Financial Assistance Policy

Policy

It is the policy of Schoolcraft Memorial Hospital (SMH) to provide medically necessary services to all patients regardless of ability to pay. SMH offers various financial assistance programs based on income and household size. The goal of the Business Office is to help all patients understand their medical bills, collect insurance dollars in a timely fashion, and work with patients on any remaining balances.

This policy outlines financial assistance programs as well as available payment plans to all SMH patients. SMH does not charge interest on any outstanding balances. The Business Office will work with patients to set up the most fair and equitable payment plan for both the hospital and the patient.

SMH will make available to all patients a copy of the Patient Financial Assistance policy and the Community Care Application upon admission. The policy and Community Care application will also be available on the hospital website for electronic viewing and submission. Financial assistance brochures will be available in the hospital admission offices and lobbies. In addition, the Patient Financial Counselor will educate the public whenever possible during the year by participating in a variety of events such as health fairs and county housing/resource events.

The Patient Financial Counselor can be contacted at (906) 341-3230.

All financial assistance programs are available to patients of all SMH providers. A complete listing of SMH providers may be found at: https://www.scmh.org/patientvisitor-info/find-a-physician/

SMH offers the following financial services to assist patients with their bills:

Uninsured Discounts

SMH recognizes that uninsured patients do not receive the same advantages as insured patients because of the contracted rates given to insurance companies by providers. Given this fact, SMH will provide any uninsured patient an “uninsured discount” for medically necessary or emergency services. The amount of the discount will equal total patient charges minus the respective Medicare inpatient or outpatient rate plus 15% from the most recent Medicare cost report.

The discount will be deducted and shown on the patient’s first statement. Patients will be advised on their first statement to contact Patient Financial Services to set up a payment plan for the remaining balance.

Community Care

The Community Care Program is designed to help financially indigent patients by offering free or discounted care. Below are the requirements for this program:

1) Patient’s total household income must not exceed 200% of the National Federal Poverty Guidelines.

a. Income: “Income” is defined as gross income, or all income from all sources before taxes.

b. household size: “household” is defined as a person(s) sharing a common abode as part of a single-family unit, including those related by blood, marriage or adoption, and others who live together as part of a single-family unit. A common roomer or boarder is not included. Inability to provide documentation of household size will not prevent a patient from being eligible for the Community Care program. However, documentation is encouraged.

2) Patients must fill out and return a Community Care Application and submit all required documentation.

3) Once approved, the patient will be covered for 6 months. Procedures that are considered not medically necessary, experimental, or cosmetic by the government or third‐party payers are not eligible for Community Care discounts. Cardiac Rehab Phase III services are deemed an exception to this exclusion as they are considered vital to the cardiac health of SMH patients and a deterrent against the need for more serious and costly cardiac services.

4) The Community Care discount is 100% of eligible hospital charges.

Medically Indigent

Patients will be considered medically indigent by SMH if the private pay portion of their medical bill exceeds 20% of their annual household income due to catastrophic costs or conditions for medically necessary or emergency services. SMH will reduce their medical bill to equal 10% of their annual household income.

Patients will need to provide the following documentation to the Patient Financial Counselor to be considered for eligibility:

1) A copy of their most recent federal income tax return

2) A signed Affirmation of Financial Disclosure form presented to them during financial counseling.

SMH uses revenue generated by the hospital’s 340b drug program to help fund the Community Care and Medically Indigent programs.

Elective Procedures

Patients will be required to meet with Patient Financial Services prior to all elective, non-covered services. The financial counselor will give the patient an estimated cost of the service and a 25% down payment will be required at that time. In addition, patients will be required to set up a payment plan with the counselor to pay for the remaining balance.

Payment Plans

SMH offers interest free payment plans to all patients. The payment plans are shown below.

Standard Plan Reduced Plan

Hospital Bill Amount Monthly Payment Monthly Payment

$0 – $1,500 $ 50 $ 25

$1,501 – $3,000 $ 75 $ 50

$3,001 – $5,000 $ 100 $ 75

$5,001 – $7,000 $ 150 $ 100

$7,001 – $10,000 $ 175 $ 125

>$10,000 $ 200 $ 150

Based on a patient’s current financial status obtained through financial counseling with the patient, the Patient Financial Counselor will determine which plan is appropriate for the patient.

