It is the policy of Highland Hospital to make financial counseling services available to all patients, including information about Charity Care and Sliding Scale discount policies that are available to qualified uninsured individuals. Financial counseling is not considered a condition of admission. Patients who present themselves for emergency examination or treatment will be treated regardless of their ability to pay for services.
The patient will be given the opportunity to request a patient advocate, designee or family member to assist in the financial counseling discussions. Financial counseling may occur at any time from admission to discharge as long as the patient’s care is not interfered with and the patient consents to the discussions.
Highland Hospital’s financial counseling program was designed to bring consistency, clarity, and transparency to patient financial communications; help patients understand the cost of services they receive, what their insurance will cover (if applicable), and their individual financial responsibility for services.
If a patient is admitted to Highland Hospital, the admissions department will attempt to gather information regarding a patient’s third party insurance coverage. If the patient is deemed uninsured, the admissions department will notify the HBPE (Hospital Based Presumptive Eligibility) assistant of the uninsured admission so the HBPE assistant can meet with the patient to assess whether or not the patient qualifies for Medicaid under Hospital Based Presumptive Eligibility. If HBPE assistant determines that the patient qualifies for Medicaid under Hospital Based Presumptive Eligibility, the HBPE assistant will follow the appropriate procedure to obtain a temporary medical card for the patient. The HBPE assistant will make effort to subsequently assist the patient with completion of the full Medicaid application. If it is determined that the patient does not qualify for Medicaid under Hospital Based Presumptive Eligibility, the patient will be referred to the IPA (In-Person Assistant), who will offer the patient assistance with obtaining coverage with a private health insurance plan through the Health Insurance Marketplace (if admission occurs during a Health Care Marketplace open enrollment period). If the patient desires to obtain coverage through the Healthcare Marketplace (during open enrollment), the IPA will assist with the process and notify admissions, UR, and billing (if the patient obtains insurance coverage during their stay). If the patient declines assistance with obtaining coverage through the Health Insurance Marketplace or if the patient is admitted during the Health Insurance Marketplace closed enrollment period, the patient will be referred to the financial counselor who will explain the financial obligation of uninsured individuals as well as make the patient aware of the available internal assistance programs (i.e. sliding fee scale and charity care) for qualified uninsured patients. The income guidelines for charity and sliding scale assistance are clearly outlined in the Charity Care and Sliding Fee scale policies.
The financial counselor will discuss the available assistance programs for qualified uninsured individuals, and/or establish a payment arrangement when applicable based on Highland’s private pay collection policy.
If a patient is insured (insurance, Medicare, or Medicaid), the admission department will advise the patient (or responsible party) that Highland Hospital offers financial counseling services to all patients to discuss their financial obligation (i.e. co-pays, coinsurance, and deductibles). If the insured patient/responsible party is interested in speaking with a financial counselor, the admissions department will notify the Accounts Receivable Manager. The Accounts Receivable Manager will ensure that a financial counselor meets with any patient/responsible party who requests assistance within 24 hours (if possible) of admission to discuss their financial obligation. The financial counselor will also assist any uninsured patient with applying for Sliding fee scale discount or Charity Care assistance when applicable.
Highland Hospital will charge uninsured patients the same contractual rates for inpatient services as it would a patient insured by the most frequently billed commercial Insurance. A yearly audit will be performed to determine the most frequently billed commercial insurance and the private pay rate will be adjusted each year if necessary.
If the patient has no other responsible party and is deemed incompetent to discuss financial matters, or does not wish to engage in face-to-face financial counseling, the billing office will mail the patient and/or responsible party a payment information and financial responsibility form (attachment 1)
The admissions department’s role in financial counseling:
Gathering the necessary information to determine whether the patient has any third party coverage (Medicare, Medicaid, and/or Private Insurance ID cards) and verifying that the coverage is active.
Supplying the billing office any payer information obtained during admission. Immediately notifying the HBPE of any uninsured admissions. Notifying the Accounts Receivable Manager if any insured patient is interested in financial counseling.
The billing specialist’s role in financial counseling:
Verification of mental health benefits (including deductibles and co-payments, available inpatient days).
Determine whether the deductible and/or co-pays have been met for the year and whether or not COB information has been updated.
If COB information has not been updated, notify the Accounts Receivable Manager so that he/she can coordinate assisting the patient in updating COB information.
Give the Accounts Receivable Manager a copy of the insurance financial responsibility form so that he/she can coordinate financial counseling, or mail the form to the patient if the patient rejects the financial counseling offer.
The HBPE (Hospital Based Presumptive Eligibility) certified Assistant’s role in financial counseling:
The HBPE assistant will interview the patient or responsible party to determine if the patient may have any type of health coverage.
If it is determined that the patient does not have any health coverage, the HBPE assistant must obtain approval from the patient for consideration for Presumptive Eligibility.
If approval is obtained, the HBPE assistant will gather data from the patient or responsible party for input into the WVinroads on-line system.
The HBPE assistant must make the final determination of whether or not the individual is eligible for Medicaid based on the information provided and based on the Medicaid Presumptive Eligibility guidelines.
The HBPE assistant will print the patient a temporary Medicaid card or a document stating why the patient was not determined to be presumptively eligible for Medicaid.
The HBPE assistant will provide the admissions department, UR department, and the billing department a copy of the patient’s temporary medical card.
The HBPE assistant will make every effort to assist the patient with completing the full Medicaid application.
If the patient does not qualify for Medicaid under Hospital Based Presumptive Eligibility, and if the patient is admitted during a Health Care Marketplace open enrollment period, the HBPE assistant will notify the IPA who will offer to assist the patient with obtaining private health insurance through the Health Insurance Marketplace.
If the patient accepts the IPA’s assistance in obtaining coverage through the Health Insurance Marketplace, the IPA will assist with the process and notify admissions, UR, and billing if private insurance coverage is obtained.
If the patient declines the IPA’s assistance in obtaining coverage through the Health Insurance Marketplace, the IPA will contact the Accounts Receivable Manager so that he/she can coordinate financial counseling to the uninsured patient.
The financial counselor’s responsibility:
Counsel uninsured patients or responsible party to make them aware of their financial obligation as an uninsured patient; including giving them an estimated average cost per day for an inpatient stay.
Counsel insured patient or responsible party to make them aware of their financial obligation as an insured patient (i.e. deductibles, co-pays, and/or coinsurance), and collect deductibles, co-pays, and/or coinsurance if possible.
Advise uninsured patients of internal programs available to qualified uninsured patients (i.e. Charity and Sliding Fee Scale programs), and assist with the application process if requested.
Advise insured and uninsured patient/responsible party of discounts available for balances paid in full.
Assist insured patients with calling their insurance and updating COB information.
Advise patients that a list of the types of services that are typically provided and the associated private pay fees can be provided is requested.
Inform patient that costs may vary from estimates depending on actual services performed.