Credit & Collection Policy

Financing Your Treatment
Financing Your Treatment

Options & Information for Financing Treatment

At Munising Memorial Hospital we are here to assist patients with understanding how to finance treatments and are available to address any questions or concerns.

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Applying for Financial Assistance

Effective September 27th, 2017, Munising Memorial Hospital implemented a new credit and collections policy.

Policy Key Points

  • Payment Arrangements
  • Financial Assistance

If you need to apply for financial assistance please download the 
Financial Assistance Application. Please sign and mail this application to the hospital for our billing specialists to review. You can consult our Sliding Scale for Financial Assistance to see if you may qualify.

Credit and Collection Policy

Munising Memorial Hospital
Credit and Collections Policy:

POLICY:

The credit and collection policy of Munising Memorial Hospital is designed to preserve a sound financial basis for operations of the institutions in order that vital essential services may be obtained.  The policy establishes a responsibility for the prompt collection of patient charges. This policy applies to all individuals who receive services from Munising Memorial Hospital, and from that, establish a financial obligation, except for services provided through Harbour View Assisted Living.  Harbour View is a “for profit” service provided under ‘unrelated business income’ guidelines with the expectation that profits from Harbour View services will subsidize Munising Memorial patient care.

 

  1. All charges are due at the time of service.
  2. Payment may be made with cash or credit card.  MMH accepts Visa and MasterCard.
  3. If insurance benefits are not received within sixty (60) days from the billing date, the patient must pay the account or make credit arrangements with MMH.
  4. Monthly installments are available if MMH’s minimum payment is met.  The following minimum payments apply to the combined hospital/clinic total balance per guarantor:

 

Balance:                                                        Minimum Monthly Payment:

0 – $250                                                          $50.00

$251 – 500                                                    $75.00

$501 – $1,000                                                $100.00

$1001 –                                                           10% – max 10 months

 

  1. An initial bill will be sent to the responsible party for the patient’s personal financial obligations.

 

  1. MMH will issue subsequent billings at least every 30 days and for a minimum of 120 days after the initial bill before referring an account to an external collection agency. The patient will receive at least 3 billing statements and a “final notice” indicating that the account will be referred to an external agency when an acceptable payment has not been received or when an appropriate payment plan has not been established.

 

  1. The statement or billing notices will be accompanied by telephone calls, collection letters, personal contact notices, and any other notification method that constitutes a genuine and responsible effort to contact the party responsible for the obligation.

 

  1. MMH will document alternative efforts to locate the party responsible for the obligation or the correct address on billings returned by the postal office service as “incorrect address.” Alternative efforts may include use of skip tracing methods, use of the internet, post office records or other purchased or widely available means of tracing a patient or guarantors residence or point of contact with the intent of collecting outstanding debt or notifying them of options and other programs of public assistance that may be available to them.

 

  1. For Emergency Care services (services that could qualify as emergency bad debt) with balances over $1,000 where notices have not been returned as “incorrect address” or “undeliverable”, MMH will send a final collection notice by certified mail. In these instances where, after a reasonable effort, an account has been deemed as undeliverable, the account shall be referred to an external collection agency for additional follow-up prior to the exhaustion of the 120 days from the attempt of the initial bill.

 

  1. Documentation of continuous collection action undertaken on a regular, frequent basis will be maintained by paper and electronic media.

 

  1. The patient’s file will include documentation of collection effort including bills, follow-up letter, telephone and personal contact, and will be maintained until an audit is complete.

 

 

Uninsured Payment Discount

Michigan Medicaid Expansion requires that Munising Memorial Hospital accept as payment in full 115% of our Medicare rate from UNINSURED patients whose household income is less than 250% of the Federal Poverty Guidelines. To receive the current payment discount, patients must complete a brief application form to verify their household income. The current discount rate and federal poverty guidelines are shown on the application. Prompt payment discounts and financial assistance will be applied to the balance due following the deduction of the uninsured payment discount.

 

Financial Assistance and Charity Care Policy

 

POLICY

Munising Memorial Hospital is committed to the provision of health care services to all persons in need of medically necessary care regardless of ability to pay.  In order to protect the integrity of operations and fulfill this commitment, the following criteria for the provision of financial assistance and charity care are established.  These criteria will assist staff in making consistent objective decisions regarding eligibility for financial assistance and charity care while ensuring the maintenance of a sound financial base.    This policy applies to all individuals who receive services from Munising Memorial Hospital, and from that, establish a financial obligation, except for services provided through Harbour View Assisted Living.  Harbour View is a “for profit” service provided under ‘unrelated business income’ guidelines with the expectation that profits from Harbour View services will subsidize Munising Memorial patient care.

