, have selected WRHS for such care, and a determination has been made that the facility is the most appropriate facility for rendering such care of service and there is no other more suitable facility or program available to such patient where compensated care could be rendered. WRHS follows federal guidelines in making reasonable efforts to determine a patient's eligibility for financial assistance, and utilizes federal poverty guidelines to inform assistance determinations.

It is necessary to adhere to an open door philosophy of furnishing adequate diagnostic and therapeutic services for emergencies in order to avoid claims of improper rejection, inappropriate transfers, or lack of recognition of cases requiring immediate attention in the emergency room. WRHS conforms with existing Emergency Medical Treatment and Active Labor Act (EMTALA) laws and provides treatment for emergency medial conditions. Further, this policy prohibits WRHS form engaging in actions that discourage treatment for emergency medical conditions or by permitting debt collection activities that interfere with the provision of emergency medical care.

Purpose

White River Health System is a not for profit, tax-exempt entity with a mission to provide a safe, efficient delivery of quality healthcare and to improve the health of our communities through education and outreach. WRHS is dedicated to a mission of public financial assistance through providing care for members of our society who benefit from our services without regard to race, sex, creed, national origin, or station in economic or social life. We are committed to making available, in such ways as to preserve human dignity and worth, the full resources of the health system to persons unable to pay. At the same time, WRHS must operate our facilities in the most efficient and economical manner possible to assure a strong future financial position necessary for the replacement and expansion of facilities, payment of our debts, establishment of adequate reserves for emergencies, the provision of future technological developments, and needed medical services.

 

Procedures

The following guidelines will be followed in providing financial assistance:

  • Uncompensated Services
  • Reduced Compensated Services
  • Discount Services

Each request for financial assistance will be evaluated on its own merits utilizing established patient accounts procedures based on this policy. Evaluation of the need for a particular patient will likely include such factors as:

  • Income, Assets, and Liabilities
  • The medical condition of the patient
  • The potential for long term medical care
  • Availability of other forms of reimbursement whether insurance, social programs, or other financial resources
  • The suitability of the facility for the patient's particular needs and whether a more appropriate facility is available at which some form of payment would be available

Requests for financial assistance may come from doctor's offices or community-minded interested party. Each requester will be required to fill out the WRHS financial assistant application unless the requesting party can show that a like form has been completed for the applicant.

All patients should be offered a financial assistance application at the time of registration and/or discharge from our facility upon request. If this evaluation is not conducted until after the patient leaves the facility, or in case of outpatients or emergency patients, a Financial Counselor will mail a financial assistance application to the patient for completion. In addition, the hospital will provide information regarding how to obtain a Plain Language Summary of the financial assistance policy to the patient within the first 120 days following the first billing statement. 

Uninsured patients and patients who qualify for financial assistance will not be charged for emergency or other medically necessary care at rates higher than the amounts generally billed (AGB) to third-party payers. The use of gross charges to such patients is prohibited. For purposes of this policy, WRHS uses the look back method to determine the AGB. The current AGB discount of 60% applies at White River Medical Center and Stone County Medical Center as of August 1, 2020 (08/01/2020).

Uncompensated/reduced compensation services will be limited to those patients whose family income is below 300% of the national poverty guidelines. The prevailing national poverty guidelines will be the basis for determining eligibility and can be requested in writing, free of charge from the hospital.

Uncollectable accounts, accounts that were not reviewed by financial counselors at the time of service, and/or questionable collectible amounts may qualify for financial assistance during the collection process if they met the above criteria.

In the following situations (known as presumptive financial assistance), a patient is deemed to be eligible for 100% reduction of charges

  • If patient is currently eligible for full Medicaid benefits, but was not eligible on a prior date of service. The facility will apply our financial assistance policy retroactively for the previous three(3) months.
  • If patient states (s)he is homeless and WRHS, through our own diligence, does not find and evidence of the contrary.
  • If patient is mentally or physically incapacitated and has no one to act on his/her behalf. 
  • If patient is currently a resident of a nursing home facility and the facility is able to provide on a letterhead stating patient is a resident on a fixed income with a provided Medicaid number.

