Financial Assistance Policy

POLICY/ PRINCIPLES

It is the policy of Hackensack Meridian Health Pascack Valley Medical Center (the “Organization”) to ensure a socially just practice for providing emergency or other medically necessary care at the Organization’s facilities. This policy is specifically designed to address the financial assistance eligibility for patients who are in need of financial assistance and receive care from the Organization.

DEFINITIONS

For the purposes of this Policy, the following definitions apply:

• “501(r)” means Section 501(r) of the Internal Revenue Code and the regulations promulgated thereunder.
• “Amount Generally Billed” or “AGB” means, with respect to emergency or other medically necessary care, the amount generally billed to individuals who have insurance covering such care.
• “Community” means geographic area of the State of New Jersey
• “Emergency Care” means labor or a medical condition of such severity that the absence of immediate medical attention could reasonably be expected to result in seriously jeopardizing the health of the patient (or unborn child), serious impairment to bodily function, or serious dysfunction of any body organ or part.
• “Medically Necessary Care” means care that is determined to be medically necessary following a determination of clinical merit by a licensed physician in consultation with the admitting physician.
• “Organization” means Hackensack Meridian Health Pascack Valley Medical Center.
• “Patient” means those persons who receive emergency or medically necessary care at the Organization and the person who is financially responsible for the care of the patient.

Financial Assistance Provided

Charity Care Program:

• The New Jersey Hospital Care Payment Assistance Program (Charity Care Assistance) is free or reduced charge care which is provided to patients who receive inpatient and outpatient services at acute care hospitals throughout the State of New Jersey. Hospital assistance and reduced charge care are available only for necessary hospital care. Some services such as physician fees, anesthesiology fees, radiology interpretation, and outpatient prescriptions are separate from hospital charges and may not be eligible for reduction.

• The source of funding for hospital care payment assistance is through the Health Care Subsidy Fund administered under Public Law 1997, Chapter 263. Other Assistance for Patients Not Eligible for Financial Assistance

Other Assistance for Patients who are not eligible for financial assistance:

Patients who are not eligible for financial assistance, as described above, still may qualify for other types of assistance offered by the Organization. In the interest of completeness, these other types of assistance are listed here, although they are not need-based and are not intended to be subject to 501(r) but are included here for the convenience of the community served by Hackensack Meridian Health Pascack Valley Medical Center.

Limitations on Charges for Patients Eligible for Financial Assistance

Patients eligible for Financial Assistance will not be charged individually more than AGB for emergency and other medically necessary care and not more than gross charges for all other medical care. The Organization calculates one or more AGB percentages using the “look-back” method and including Medicare fee-for-service and all private health insurers that pay claims to the Organization, all in accordance with 501(r). A free copy of the AGB calculation description and percentage(s) may be obtained by request in any admissions area. Patients may also request a free copy of the AGB calculation and percentage by mail by calling Patient Financial Services at 201-383-1043 to request a copy be sent to the Patient’s mailing address.

Applying for Financial Assistance and Other Assistance

A Patient may qualify for financial assistance through presumptive scoring eligibility or by applying for financial assistance by submitting a completed FAP Application. Services greater than 240 days from the date of the first post-service billing statement prior to the date that the patient initially submits the Financial Assistance Application will be considered for Financial Assistance.  The FAP Application and FAP Application instructions and Plain Language Summary (PLS) will be made available upon patient request and without charge to the patient. If a Patient wishes to apply for financial assistance after the day(s) of service, a Patient may access the FAP Application and FAP Application instructions and print directly from Hackensack Meridian Health Pascack Valley Medical Center website. Patients may also request a copy of the FAP Application and FAP Application Instructions by mail. To request a copy of the documents by mail, Patients should call the Patient Financial Services department at 201-383-1043. In each of the aforementioned accessible locations, the FAP Application and FAP Application instructions are available in the primary language of any populations with limited proficiency in English that constitute the lessor of 1,000 individuals or 5 percent of the community served by the hospital.