 

 

COMMUNICATIONS TO THE PUBLIC

 

Information about the MMH’s financial assistance and charity care policy shall be made publicly available as follows:

 

  • A notice advising patients that MMH provides financial assistance and charity care shall be posted in key public areas of MMH, including Admissions, the Emergency Department, Clinic Office, and the Business Office.
  • MMH will distribute a written notice about the availability of financial assistance and charity care to all patients.  This will be done at the time that MMH requests information pertaining to third party coverage.  The written notice also shall be verbally explained at this time.  If for some reason, for example in an emergency situation, the patient is not notified of the existence of financial assistance and charity care before receiving treatment, he/she shall be notified in writing as soon as possible thereafter.
  • Both written notice and verbal explanation shall be available in any language spoken by more than 10% of the population in the Hospital’s service area, and interpreted for other non-English speaking or limited-English speaking patients and for other patients who cannot understand the writing and/or explanation.
  • MMH shall train front-line staff to answer financial assistance and charity care questions effectively or direct such inquiries to the appropriate department in a timely manner.
  • Written notice about MMH’s financial assistance and charity care policy shall be made available to any person who requests the information, either by mail, by telephone or in person.  MMH’s sliding fee schedule, if applicable, shall also be made available upon request.

 

ELIGIBILITY CRITERIA

 

  • Financial assistance and charity care are generally secondary to ALL other financial resources available to the patient, including group or individual medical plans, worker’s compensation, Medicare, Medicaid or medical assistance programs, other state, federal, or military programs, third party liability situations (e.g. auto accidents or personal injuries), or any other situation in which another person or entity may have a legal responsibility to pay for the costs of medical services.
  • Patients will be granted financial assistance and charity care regardless of race, creed, color, national origin, sex, sexual orientation, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a disabled person.
  • Financial assistance and charity care shall be limited to those residing within the hospital’s designated service area.
  • Services eligible under this policy:  For the purposes of this policy “financial assistance” refers to healthcare services provided without charge or at a discount to qualifying patients.  The following healthcare services are eligible for financial assistance:
  1. Emergency medical services provided in an emergency room setting;
  2. Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting; and
  3. Medically necessary services, evaluated on a case-by-case basis at MMH’s discretion.
  • In those situations where appropriate primary payment sources are not available, patients shall be considered for financial assistance and charity care under this policy based on the following criteria:
    • The full amount of uncovered hospital charges will be determined to be charity care for a patient whose gross family income is at or below 100% of the current federal poverty level and whose net assets are less than $100,000.
  • The responsible party’s financial obligation which remains after the application of any sliding fee schedule shall be payable as negotiated between MMH and the responsible party.  The responsible party’s account shall not be turned over to a collection agency unless payments are missed or there is some period of inactivity on the account, and there is not satisfactory contact with the patient.
  • MMH shall not require a disclosure of the existence and availability of family assets from financial assistance and charity care applicants whose income is less than 100% of the current federal poverty level but may require a disclosure of the existence and availability of family assets from financial assistance and charity care applicants whose income is at or above 100% of the current federal poverty level.

 

FINANCIAL ASSISTANCE AND THE AFFORDABLE CARE ACT

 

  • Effective April 1, 2014, financial assistance for uninsured patients, once approved, will remain in effect until the end of the calendar year in which it was granted. Patients will be encouraged to purchase an affordable insurance plan during the next open enrollment period. If a patient chooses not to purchase affordable coverage, they will not be eliglble for financial assistance in subsequent calendar years.
  • Patients who have purchased insurance under the Affordable Care Act will be eligible to apply for financial assistance to aid in payment of plan deductibles, co-pays, and other non-covered, medically necessary charges.

 

 

 

PROCESS FOR ELIGIBILITY DETERMINATION

 

