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Financial Policy

Purpose Statement

In order for Blount Memorial Hospital to provide services to the Blount County community, and maintain an acceptable financial position, it is necessary to adhere to appropriate hospital billing and payment policies.

Policy

Blount Memorial Hospital is a governmental common non-profit organization, and must depend upon payment from insurance companies and patients to maintain hospital services and programs.  Anyone in need of critical care, emergent or urgent health care will be treated regardless of financial status or ability to pay. 

Emergent or Urgent Services

Medical Services will be provided regardless of the patient’s ability to pay, consistent with the Blount Memorial Hospital mission and in compliance with applicable Federal and State regulations.Established collection policies will be enforced after the medical screening examination has been completed and the patient has been stabilized.  Patients admitted to the hospital to stabilize their condition will be identified and monitored for financial resolution prior to discharge.

Payment Responsibility

The patient, guarantor or legal representative is ultimately responsible for all charges incurred for the medical service provided.  Any individual signing the BMH Consent/Release or financial responsibility form will be liable for payment of the related account.  The amount of responsibility is the full balance of the account including any insured amount.  Payment of the amount owed is expected at the time of service.  The balance due will be considered delinquent after 60 days and may be reviewed for further collection action.

Non-Emergent or Urgent Scheduled Patients

Patient/guarantors are expected to resolve their identified financial obligations to Blount Memorial Hospital prior to their scheduled date and time of service.  Services may be clinically reviewed for delay, rescheduling or cancellation if one of the following occurs:

  • Required deposit is not made
  • Approved payment arrangements are not finalized
  • Previous payment delinquency without good cause is identified

Assignment of Benefits

Blount Memorial Hospital will bill insurance plans that are contracted with the hospital if adequate and timely proof of coverage is provided. 

  • Patients are responsible for ensuring that all requirements are met for their insurance plan, such as precertification of services, second opinions and in-network restrictions. 
  • The patient and/or subscriber may be required to assist in the follow-up process of the claim and will be required to make payment if the insurance payer has not resolved a clean claim within 60 days.
  • Blount Memorial Hospital will not bill an insurance plan if timely filing limits have expired or the primary insurance plan does not provide a payment denial or explanation of benefit.
  • Patients are responsible for the payment of the following charges:
    • Those denied by their insurance plan as non-covered or patient comfort
    • Out of Network balances that exceed reasonable and customary
    • Co-payment and/or Coinsurance
    • Deductible

All other insurance plans will be billed as a courtesy if the patient/guarantor provides the required insurance billing information timely.  The following is required: 

  • A completed BMH Consent/Release form which includes the Assignment of Benefits statement and/or, 
  • A Letter of Assignment signed and dated by the patient/guarantor (required for liability carriers including motor vehicle and personal injury). 

Partial Insurance Coverage/Non-Covered Services

Patients with insurance policies that cover only a portion of the hospital services must pay the difference between the hospital charges and the anticipated insurance payment.

  • This payment may be requested and is due at the time of service or discharge.
  • A preadmission deposit may be required for elective services.
  • Prompt payment discounts are available for patients who pay their patient portion within 30 days of the first billing statement prepared for mailing.

Patients with insurance policies that do not cover services for conditions which are not considered medically necessary, will be required to pay an estimated or negotiated amount before service is provided.  These conditions include but are not limited to treatment for patient:

  • comfort
  • appearance
  • convenience

Self-Pay Uninsured Patients

 “Uninsured patient” is defined as a person with no public or private source of payment for medical services. 

  • Blount Memorial Hospital provides a self-pay uninsured discount in accordance with Tennessee Code Annotated, 68-11-262. 
  • Payments for all charges are due and payable at the time of service or discharge.
  • Patients will be assisted, upon request, in applying for State and Federal assistance   programs, as well as the BMH Charity Care program based on eligibility guidelines.

Preadmission Program

Preadmission information may be requested prior to certain scheduled admissions or outpatient services.  Patients may be contacted by our Patient Access department regarding insurance and demographic information. 

Financial counseling is available at the time of preadmission testing or by phone before admission.  Various options for payment will be discussed and arranged before admission. 

Verification of Information

All information regarding third-party insurance, employment, the ability to pay, etc. will be subject to verification.  All records and information, including knowledge of a debt, are subject to HIPAA compliance and remain confidential.  A photo ID is required at the time of registration as a protection against identify theft.

Deposits

All patients are expected to contribute to the cost of their care based upon their individual ability to pay.  Payment deposits may be requested or required from patient/guarantors for estimated charges prior to admission, outpatient service or upon discharge for services that are:

  • scheduled
  • non-covered
  • uninsured

In-House Collections

In the event the uninsured liability was not determined prior to admission, the patient/guarantor may be contacted and requested to make payment arrangements on balances that will be due at discharge.  Financial Counselors are available to assist with insurance questions and payment arrangements.

