Midlands Health Center Financial Policy
We would like to thank you for choosing Midlands Health Center as your medical provider. Our aim is to facilitate and offer you with the highest healthcare services in a friendly and cost effective way. To reduce misunderstanding and or confusion between the health facility and our patients, we have laid down the following financial policies. If there are any queries regarding the policies, please feel free to discuss the matter with our office manager (Valerius, & Seggern, 2008). Our ability to serve you better and achieve our objectives lies on your understanding of the financial policies. We are dedicated to seeing that you get the maximum allowable benefits from your medical insurer, but this will only be possible if you are actively involved in the insurance claims process. Your understanding of the financial implication is an essential part in your care and treatment (Kid Lungs, 2011; Ear, 2010).
We will submit and accept all charges and claims made to Medicare. Midlands Health Center will also file to your secondary insurance. Our Health Center being a participating provider of Part B* or physician Services for Medicare, we will only charge you for services rendered that are not covered under Medicare. Any other service offered to you will be charged directly to Medicare (Valerius, & Seggern, 2008).
You will be made aware of services that are going to be rendered to you and are not covered under Medicare. When you sign for the appropriate Medicare waiver form, you authorize the physician to offer you services that will be billed to you and accept financial implications thereof. For those people holding only Medicare Part A, our Health Center will not be able to bill Medicare and therefore you will have to bear the financial cost (Valerius, & Seggern, 2008).
Commercial Insurance Patients
In no instance will Midlands Health Center be mandated to follow up on your insurance claim from your insurer. Your insurance contract exists only between you and your insurer, and therefore if your insurer pays only part of the bill or rejects it, you will have to bear the financial cost and you are required to pay the balance upon receipt of your statement.
Your insurance contract might also dictate that we bill for deductibles, coinsurance and co payments. Please note that this will not be subject to adjustments or discounts. If we hold a contract with your insurer we will make the necessary adjustments. You will be responsible for 1) claims that are denied 2) balances that may reflect after your insurer honors their commitment 3) and all other services that are not covered under your insurance policy (Ear, 2010).
Hmo and or Managed Care Insurance Patients
Many HMO and Managed care plans will not honor bills given for services rendered by our specialists if a patient is attended without a referral. Responsibility of obtaining a referral falls under the patient and or the guardian in cases of minors. The patient will also be required to update the required health plan. If you do not provide a current referral you may have the appointment rescheduled until one is obtained. At times you may be required to pay for all the authorized services that are rendered to you at the time of service (Ear, 2010).
Patients With No Insurance
Patients visiting the health center and do not have insurance will be required to pay amounts charged in full at the time of service. Cost for services rendered will be calculated and billed after services are rendered. In cases of special financial arrangement, you will be assisted by the billing and finance department. It is important you adhere to the rules and regulations of the hospital concerning the financial policy for better cooperation with the Health center (Valerius, & Seggern, 2008).
In case of a returned check, there will be a service charge of $35.00 (Ear, 2010).
Patients and clients aged below 18 will be required to be accompanied by a parent or a legal guardian for services to be rendered. The legal guardian or parent will be responsible for paying for the rendered services (Ear, 2010).
Methods of Payment
Our Health Center accepts MasterCard, Visa, PayPal, Check and Cash. In efforts to reduce overhead costs, we will require you to make payments at the time of service or when you receive your statement once your insurer has paid. When we pursue payment for services rendered the healthcare cost increases (Ear, 2010).
I have read and understood the MIDLANDS HEALTH CENTER financial policy. I hereby agree transfer my insurance benefits to The MIDLANDS HEALTH CENTER when required. I also agree that in cases of default, my account details may be forwarded to a collection agency. Also in addition to the amount owed , I agree that I will be responsible for all fees that will be imposed by the collection agency (Associated, 2012).
Review of the Financial Policy
Success of a health facility partly depends on the strengths of the financial policy put in place. It is the mandate of the business office department to ensure that the business side of the health center is running smoothly. A good medical financial policy should address the following strategic plans, Contracts, Charge capture, payment methodology, Fraud and Abuse, and Revenue cycle (Sommers, 1998).
I believe my policy is most suited not only for Midlands Health Center, but for all other Health Centers. The policy begins by identifying the strategic plan of the center which is to “facilitate and offer you with the highest healthcare services in a friendly and cost effective way.” This part enlightens the patient and clients of the goals the health care center aims to achieve (Sommers, 1998).
The policy above gives the conditions and advices the patients on how to fill claims for various insurance options and medical covers such as Medicare, Managed care and Insurance claims (Sommers, 1998). A good financial policy should be legally binding and should help to cultivate a financial relationship with the patients and clients. It should explicitly explain to the client the terms and conditions that will govern the financial policy.
A good financial policy should offer clients and patients various methods they can use to pay for services rendered. The policy given above gives the patient more than three options that they can use to pay the health facility for services rendered (Sommers, 1998).
Fraud and Abuse
A good financial policy should take into consideration all the legal concepts concerning payment that may arise. The financial policy should be legally binding and should be structured in a way that the medical facility can use it to claim for payment even if it means through a court of law. The policy above caters for all this and in addition it adds several clauses that are important. For example it has a section that covers for treatment of minors, which can be tricky because they cannot be compelled to pay. Any minor seeking treatment has to be accompanied by an adult or guardian and therefore the health center will bill the accompanying adult or guardian for services rendered to the minor. It also caters for situations where an insurer may reject a claim made by its client. This is done by making it mandatory for the patient to clear any balances that may arise after the health center has billed the insurer (Sommers, 1998).
This refers to the time taken from the time a client makes or is scheduled for an appointment to the time when payment is received from the insurer, Medicare or patient. The policy above details that a client with no insurance should pay once services are rendered, and goes to tell the patient on how to apply and seek help from the finance department during special occasions. It also tells the client that a charge will be imposed for all checks that are not honored or are returned. This is important because it gives the payment conditions that the health center requires its clients and patients to follow (Sommers, 1998).
Associated Medical Group. (2012).Put your Health Care in Our Hands. Web.
Ear, Nose, and Throat Specialists of Wisconsin. (2010). PATIENT FINANCIAL RESPONSIBILITY ACKNOWLEDGEMENT. Web.
Kid Lungs. (2011). Patient Financial Policy Sheet.
Sommers, P. A. (1998). Medical group management in turbulent times: how physician leadership can optimize health plan, hospital, and medical group performance. London: Routledge.
Valerius, J., & Seggern, J. (2008). Medical Insurance: An Integrated Claims Process Approach, 3rd Edition. New York: McGraw-Hill.