Page 1 of 3 DESCRIPTION/OVERVIEW This procedure describes ...

Applies To: CRTCFunctional Area: Fiscal Services, Patient ServicesComponent (If Limited To): N/ADepartment (If Limited To): N/ATitle: Point-of-Service CollectionsProcedurePatient Age Group:AllDESCRIPTION/OVERVIEWThis procedure describes payment required from self-pay and insured patients.REFERENCES• UNMH Point-of-Service Collections for Self-Pay Patients• UNMH Bernalillo County Financial Assistance• UNMH Out of County Medically Indigent• CRTC Payment PlansAREAS OF RESPONSIBILITYCRTC will comply with the Emergency Medical Treatment and Active Labor Act (EMTLA).Patient Services representative, Financial Counselor and Neltner Billing and Consulting (NBC)staff will screen all patients for any insurance coverage and any required relevant authorizationsincluding third party coverage or eligibility for the UNM HSC financial assistance programs.PROCEDURE1. Patients will be informed of the need for the initial fee and financial eligibility screeningat the time a medical appointment is made. Appointments with a financial counselor willbe made prior to the medical appointment, whenever possible. Failure by staff, for anyreason, to inform patient does not relieve patient of his/ her financial responsibility.2. Patients classified as self-pay will be required to pay a minimum of 50% of the estimatedcharges for visits or procedures before receiving those services. A discounted charge willbe applied to patients meeting certain income level criteria. Payment of 50% of thediscounted charge is also expected. Patients under insurance plans and/or UNM HSCfinancial assistance programs will be required to pay applicable co-pays for clinic visits,pharmaceuticals and/or procedures/therapies.3. Point-of-service collection will be solicited at the time of the patient’s visit. All patientspresenting for a medical appointment who are unable to pay will be rescheduledand/or referred to the financial counselor unless the physician deems the patient’smedical condition as urgent/emergent or if the patient is participating in a fundedprotocol/clinical trial. An appointment with the Financial Counselor will be requiredprior to any future medical visits.4. Patients will be informed that their current charge and payment represent partial paymentfor services and will be applied to their total bill, with the remainder to be billed anddue upon receipt.Title: Point-of-Service CollectionsOwner: Manager of Patient ServicesEffective Date: 1/17/06Page 1 of 3

5. Neither clinical staff nor physicians may waive co-payments or partial payments(although patients may be seen in certain circumstance in accordance with 2. above).Financial matters should be referred to the Financial Counselor for assessment andrevision to the payment plan, as appropriate.6. Patients who are identified as having special needs by a physician or other staff membermay be referred to the Social Worker for evaluation.7. Refunds may occur for patients who, subsequent to a visit, qualify for financialsponsorship, including Medicaid, and depends on the effective date for sponsorship.Patients presenting for an appointment who do not receive services will receive a refund,if applicable.8. Patients requiring multiple, frequent visits (more than two per month) for a chroniccondition over a long period of time, e.g. chemotherapy, radiation therapy, etc. will beexpected to pay a fee at the time of service. Patients unable to pay a fee at each visit willbe required to meet with the Financial Counselor to arrange monthly payments (althoughpatients may be seen in certain circumstance in accordance with 2. above).DEFINITIONSSelf pay patients are defined as not eligible for Medicare, Medicaid, commercial insurance orany financial assistance programs for qualified patients.SUMMARY OF CHANGESJuly, 2005 - Changed from a guideline to a procedure.KEY WORDSCRTC, Point-of-Service, Collections, Self-PayRESOURCES/TRAININGResource/OfficeNeltner Billing andConsultingPosition/TitleDept.PhoneInternet/LinkDOCUMENT APPROVAL & TRACKINGItem Contact Date ApprovalOwnerManager Patient ServicesConsultant(s)Committee(s) CRTC PPG Committee, Management Group YNursing Director Terry Amerine, Clinical Operations Director YMedical Director Ian Rabinowitz, MD N/AHuman ResourcesN/ACompliance Stanton Royce, Manager Clinical Therapy Programs YLegalN/AFiscal Anthony Masciotra, CFO YTitle: Point-of-Service CollectionsOwner: Manager of Patient ServicesEffective Date: 1/17/06Page 2 of 3

Official Approver Russell Dilts, CAO YOfficial SignatureEffective DateOrigination Date[Month/Year]Issue Date Clinical Operations P&P Coordinator [Day/Mo/Year]ATTACHMENTSNoneTitle: Point-of-Service CollectionsOwner: Manager of Patient ServicesEffective Date: 1/17/06Page 3 of 3