Patient Collections Timeline – Inpatient and Outpatient Services

Hackensack Meridian Health Pascack Valley Medical Center provides billing statements for services rendered after insurance has processed the claim, or immediately for patients without insurance.

Balances that are the responsibility of the patient include the following:

• Self-Pay (Patient without insurance)
• Self-Pay after Insurance (Insurance has satisfied their responsibility, with the remaining balance being the responsibility of the patient)
• Charity Care (Discounted charges based on charity percentiles)
• Self-Pay after Medicare (Patient responsibility as defined by Medicare)

Statement Cycle

For all patients, a statement is mailed approximately five days after the balance becomes the responsibility of the patient.

All self-pay balances – Notification Period is the 120-day period, which begins on the date of the 1st post-discharge billing statement, in which no extraordinary collection efforts may be initiated against the patient. A statement is sent to the patient after insurance has satisfied their portion, if applicable. If the total past-due patient responsibility is not collected by the due date, the patient will continue to receive subsequent statements (up to 4 total). If payment is still not received, the account will be sent to a collection agency.

Actions that may be taken in the event of non-payment:  In accordance with the Hackensack Meridian Health Pascack Valley Medical Center Billing/Collection Policy, and summarizing the pertinent aspects of that policy here:

When a Financial Assistance Application is received, Hackensack Meridian Health Pascack Valley Medical Center will:

1. Route the application to the Hackensack Meridian Health Pascack Valley Medical Center Financial Counseling Department
   • Financial Counselors will
   • Document receipt of the application in the hospital accounts receivable system notes.
   • Submit a copy of the application and any supporting documentation/ correspondence to the scanning department to be attached to the account as digital images.
   • For accounts placed with early-out or collection agency: Notify relevant agencies with whom the patient’s accounts have been placed that a Financial Assistance Application has been received and instruct them to:
     • i. Place a 30-day hold on all collection activities with the exception of normal dunning by statements.
     • iI .Suspend all extraordinary collection activities (ECA) until the application is approved or denied by Hackensack Meridian Health Pascack Valley Medical Center
2. Review the application for completeness and submission of all supporting documentation. If an application is not complete or is missing necessary supporting documentation, the application will be denied; however, the application will be reconsidered if the missing documentation is supplied within 30 days. A letter will be sent to the applicant
   • Informing them that the application has been denied as incomplete; but will be reconsidered if the missing information is supplied within 30 days 
   • Specifically listing the items that are missing or otherwise specifically describing the defect or missing information
   • Informing the applicant of the due date, which shall be 30 days after the date of the letter. This period may be extended an additional 30 days, if at the discretion of the Financial Counseling Dept., it is believed that the applicant is acting in good faith and due diligence to obtain the missing information, but such information is delayed for reasons outside of the control of the applicant. The Financial Counselor will follow or repeat steps i. and ii. above to ensure any further collection activities are suspended for 30 days until the next due date. If after the 30 days from the statement and the account is 120 days or greater and there is no payment, the account will be designated as delinquent and will be sent to collections.

Patients with inquiries regarding their balance or questions concerning financial assistance may call Customer service at 844-220-0013.

APPENDIX A: Providers by Department that provide emergency or other medically necessary healthcare services within the hospital facilities

Hackensack Meridian Health Pascack Valley Medical Center

Department/Group	Covered by Financial Assistance Policy
Anesthesiology	NO
Dentistry	NO
Emergency Medicine	NO
Family Practice	NO
Medicine	NO
Obstetrics and Gynecology	NO
Ophthalmology	NO
Orthopedics	NO
Pathology	NO
Pediatrics	NO
Psychiatry	NO
Radiation	NO
Oncology	NO
Radiology	NO
Surgery	NO

Financial Assistance Application – English
Financial Assistance Application – Spanish
Billing Policy