In the event of a patient's death, the family of the deceased patient will be eligible for our Presumptive Charity discount by presenting a copy of the patient's death certificate. Once collection efforts have been met, the remaining balance will qualify for Presumptive Charity.

WRHS will provide any member of the public or state governmental entity a copy of our financial assistance policy and application upon request, free of charge. The policy can be requested by calling WRHS Patient Financial Counseling Office at 870-262-1118 or 870-262-1188, or by mail at 1710 Harrison Street, Batesville, AR 72501. The policy is also available online at www.whiteriverhealthsystem.com, at all points of the registration within the facility, and also provided via mail to any requester, free of charge. A plain language summary of the policy is available in these locations as well. Notices of this Financial Assistance Policy will also be included on billing statements.

This Financial Assistance Policy applies only to WRHS hospital charges and does not include charges that are not billed via White River Medical Center (WRMC). This policy only applies to emergency and medically necessary services and may not apply to elective procedures. See attached list of providers covered by our policy. 

All approved financial assistance at White River Medical Center and/or Stone County Medical Center will be valid for six(6) months from the date patient or representative submits application to assist with the expense of upcoming care: unless, patient's source of income is Social Security, financial assistance will be valid for 12 months. All approved financial assistance will apply retroactively for three(3) months, or, from the most recent episode causing applicant to file for assistance. 

This policy will be applied equally to all patients regardless of payer source. Applications that do not meet the criteria set forth in our policy may, in extraordinary circumstances, be approved by the Chief Financial Officer. 

ADMINISTRATION OF FINANCIAL ASSISTANCE POLICY

Policy

WRHS provides uncompensated, reduced compensation, or discount services to all eligible persons unable to pay.

Eligibility for uncompensated services is limited to persons whose verifiable family income is equal to or less than 150% of the current poverty income guidelines as established by the Department of Health and Human Services.

Eligibility for reduced compensation services is limited to persons whose verifiable family income is greater than 150% of the current poverty income guidelines but not greater than 300% of the current poverty income guidelines as established by the Department of Health and Human Services.

Accounts that have been placed with a third party collection agency are eligible for benefits provided requiring they meet appropriate set guidelines. If approved, the account will remain with the collection agency but will receive the approved financial assistance reduction. 

Acceptable household income verification for our Financial Assistance Application includes:

  • Most recent federal income tax return
  • Most recent three(3) pay stubs
  • Most recent W-2 or 1099
  • Work history report from the Social Security Office
  • Social Security award letter
  • Pension or retirement statement
  • Child support

White River Health System reserves the right to pursue collections activity on unpaid balance if the patient or representative does not meet the agreed upon schedule.

White River Health System sends account statements to patients on a monthly cycle. The first statement is sent to the patient 30 days after discharge or 30 days after insurance is completely processed. If no payment is received, a second statement is issued 30 days after the first statement. If no payment is received, a final notice is mailed to the patient stating the payment must be received within 30 day of notice to prevent assignment to a third party collection agency. Accounts with no payment within 30 days of final notice are reviewed by the WRHS Patient Financial Services office to ensure all reasonable efforts to determine eligibility for financial assistance have been met prior to assigning to a collection agency. WRHS will make reasonable efforts to orally notify the patient about our Financial Assistance Policy and how they may obtain assistance with the process before the account is placed with a third party collection agency. Any collection agency utilized by WRHS will agree to refrain from abusive collection practices. Reasonable efforts include notifying individuals of this Financial Assistance Policy upon admission/discharge, and in written or oral communications with the individual concerning his or her bill. Extraordinary collection efforts include filing lawsuits, placings liens on residences, reporting adverse information to consumer credit reporting agencies or credit bureaus, writ of civil action, and other similar activities.

Purpose

To ensure that requests for uncompensated service, reduced compensation services, and discount services are handled consistently, accurately, and timely.

