d.

Application for charitable services required: the Emilie Gamelin Charitable Services program for the SFVSA and the Mary Potter Program for Human Dignity for the LCMSA.

e.

Patients whose gross income is less than two times the current Federal Poverty Guidelines that are applicable at the time the patient has applied for charitable services. Persons with this income level will be deemed eligible for 100% charity.

f.

Patients whose gross income is between two and three times the current Federal Poverty Guidelines that are applicable at the time the patient has applied for charitable services will have their individual financial situations (medical debt load, etc.) evaluated. However, they will owe no more than 100% of the applicable Medicare inpatient or outpatient reimbursement levels, or stated co-pay amounts, whichever is the lesser.

g.

Patients whose gross income might be greater than three times Federal Poverty Guidelines will have their applications assessed for an inability to pay (or a partial inability to pay) and will have their bills discounted accordingly. This can include persons with generally adequate income who are faced with catastrophic medical expenses.

h.

No patient shall be required to pay more than the discounted amounts as determined by the Regional Private Pay Discounting Policy, or the co-payment amount as reported by their third party payer, if covered by a third party payer source of payment.

a.

Bad debt: A bad debt results from a patient’s unwillingness to pay. It can also result from a failure to apply for charitable services that would otherwise prove an inability to pay.

b.

Contractual adjustment: This is the amount between the retail charges for services and the amount allowed by a governmental or contracted managed care payer for covered services.

c.

Other discounts:

i.

Customer service adjustments when the patient identified a less than optimal performance of duties.

ii.

Risk management adjustments, where a potential risk liability situation is identified and Providence Risk Management has elected to absorb the cost of care and not have the patient billed.

iii.

Payer denials where the facility was unable to obtain payment due to untimely billing per contractual terms.

iv.

Retroactive denial of service by a managed care payer/appeal not successful.

a.

TAR denials, Medi-Cal non-covered services, and untimely Medi-Cal billing write-offs will be recorded with their respective adjustment transaction codes. Medi-Medi accounts are written off.

i.

Finance will identify the amounts posted to those codes and transfer those amounts from contractual to charity in the general ledger.

ii.

For Medi-Medi adjustments, that portion not claimed as Medicare bad debt reimbursement will be reclassified as charity in the general ledger.

b.

Services denied to restricted Medi-Cal coverage will be written off to charity when the denial is received on a Medi-Cal remittance advice.