Actions for Unpaid Accounts

SMH will work with patients to set up payment plans for the patient portion of their medical bill. Hospital statements are sent out on a monthly cycle. If a patient makes no payment after three statements, they will be notified with a letter to contact SMH to make payment arrangements. If contact is not established and payment arrangements completed at this time, a final warning letter will be issued prior to placement of the account with a collection agency. SMH will make every effort throughout this process to contact the patient.

Rural Health Clinic Sliding-Fee Scale

SMH Rural Health Clinic will offer a Sliding-Fee Discount Program to all who are unable to pay for healthcare services provided by the RHC. SMH will base program eligibility on a person’s income and household size and will not discriminate on the basis of age, gender, race, sexual orientation, creed, religion, disability, or national origin.

Procedure:

The following guidelines are to be followed in providing the Sliding-Fee Discount Program.

1. Notification: SMH RHC will notify patients of the Sliding-Fee Discount Program by:

a. Placing notification and signage in the clinic waiting area.

b. Include an explanation and application on the SMH RHC website.

2. All patients seeking healthcare services are assured that they will be served regardless of ability to pay. No one is refused service because of lack of financial means to pay.

3. SMH RHC admitting staff will inquire of all patients if they have healthcare coverage. For those with insurance or benefits, appropriate information is documented in the EMR at that time of registration. Uninsured patients will be encouraged to meet with the Patient Financial Counselor to explore coverage options and begin enrollment in the Sliding-Fee Discount program.

4. Request for Discount: Request for discounted services may be made by patients, family members, social services staff or others who are aware of the existing financial hardship. Information and forms can be obtained from Patient Financial Services.

5. Administration: The Sliding-Fee Discount Program will be administered through the Patient Financial Services Representative. Information about the program policy and procedure will be provided and assistance offered for completion of the application. Dignity and confidentiality will be respected for all who seek and/or are provided charitable services. .

6. Completion of Application: The patient/responsible party must complete the Sliding-Fee Discount Program Application in its entirety. By signing the application, persons authorize SMH RHC access in confirming income as disclosed on the application form. Providing false information on an application will result in all Sliding-Fee Discounts being revoked and the full balance of the accounts restored and payable immediately.

If an application is unable to be processed due to the need for additional information, the applicant has two weeks from the date of notification to supply the necessary information. If the applicant does not provide the information within the two week time period, their application will be re-dated to the date they supply the information requested. Any accounts turned over for collection as a results of the patient’s delay in providing information will not be considered for the Sliding-Fee Scale Program.

7. Eligibility: Discounts will be based on the Federal Poverty Guidelines for income and household size, defined as follows:

Income: “Income” is defined as gross income, or all income from all sources before taxes.

household size: “household” is defined as a person(s) sharing a common abode as part of a single-family unit, including those related by blood, marriage or adoption, and others who live together as part of a single- family unit. A common roomer or boarder is not included..

The sliding scale is as follows:

8. Income verification: Applicants must provide one of the following: prior year income tax return, and pay stubs for most recent two months. Self-employed individuals will be required to submit detail for the most recent three months of income and expenses for the business. Self-declaration of Income may only be used in special circumstances. Specific examples are homeless individuals.

9. Waiving of Charges: Waiving of charges may only be used in certain circumstance and must be approved by the SMH CEO, CFO, or RHC Director. Any waiving of charges should be documented in the patient’s files along with an explanation.

10. Applicant Notification: The Sliding-Fee Discount Program determination will be provided to the applicant(s) in writing and will include the percentage of Sliding-Fee Discount, write off, or if applicable, the reason for denial.

Sliding-Fee Discount Program applications cover outstanding patient balances prior to the application date and any balances incurred within six (6) months after the approval date, unless their financial situation changes drastically. The applicant has the option to reapply after the six (6) months have expired or anytime there has been a significant change in family income. When the applicant reapplies, the look back period will be the lesser of twelve (12) months or the expiration of the Application.

11. Refusal to pay: If a patient verbally expresses an unwillingness to pay or vacates the premises without paying for services, the patient will be contacted in writing of their payment obligations. If the patient is not on the sliding-fee schedule, a Patient Financial Counselor will contact the patient to inform the patient of the sliding-fee

schedule. If the patient does not respond within 60 days or does not make an effort to pay, this constitutes refusal to pay.

