Billing and Collection Policy
Holy Name Medical Center (HNMC or Hospital) is committed to bill patients and insurance carriers in a manner that is understandable, professional, compassionate and in compliance with State, Local and Federal rules including IRS 501 R.
It is the intention that this policy be consistent with HNMC's Financial Assistance Policy (FAP) and any inconsistencies shall be guided by the FAP and applied in a manner that benefits the patient.
- Patients shall be registered in the Hospital's Information System in a manner that ensures the capture of the information necessary to effectively provide medically necessary care and to professionally bill for services rendered.
- After services are rendered the patients or guarantor's insurance (if any) shall be billed. If the patient has no insurance and was registered self-pay the bill for services will be adjusted in accordance with the Hospital's FAP.
- The Hospital will make reasonable efforts to collect from an insurance carrier prior to billing the patient for services rendered. If after reasonable efforts are made to collect from the insurance carrier the hospital shall seek assistance from the patient to contact the insurance carrier and resolve the outstanding claim. If these efforts are not successful then the account may be changed to a self-pay account.
- After the account, or any portion of such account, is deemed self-pay the Hospital, or it's designated agent, will bill the patient or guarantor for the remaining balance on the account.
- Accounts that are deemed self-pay will receive up to four statements and/or notices asking that the account balance be paid.
- After exhausting reasonable efforts over a period of up to 120 days to collect a self-pay balance, the Hospital may refer the account to a collection agency. Such referral shall not be deemed to be an Extraordinary Collection Action (ECA).
- An account with a collection agency shall generally be pursued up to 180 days unless, after consulting with the Hospital, it is determined to maintain an account beyond that timeframe. If it is determined by the Hospital's Patient Financial Services department that the account requires an ECA, and such account meets the requirements of 501R, including but not limited to waiting a minimum of 120 days after the first post discharge bill to commence ECA activities, the agency shall notify the patient in writing a minimum of 30 days prior to commencing ECA. Such notification shall include a copy of the Hospitals plain language summary of the FAP along with a statement as to which ECA's the agency may be taking. If within the 30 day notice period the patient requests financial assistance, and the account is not older than 240 days from the first post discharge bill, then the patient shall be given 10 days to apply for financial assistance before ECA may be initiated. In the event ECA has been initiated and the account is not older than 240 days from the first post discharge billing date and the patient requests financial assistance then the ECA will be suspended for up to 10 days to allow for the patient to apply for financial assistance. (the first post discharge bill shall be the first bill a patient receives for services regardless if services are ongoing)
- ECA's that the Hospital or its agents may take include:
- Reporting adverse information to a credit reporting agency
- Placing a lien on property
- Foreclosing on property
- Attaching or seizing a bank account or property
- Garnishing wages
- Deferring, denying or requiring payment for non-emergency medically necessary care when there is non-payment of previously provided care.