Responsibility

WRHS Revenue Cycle Director

WRHS Patient Financial Services Associates

Procedure

Process Steps:

  • Patient or representative requests financial assistance.
  • Patient is screened on-site for Medicaid eligibility if uninsured at the time of service.
  • Patient or representative completes the application. If the applicant is unable to provide the required financial information, (s)he may call the Patient Financial Services office to discuss other evidence that may be provided to demonstrate eligibility.
  • Patient Financial Services reviews application for completeness no longer than 15 days of receipt. If the application is not properly completed, patient or representative is contacted for specific additional information required. If needed information is not provided, within 10 business days, the application is denied. 
  • Patient Financial Services reviews services provided to verify eligibility. If the service is covered by other third-party payers, the patient or representative is contacted and these avenues are pursued. If the question of extraordinary circumstances arises, the account if referred to appropriate management for determination of eligibility. Based upon management decision, the account is either returned for processing or denied. If denied, payment options are discussed with the patient or representative. See attached Payment Plan Guide (Exhibit 2).
  • Patient Financial Services reviews to determine if account is placed with a collection agency. If the account is being serviced by an agency, patient may obtain a financial assistance application and collection efforts will be temporarily suspended while determination is processed one the application is complete and returned in full by the patient or representative. 
  • Patient Financial Services compares family income to current Department of Health and Human Services poverty guidelines. If the family income is at or below 150%, the account is discounted 100% and notification is sent to the patient or representative. Determination of eligibility will be provided, generally, within 60 days.
  • If the family income exceeds 150% of the Department of health and Human Services poverty guidelines, Patients Financial Services compares family income to the reduced compensation schedule as outlined below in Exhibit 1. If the family income meets the requirements, the patient or representative is notified of acceptance, detail of procedure is explained, payment plan is established, the account is discounted appropriately and notes detailing discount procedure are placed on the patient's account record.
  • If the account is ineligible for reduced compensation benefits, the patient or representative is notified of denial. A payment plan with appropriate discount is established. See attached Payment Plan Guide (Exhibit 2).
  • All applications for financial assistance will be maintained for a period of seven(7) years.

Exhibit 1:

 

Discount 100% 90% 80% 70% 0%
Family Size      100%      138%      150%        200%        250%        300%       400%
1    $12,760    $17,690    $19,140     $25,520     $31,900     $38,280 $51,040
2    $17,240    $23,791    $25,860     $34,480     $43,100     $51,720 $68,960
3    $21,720    $29,974    $32,580     $43,440     $54,300     $65,160 $86,880
4    $26,200    $36,156    $39,300     $52,400     $65,500     $78,600 $104,800
5    $30,680    $42,338    $46,020     $61,360     $76,700     $92,040 $122,720
6    $35,160    $48,521    $52,740     $70,320     $87,900     $105,480 $140,640
7    $39,640    $54,703    $59,460     $79,280     $99,100     $180,920 $158,560
8    $44,120    $60,886    $66,180     $88,240     $110,300     $132,360 $176,480

 

Adds $4,480 per family member exceeding 8.

Exhibit 2:

Balance Month Term
              $100-500       6 Month Maximum Term
           $501-1,000     12 Month Maximum Term
        $1,001-2,500     18 Month Maximum Term
        $2,501-5,000     24 Maximum Term
  $5,000+ See Financial Counselor for arrangements

 

Services covered under White River Health System Financial Assistance Policy include White River Medical Center, Stone County Medical Center, all WRHS owned clinics excluding our rural health clinics and primary care clinics. Approved financial assistance will be honored by all participating clinics (as listed below) for all future care visits following the application approval date; clinics will not honor retro-activity. It is the patient's responsibility to communicate approved financial assistance with the participating clinics as needed.

Batesville Neurology Clinic

Batesville Oncology Clinic

Batesville Pulmonology Clinic

Stone County Medical ER

White River Orthopaedic and Sports Medicine Clinic

WRHS Anesthesia

WRHS ER Physicians Group

WRHS Rheumatology Clinic

WRMC Cancer Care Center

WRMC Cardiology

WRMC Hospitalist Group

WRMC Orthopaedic and Sports Medicine Clinic

WRMC Pain Management Clinic - All locations

WRMC PROS Therapy Services - All locations

WRMC Sleep Center

WRMC Surgery Clinic

WRMC Wound Healing Center - All locations

WRMC Wound Care Physicians