BronxCare Health System

Determining Patient Eligibility under this Policy for Inpatient and Outpatient Services

1.

When registering or scheduling a patient, responsible Staff should inform all self-pay patients of this Policy, and, assist the self-pay patient in determining eligibility under this Policy. If a “self-pay” patient does not have health insurance and does not receive benefits from a governmental assistance program, such as Medicaid, HMO/Managed Care program; patient needs to be assessed for Financial Aid- Charity Care

2.

Insured patients may apply for a sliding fee discount as a secondary coverage. Responsible Staff will be as follows:

a. Financial Investigator/Certified Application Counselor

b. Registrar/Receptionist, Patient Access Associates, and/or Central Registration Associates for outpatient/clinic appointment services.

3.

Self-pay patients who reside in the Institution’s Service Area, as defined above, should complete an application for assistance under this Policy and any applicable governmental program and provide supporting documentation of identity, address, household income and household composition.

4.

Staff will refer patients who may be eligible for governmental assistance, such as Medicaid, HMO/Managed Care program to the Department of Patient Access-Office of Financial Aid and Charity Care, and/or the Office of Managed Care.

5.

Staff will provide guidance, assistance with the completion of the application and proceed to review the final determination for Financial Aid or Charity Care under this Policy.

6.

Eligibility should be determined prior to all elective ambulatory procedures, diagnostic and High Cost Outpatient services, such as Interventional Radiology, MRI, CAT Scan, or PET Scan.

7.

If the patient is eligible, Staff will determine what level of Financial Aid or Charity Care is applicable, as well as the patient’s financial commitment under this Policy.  The patient, legal guardian or financially responsible person, as the case may be, should be advised of the determination, and each of these determinations should be documented in the patient’s file. Application and supporting documents are scanned to the “Click-On” application.

8.

If a patient receives a bill for the services rendered, this bill should state amount which is being provided as financial aid or Charity Care and the amount which is the patient’s financial obligation. Generally, the patient’s financial obligation will be a fixed amount for outpatient services or a percentage of the charges for services.

Example – Determination of Patient’s Financial Obligation

If the patient’s assessment/application demonstrates an annual family income of $35,000 and there are 4 family members, the patient would fall within 150% of the Federal Poverty Guidelines.

Inpatient Services: the patient would be financially responsible for 20% of charges; balance will be under Financial Aid or Charity Care

For example:

Inpatient Charges: $10,000

Patient’s Financial Obligation (20% of charge): $2,000  (Includes HCRA Surcharge applicable to Self-Pay Patients)

Financial Aid and Charity Care Provided: $8000

General Outpatient Services: the patient would be financially responsible for the fixed payment of $30 and the balance in charges would be Financial Aid and Charity Care

High Cost Outpatient Services: the patient would be financially responsible for 20% of the Medicaid rate and the balance in charges would be under Financial Aid and Charity Care 

1. Staff should review the patient’s outstanding financial obligations when the patient arrives for outpatient services. If a patient has not made a payment between his/her last and current visit or within 60 days from his/her last visit, the case should be referred to the Practice Administrator or his/her designee, and, if necessary, discussed with the Medical Director, or his designee.

2. The patient is allowed 90 days from the date of discharge or of service to apply for financial assistance and 20 days to submit a completed application (including all required documentation). A written response to patients who have completed applications for Financial Aid or Charity Care approving or denying the application will be sent within 30 days after receipt of a completed application. If an application is not complete, the patient should be requested to provide the necessary information to complete the application. If the patient does not provide the requested information within the allowed timeframes, the application may be denied.

3. Once a completed application, including required documentation or other information needed to make a determination on the request for Financial Aid or Charity Care has been submitted, the patient could disregard any bill that has been sent until the hospital has rendered a decision on the application.

4. Eligible patients may request an extended payment plan. Installment payments will not be greater than 10% of gross monthly income.