Financial policy

Institution Name: Medicare Centre

At Medicare Centre, we are dedicated to providing quality healthcare services, guidance and education in promoting wellness to all our patients not withstanding their social or financial status.

Collection of copayments, coinsurance, deductibles and past due payments

Medicare policy is that the patient is responsible for the coinsurance amount. The amount is 20% of the approved cover by your insurance or healthcare plan provider. In addition, the patient is responsible for all the deductibles and copayments as specified in the insurance cover. The bill of all sums will be made to the patient as per the services rendered and are to be paid within a period of 30 days once discharged. However, copayments on drugs and consultation services either have to be made before or immediately after the services are offered.

All the copayment and past due are due at the time that the patient checks in unless other arrangements have been made with the chief financial officer. A letter of past due payments will be made to the patient after 30 days before further action can be taken against them. Such a patient is considered a candidate for our payment plan program. The patient will have to sit down with the chief financial officer to discuss a workable payment plan. Further legal action may be considered against the patient that defaults his/ her payments.

Handling of unpaid balances

All financial obligations with the institution must be dealt with within 30 days. Our institution will reassess the fees charged for any unpaid balances on a case-by-case basis. No services will be rendered to a patient with unpaid balances after the specified period.

Payments for non-covered services

Our institution will only bill the patient for services not covered by the insurance company or even under the patient’s health care plan. The usual or customary fees will be charged to the patient once he/ she has signed a waiver in advance specific to the service that he/ she may be seeking. Ensure that you contact your insurance company or health care plan provider to be certain of services covered or not covered under your healthcare plan.

If we inadvertently bill the patient’s healthcare plan or insurance company for services not covered, we will promptly refund any copayments or deductibles collected from the patient, the insurance or the health care plan payor.

Prepayment policy

Due to the fact that most prepaid programs offered by a majority health plans require you to follow up with a copayment, Medicare Centre will not bill you prior to receiving our services. However, you will have to pay the copayment upfront.

Payment policy

Our institution accepts payments through any of the following means: Cash, checks, money orders and credit or debit cards. All cash payments are made to the cashier for amounts not exceeding $500. Amounts exceeding $250 are to be made through any other specified methods above. It is also our policy however that if a check is returned or bounces, then a charge of $30 is payable by either cash or money order. All extra charges as pertains to transactions are to be billed by you if you use credit or debit cards in paying your bill.

Sliding scales and low-income payments

As an institution, we recognize the fact that both uninsured and underinsured individuals also do require healthcare services like everyone else. It is for this reason that our institution has in place a program to assist such individuals.  A fund has been set up to collect funds that can help reduce the burden on low-income individuals seeking medical care from our institution.

The aid may come in terms of waivers on the copayment, coinsurance or even deductibles on the patient’s insurance cover. The waivers are only applicable on a case-by-case basis. The patient may have minimum waivers on their copayments, coinsurance or even deductibles depending on predetermined procedures to fit each patient’s needs.

If the patient is uninsured, facing hardships or even low income, they may qualify for a sliding scale in our medical institution for our medical services. A discount may be extended to the patients that qualify for the services. The discount can only be extended to services that are only offered at our institution; services such as lab work that may have to be outsourced are not included in the program.

The eligibility of a patient to be in the institution is determined using internal mechanisms once the patient fills up the necessary documents and provides us with proof or evidence of their claims. All requested documentation must be provided for the patient to be considered for the program.

Since we do not receive any assistance from the government, we may not be in a position to extend our services to all individuals that qualify. In addition, we do reserve the right to discontinue the program at anytime depending on the prevailing conditions.  After application to be included in the program, the patient has to wait for a period not less than 30 days for approval. Until the process is completed and awarding of the discount benefits from the program, the patient will be responsible for the full charges. The sliding fee is valid for six months from the date of application after which the patient has to reapply in order to continue receiving a sliding fee.

Double charging and repayment

If discovered that we have inadvertently charged either both the patient and the insurance company for covered or non-covered services, then we are obliged to promptly refund either the patient or the insurance company any deductibles or copayments received.

Once a patient receives a sliding fee from the institution, then the excess will be used to cover for the services currently being rendered until the patient is well. However, if the patient gets well before the excess is exhausted, then the amount is either going to be refunded to the patient or if the patient wishes, transferred to the hospital fund. The fund helps in financing the sliding scale program.

Any complaints, suggestions or requests as pertains to fees should be filled with the chief financial officer for quick processing of the claims.

Review of financial policy

The success of a health facility depends on the development of a good financial policy. Therefore, whoever sits down to prepare a financial policy for a healthcare facility should take into consideration every aspect of the business in order to ensure its success. My financial policy is designed to best bring out this features to ensure that Medicare Centre has the all the ingredients to prosper by managing its financial cycles.

A good financial policy should support the various office management practices and vice versa. The financial policy I have designed is both exclusive and inclusive the determination of all the matters that pertain to the payment procedures in the healthcare institution. As a consequence, in running of all the requirements and other aspects in the running of the office, the staff and the patients can refer to the financial policy.

A good financial should include cheap yet acceptable ways in which the patients or clients can make payments for services rendered. According to Higgins (2004) should include every possible means possible means out there that the patients can use to access various services rendered. These forms of payment, in line with his argument, are used by the patients to pay the deductibles, copayments and discounted services for the uninsured people.

 The financial policy adopted by a health facility should be very simple to interpret  and understand for the patients. This should use simple language and easy vocabulary to cater for the different groups of individuals that may visit the institution. A close study of the policy I have designed, the language is simple and straight to the point. The language is also personalized to make the patients or clients more receptive of the document.

In the preparation of  a financial policy, the Scope of the document should encompass every possible aspect that needs to be mentioned. A financial policy may be used in the predetermination and implementation of  the facility’s goal and such should into every little detail especially the financial part. ”strategy starts with the development and implementation of a workable financial.” (Kongstvedt 2001). In my design, every aspect that pertains to payments and the revenue cycle of the business has been analyzed.

 A well designed financial policy for health facility or institution should be all-inclusive. There are different people in the society in the different walks of life. The financial policy I have designed is also complete in that it caters for every group in the society that may visit the institution. The inclusion of a sliding a scale and a low-income policy clause in the policy ensures that this issue is sorted out. According to Bluhm,  (2007), a good financial system should include a system that caters for the less fortunate and uninsured group of the society.

Finally, the phrasing of a financial policy document should be friendly and accommodative. This will make the reader to be more relaxed and in the analysis of the document. It also makes it quite easy for the patients to understand the document while going through it. In my document, I have used the second person “you” to make the financial policy more relatable to the patient. The patient is certain that the document is meant for him or her and not for someone else.

References

Babbel, D., Fabozzi, F.J. (1999).Investment management for insurers. Frank J. Fabozzi &Assoc.

Bluhm, W.F., (2007). Individual health insurance. Actex.

Higgins, R.C. (2004). Analysis for financial management and standard and poor’s educational      version of market insight (8^th ed.). McGraw-Hill/Irwin.

Kongstvedt, P.R. (2001). Managed Health Care Handbook (4^th ed.). Aspen Publishers