12. Record Keeping: Information related to the Sliding-Fee Discount Program decision will be maintained and preserved in a centralized confidential file located in the Patient Financial Services office.

The Patient Financial Services Representative is responsible for the confidential storage and maintenance of patient information. Details include applicant name, dates of coverage and percentage of coverage. A monthly log will be maintained identifying recipients and dollar amounts. Denials will also be logged.

13. Policy and Procedure Review; The Sliding- Fee Discount Program amount will be reviewed and updated annually in accordance with the most current Federal Poverty Guidelines by the Patient Financial Services Representative, Billing Supervisor and the Clinic Director.

Billing and Collections Policy

It is the policy of Schoolcraft Memorial Hospital (SMH) to provide medically necessary services to all patients regardless of their ability to pay. SMH offers patients several payment options through its Patient Financial Assistance (PFA) policy #10 BO. SMH will make every effort to inform patients of its PFA policy and to determine eligibility for financial assistance as outlined in the PFA policy and billing and collection procedures below.

SMH cannot make a determination on a patient’s eligibility under its PFA policy unless all of the required paperwork is returned. If a patient qualifies for financial assistance, but does not return all of the paperwork to validate it, SMH must follow the same collection efforts as it does with other delinquent accounts.

If a patient does not respond to SMH by filling out financial assistance paperwork, setting up a payment plan, or making a payment, then the account will be sent to an external collection agency.

Once an account is placed with an outside collection agency, the collection agency must notify and get approval from SMH prior to taking legal action on any accounts. SMH will only permit the collection agency to pursue a court order to seek judgement that would allow garnishment of wages, State tax refunds, or bank accounts in accordance with Michigan law. SMH will not allow the collection agency to enter into any lawsuit that permits the arrest of a person, places a lien on a residence, or seizes property in order to collect a patient’s account

Procedures:

1. SMH will give all uninsured patients a copy of its PFA policy #10 BO upon admission.

2. SMH will encourage all uninsured, non-emergent patients to speak with the Patient Financial Service (PFS) counselor upon admission.

3. A copy of the PFA policy will be available to all patients in a brochure located in all admission offices, hospital lobbies, and on the hospital website.

4. Hospital statements will be sent out on a monthly basis. If the minimum payment is not made after three statements The PFS counselor will attempt to contact the patient to inform them of that their account is delinquent and will be sent to collections. The PFS counselor will notify the patient of their payment options under the PFA policy and will work with the patient to establish a payment plan.

5. If payment is not received within 30 days, patient accounts are reviewed to verify call was made. If call was made, account will be sent to an outside collection agency if payment is not received within 10 days.

6. Accounts where payment is not received after this final 10-day period will be listed on a report prepared by the PFS counselor and given to the Finance Committee and Board of Trustees to review at their monthly meeting.

Accounts with a balance greater than $500.00 are individually listed (excluding patient names and account numbers). Accounts with a balance less than $500.00 are reported in aggregate. Those accounts with a balance greater than $5,000.00 are given footnoted detail.

7. Once the total monthly bad debt amount is approved by the Board of Trustees at the monthly meeting, the PFS counselor will write off the bad debt balance within 3 days. The accounts are then placed with SMH’s collection agencies.

Download the SMH Community Care Application (for reduced monthly payments)

Financial Assistance Policy Plain Language Summary

Schoolcraft Memorial Hospital’s Financial Assistance Policy (FAP) exists to provide eligible patients, partially or fully-discounted emergency or other medically necessary healthcare services provided by Schoolcraft Memorial Hospital, its Rural Health Clinic (RHC), Homecare, hospice, or employed/contracted providers. Schoolcraft Memorial Hospital offers various discounts and an assistance program. Patients seeking assistance must apply for the program.

Eligible Services: In general, the FAP applies to emergency or medically necessary healthcare services provided and billed by Schoolcraft Memorial Hospital, its RHC, Homecare, hospice, or providers.

Eligible Patients: Patients receiving eligible services, who submit a complete Financial Assistance Application, which includes related documentation/information, and who are deemed eligible for financial assistance by Schoolcraft Memorial Hospital.