  • Initial Determination:
    • MMH shall use an application process for determining eligibility for financial assistance and charity care.  Requests to provide financial assistance and charity care will be accepted from sources such as physicians, community or religious groups, social services, financial services personnel, and the patient, provided that any further use or disclosure of the information contained in the request shall be subject to the Health Insurance Portability and Accountability Act privacy regulations and MMH’s privacy policies.  All requests shall identify the party that is financially responsible for the patient (“responsible party”).
    • The initial determination of eligibility for financial assistance and charity care shall be completed at the time of admission or as soon as possible following initiation of services to the patient.
    • Pending final eligibility determination, MMH will not initiate collection efforts or request deposits, provided that the responsible party is cooperative with MMH’s efforts to reach a final determination of sponsorship status.
    • If MMH becomes aware of factors which might qualify the patient for financial assistance or charity care under this policy, it shall advise the patient of this potential and make an initial determination that such account is to be treated as qualified to receive financial assistance or charity care.
  • Final Determination
    • Prima Facie Write-Offs.  In the event that the responsible party’s identification as an indigent person is obvious to Hospital’s personnel, and MMH can establish that the applicant’s income is clearly within the range of eligibility, MMH will grant charity care based solely on this initial determination.  In these cases, MMH is not required to complete full verification or documentation.
    • Financial assistance and charity care forms, instructions, and written applications shall be furnished to the responsible party when financial assistance or charity care is requested, when need is indicated, or when financial screening indicates potential need.  All applications, whether initiated by the patient or MMH, should be accompanied by documentation to verify information indicated on the application form.  The following types of documents shall be used as evidence upon which to base the final determination of charity care eligibility:
      • A “W-2” withholding statement;
      • Pay stubs from all employment during the relevant time period;
      • An income tax return from the most recently filed calendar year;
      • Forms approving or denying eligibility for Medicaid and/or state-funded medical assistance;
      • Forms approving or denying unemployment compensation; or
      • Written statements from employers or DHS employees.
      • A determination of net assets less than $100,000.
    • During the initial request period, the patient and MMH may pursue other sources of funding, including Medical Assistance and Medicare.  The responsible party will be required to provide written verification of ineligibility for all other sources of funding.  MMH may not require that a patient applying for a determination of indigent status seek bank or other loan source funding.
    • Usually, the relevant time period for which documentation will be requested will be 3 months prior to the date of application.  However, if such documentation does not accurately reflect the applicant’s current financial situation, documentation will only be requested for the period of time after the patient’s financial situation changed.
    • In the event that the responsible party is not able to provide any of the documentation described above, MMH shall rely upon written and signed statements from the responsible party for making a final determination of eligibility for classification as an indigent person.
    • MMH will allow a patient to apply for charity care at any point from preadmission to the time the bill becomes delinquent, recognizing that a patient’s ability to pay over an extended period may be substantially altered due to illness or financial hardship, resulting in a need for financial assistance or charity care services.  If the change in financial status is temporary, MMH may choose to suspend payments temporarily rather than initiate charity care.
  • Time Frame for Final Determination and Appeals
    • Each financial assistance applicant who has been initially determined eligible for charity care shall be provided with at least 14 calendar days, or such time as may reasonably be necessary, to secure and present documentation in support of his or her financial assistance application prior to receiving a final determination of sponsorship status.
    • MMH shall notify the applicant of its final determination within 14 days of receipt of all application and documentation material.
    • The responsible party may appeal a denial of eligibility for charity care by providing additional verification of income or family size to the Chief Financial Officer within 30 days of receipt of notification.
    • The timing of reaching a final determination of charity care status shall have no bearing on the identification of charity care deductions from revenue as distinct from bad debts
  • If the patient or responsible party has paid some, or all of the bill, for medical services and is later found to have been eligible for financial assistance or charity care at the time services were provided, he/she shall be reimbursed for any amounts in excess of what is determined to be owed.  The patient will be reimbursed within 30 days of receiving the financial assistance or charity care designation.
  • Adequate notice of denial:
    • When an application for financial assistance and charity care is denied, the responsible party shall receive a written notice of denial which includes:
      • The reason or reasons for the denial;
      • The date of the decision; and
      • Instructions for appeal or reconsideration.
    • When the applicant does not provide information and there is not enough information available for MMH to determine eligibility, the denial notice also includes:
      • A description of the information that was requested and not provided, including the date the information was requested;
      • A statement that eligibility for charity care cannot be established based on information available to MMH; and
      • That eligibility will be determined if, within thirty days from the date of the denial notice, the applicant provides all specified information previously requested but not provided.
    • The Chief Financial Officer and/or Administrator will review all appeals.  If this review affirms the previous denial of financial assistance and charity care, written notification will be sent to the responsible party and the Department of Health in accordance with state law.
  • If a patient has been found eligible for financial assistance or charity care and continues receiving services for an extended period of time without completing a new application, MMH shall re-evaluate the patient’s eligibility for financial assistance and charity care at least semi-annually to confirm that the patient remains eligible.  MMH may require the responsible party to submit a new financial assistance and charity care application and documentation.

 

 

CHARGES TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE

 

Uninsured patients determined to be eligible for financial assistance will be charged no more than amounts generally billed to patients with insurance. The hospital will reduce gross charges to the amount currently being paid by Medicare as documented in Munising Memorial Hospital’s annual interim rate review letter from Medicare. Invoices will show gross charges, as well as a discount reducing the charges to the Medicare rate.