Delinquent Accounts

Prior to providing elective outpatient services or scheduling a new admission, payment of prior outstanding account balances may be requested.  Payment is expected or specific payment arrangements must be approved by the Business Office.

Unpaid Insurance Balances

Any insurance claim that remains unpaid 60 days or more will become the payment responsibility of the patient/guarantor (except when prohibited by contract).  The patient/guarantor may be requested to assist in the follow up process prior to 60 days. 

Patient/guarantors will be billed for unpaid insurance balances immediately upon notification that additional information is required from the insured and no response has been received. 

State laws governing the timeliness of clean claim processing will be enforced, as well as contract terms for claim turnaround. 

Third-Party Litigation

Blount Memorial Hospital will not become involved in disputes arising from third-party claims (i.e. motor vehicle accidents, liability claims, etc.) with the exception of verified workers’ compensation claims, or claims involving Medicare or TennCare/Medicaid. 

  • Hospital staff will provide copies of documents requested by the patient/guarantor, or representative with approved release of information form.
  • Any outstanding balance regarding that account will be due in full following routine insurance filing. 
  • Should the account remain unpaid, it may be referred to an outside collection agency or attorney. 
  • All applicable finance charges, late charges, interest and collection costs will be added to the account balance.

Payment Methods

The following payment methods are accepted:

  • Cash
  • Personal or certified check
  • Money Order
  • Visa, MasterCard, Discover and American Express
  • Approved Payment Plans
  • Employee Payroll Deductions

Payment Arrangements

If a patient/guarantor is unable to make full payment of the patient balance due, periodic partial payments may be approved in accordance with payment plan guidelines. 

  • A payment plan may be established based upon the account balance and the patient’s ability to pay. 
  • A Confidential Financial Evaluation form may be requested to determine appropriate payment arrangements, eligibility for financial assistance or charity care.

Referral for Outside Collections

Accounts that cannot be collected by hospital staff through routine telephone and mail follow up, may be referred to a collection agency or attorney for further collection action, in accordance with established guidelines. 

  • The average period of time for in-house follow up is 120 days, although, the age may vary somewhat for each account based on billing and follow up. 
  • The patient/guarantor will be responsible for the payment of any applicable interest, late fees, finance fees and collection costs as they apply to the resolution of the debt.

Legal Action

If deemed appropriate by the Director of Patient Accounts or designee, the hospital or the collection agency may take legal action, including the lien on personal property or pending claim settlement or garnishment of wages, in order to collect balances owed.  Claims will be filed against estates in the case of unpaid claims for deceased patients.

Third-Party Audits

The hospital recognizes the need for audits of insurance claims by insurance companies or their contracted audit firms.  The hospital will cooperate in making available required information as outlined in the current audit policy and procedure.

Discounts

The hospital will discount self-pay uninsured accounts in accordance with TCA 68-11-262 and the Joint Annual Report of Hospitals charge-to-cost ratio for our facility.  Prompt payment discounts may be available for payments made at the time of service or within 30 days of the first billing statement sent to the patient/guarantor.  Negotiated discounts are at the discretion of the Director of Patient Accounts or designee, if deemed appropriate. 

Charity Care Allowances

If a patient is determined to be financially indigent, the Patient Accounting staff will assist the patient in applying for programs of financial assistance.  If no source of financial assistance is available, the hospital will review the account for a charity care allowance.  The charity care determination will be based upon the hospital’s current charity care guidelines.  Patients must complete a Confidential Financial Evaluation form and provide verification of income and assets as outlined in the current Charity Care/Financial Assistance policy and procedure.

Contractual Allowances

Contractual adjustments will be handled in accordance with the administrative contract negotiated between the payer and Blount Memorial Hospital.

Refunds

Credit balances are reviewed daily.  Refund requests and overpayments will be prepared in accordance with the Credit Balance policy and procedure.

NSF Checks

Returned checks for non-sufficient funds will be handled in accordance with Patient Accounting Department returned check procedures.  Check Velocity, an outside vendor, manages NSF checks with applicable fees to the patient.

TennCare Eligibility

Self-pay uninsured patients will be evaluated for TennCare eligibility by a representative of MEDASSIST.  The representative will coordinate with the county Department of Human Services to begin the application process.  Accounts pending TennCare approval will be withheld from collection activity.

Confidentiality

Staff will treat all patients and their families with courtesy and respect.  All records and information, including knowledge of a debt, will be held in strictest confidence and compliance with HIPAA guidelines.  Although the Fair Debt Collection Practices Act does not apply to collection activity by health care organizations, those guidelines will be maintained.

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