Billing and Collection Policy

Billing and Collection Policy

Policy Statement

Holy Name Medical Center (HNMC) is committed to billing patients and insurance carriers in a manner that is understandable, professional, compassionate and in compliance with federal, state and local rules, including IRS 501 R.

This billing and collection policy is intended to be consistent with Holy Name’s FAP. Any inconsistencies shall be guided by the FAP and applied in a manner that benefits the patient.

Procedures

1. Patients shall be registered in the Hospital's Information System in a manner that ensures information is included that is necessary to effectively provide medically necessary care and to professionally bill for services rendered.
2. 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.
3. Holy Name will make reasonable efforts to collect from an insurance carrier prior to billing the patient for services rendered. If there is an outstanding claim after reasonable efforts are made to collect from the insurance carrier, Holy Name shall seek assistance from the patient to contact the insurance carrier and resolve the issue. If these efforts are not successful then the account may be changed to a self-pay account.
4. After the account, or any portion of such account, is deemed self-pay, Holy Name or its designated agent, will bill the patient or guarantor for the remaining balance on the account.
5. Accounts that are deemed self-pay will receive up to four statements and/or notices asking that the account balance be paid.
6. After exhausting reasonable efforts over a period of up to 120 days to collect a self-pay balance, Holy Name may refer the account to a collection agency. Such referral shall not be deemed to be an Extraordinary Collection Action (ECA).
7. An account with a collection agency shall generally be pursued up to 180 days unless, after consulting with Holy Name, it is determined to maintain an account beyond that timeframe. If it is determined by Holy Name'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 Holy Name’s 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.)
8. ECA's that the Hospital or its agents may take include:
   • Reporting adverse information to a credit-reporting agency
   • Placing a lien on property
   • Garnishing wages