SMH offers the following financial assistance discounts/programs:

Uninsured Discounts

SMH will provide all uninsured patients a discount for emergency and other medically necessary charges in the amount of total patient charges less the respective Medicare inpatient or outpatient rate plus 15%. In addition, patients that receive the uninsured discount are also eligible for the prompt-pay discount.

Community Care Program

The Community Care Program is designed to help financially indigent patients by offering free or discounted care. Following are the requirements for this program:

1) Patient’s total household income must not exceed 200% of the National Federal Poverty Guidelines.

a. Income: “Income” is defined as Gross income, or all income from all sources before taxes.

b. household size: “household” is defined as a person(s) sharing a common abode as part of a single-family unit, including those related by blood, marriage or adoption, and others who live together as part of a single-family unit. A common roomer or boarder is not included. Inability to provide documentation of household size will not prevent a patient from being eligible for the Community Care program. However, documentation is encouraged.

2) Patients must fill out and return a Community Care Application and submit all required documentation.

Eligible patients will receive a 100% discount on eligible hospital charges.

3) Once approved, the patient will be covered for 6 months. Procedures that are considered not medically necessary, experimental, or cosmetic by the government or third‐party payers are not eligible for Community Care discounts. Cardiac Rehab Phase III services are deemed an exception to this exclusion as they are considered vital to the cardiac health of SMH patients and a deterrent against the need for more serious and costly cardiac services.

Medically Indigent

Patients will be considered medically indigent by SMH if the private pay portion of their medical bill exceeds 20% of their annual household income due to catastrophic costs or conditions for medically necessary or emergency services. SMH will reduce their medical bill to equal 10% of their annual household income.

Patients will need to provide the following documentation to the Patient Financial Counselor to be considered for eligibility:

1) A copy of their most recent federal income tax return

2) A signed Affirmation of Financial Disclosure form presented to them during financial counseling.

SMH uses revenue generated by the hospital’s 340b drug program to help fund the Community Care and Medically Indigent programs.

Rural Health Clinic Sliding Fee Scale

The Sliding Fee Discount Program will be offered through the Community Cares Program.

Eligibility: Discounts will be based on the Federal Poverty Guidelines for income and family size, with income and family size defined as follows:

Income: “Income” is defined as gross income, or all income from all sources before taxes.

household size: “household” is defined as a person(s) sharing a common abode as part of a single-family unit, including those related by blood, marriage or adoption, and others who live together as part of a single- family unit. A common roomer or boarder is not included. Inability to provide documentation of household size will not prevent a patient from being eligible for the sliding fee. However, documentation is encouraged.

How to Apply: The FAP and related Application Form may be obtained/completed/submitted as follows:

· At Schoolcraft Memorial Hospital’s main Registration desk, RHC registration desk, or Emergency Room desk;

· Request documents be mailed to you, by calling Schoolcraft Memorial Hospital’s Patient Financial Services Counselor at (906) 341-3230;

· Request documents in person at Schoolcraft Memorial Hospital at 7870 W US Hwy, 2, Manistique, MI 49854;

· Download the documents from Schoolcraft Memorial Hospital’s website www.scmh.org/patientvisitor-info/financial-assistance-policy/;

· Mail completed Applications (with all required documentation/information specified in the application instructions) to the address listed above;

· Reserve an appointment with a Patient Financial Services Counselor to receive assistance completing the Application, by calling (906)-341-3230.

Schoolcraft Memorial Hospital also translates its Financial Assistance Policy, Community Cares Application and this Plain Language Summary of its Financial Assistance Policy in other languages when the primary language of the residents of the community served by Schoolcraft Memorial Hospital is either a minimum of 5% or 400 individuals within the population likely to be affected or have an encounter with Schoolcraft Memorial Hospital. Translated versions are available upon request in person, at the address listed above, by mail, and on Schoolcraft Memorial Hospital’s website.

For assistance or questions please visit Schoolcraft Memorial Hospital registration, RHC registration or Emergency Room desk at the address listed above, Monday through Friday 8:00 am to 6:00 pm, and Saturday 8:00 to Noon. A Patient Financial Services Representative can also be reached by phone at (906) 341-3230.

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