 

DOCUMENTATION AND RECORDS

 

  • Confidentiality:  All information relating to the application will be kept confidential.  Copies of documents that support the application will be kept with the application form.
  • Documents pertaining to financial assistance and charity care shall be retained for 5 years.
  • This policy will be reviewed and updated annually.
  • Attachments:                         Patient/Guarantor Account Statement Timeline

Financial Assistance Application

Patient/Guarantor Account Statement Timeline

 

Patient registers with insurance coverage:

  1. Bill sent to insurer
  2. After insurance determines level of coverage, patient is sent the first statement identifying the amount they are responsible for, if any.

 

First Statement (approximately 30-60 days following date that bill is sent to insurer.  Patient/Guarantor choose one of the following actions:

  1. Pay balance within 15 days of date of statement and qualify for a prompt pay discount.
  2. Arrange payment schedule according to the Credit and Collections Policy.
  3. Apply for Financial Assistance within 15 days of date of statement (possible qualification for payment discount).

 

Second Statement (approximately 30 days following original statement):

  1. Arrange payment schedule according to the Credit and Collections Policy
  2. Apply for Financial Assistance

 

Third Statement (approximately 60 days following original statement):

  1. Arrange payment schedule according to the Credit and Collections Policy
  2. Apply for Financial Assistance

 

Fourth Statement (approximately 90 days following original statement):  Patient/Guarantor notified that if they have not arranged a payment schedule or qualified for Financial Assistance within 30 days of the date of this notice, the account is turned over to a collection agency.

 

Patient registers without insurance coverage:

  1. Patient is informed of Financial Assistance Policy at the time of registration.
  2. Within 15 days of registration the patient/guarantor is sent the 1st

 

First Statement: Patient/Guarantor choose one of the following actions:

  1. Pay balance within 15 days of date of statement and qualify for prompt pay discount.
  2. Arrange payment schedule according to the Credit and Collections Policy.
  3. Apply for Financial Assistance within 15 days of date of statement (possible qualification for payment discount).

 

Second Statement (approximately 30 days following original statement):

  1. Arrange payment schedule according to the Credit and Collections Policy
  2. Apply for Financial Assistance

 

Third Statement (approximately 60 days following original statement):

  1. Arrange payment schedule according to the Credit and Collections Policy
  2. Apply for Financial Assistance

 

Fourth Statement (approximately 90 days following original statement):  Patient/Guarantor notified that if they have not arranged a payment schedule or qualified for Financial Assistance within 30 days of the date of this notice, the account is turned over to a collection agency.

Uninsured Discount

Michigan Medicaid Expansion mandates that we accept a payment in full 115% of our Medicare rate from UNINSURED patients whose household income is less than 250% of the Federal Poverty Guidelines. To receive the current payment discount you must complete a brief application form. Uninsured Discount Application.

Billing Statement Schedule

All charges are due at the time of service. To aid in your payment, a monthly installment plan is available. That plan must be established sometime within the billing schedule. The timeline for billing depends upon whether you have insurance coverage or will be paying for services yourself. MMH will issue bills/statements on the following schedule:

For patients with insurance

15 days                         Bill sent to insurance company/(s)

30-60 days                   1st statement sent to patient

60-90 days                   2nd statement sent to patient

90-120 days                 3rd statement sent to patient

*After 30 more days account turned over to an outside collection agency

For patients without insurance

15 days                           1st statement sent to patient

45 days                          2nd statement sent to patient

75 days                          3rd statement sent to patient

105 days                        4th statement sent to patient

*After 30 more days account is turned over to an outside collection agency

Financial Assistance Overview

MMH is committed to providing financial assistance to individuals whose income and assets are such that payment is simply not possible. If you have less than $100,000 in net assets and your income level falls in the categories below, you may be eligible for complete or partial reduction of fees.

# in household    100% Poverty*            200% Poverty

1                                  $11,490                          $22,980

2                                 $15,510                           $31,020

3                                  $19,530                          $39,060

4                                  $23,550                         $47,100

5                                  $27,570                         $55,140

*Figures subject to change-call for the most recent numbers

Do I Qualify for Financial Assistance?

In order to qualify for Financial Assistance, patients must first exhaust other resources, including:

  • group or individual medical plans
  • worker’s compensation
  • Medicare, Medicaid, or other medical assistance
  • other state/federal/military programs
  • third-party liability or any situation where another person/entity has a legal responsibility to pay for your medical services

Which Services Qualify for Financial Assistance?

Services that qualify for financial assistance include:

  • emergency medical services (provided in the ER)
  • non-elective services provided in response to life-threatening circumstances
  • medically-necessary services, evaluated on a case-by-case basis at MMH’s discretion

If the items above accurately reflect your situation, ask a billing representative about financial assistance. You will be required to provide proper documentation to demonstrate need for assistance.