Financial Assistance

Financial Assistance Policy

Financial Assistance Policy

As a tax exempt not-for-profit charitable organization, Madison Healthcare Services (MHS) strives to ensure that the financial capacity of people needing care does not prevent them from seeking or receiving care.  MHS is committed to providing financial assistance to persons who have health care needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay.

Eligibility

1. Financial Assistance is available for patients who require emergency services and medically necessary care. If a patient elects not to bill his/her insurance for a particular procedure or date of services, that visit will not be eligible for Financial Assistance.
2. The providers delivering emergency or other medically necessary care at our facility and covered under this financial assistance policy are: Dr. Brant Hacker, Dr. Maria Nolte, Michael Deyo – PA, MariBeth Olson – PA, Paul Hodge – NP, Melanie Miller – NP, Jan Briones – NP, Dr. David Freeman, Dr. Miranda Renfrow, Dr. Vikram Chatrath, Karin Tansek, Deb Colon – PMHNP, Kelsey Tollefson – LSW, Lisa Kuechenmeister – LCC and all locum providers from Acute Care covering our facility.
3. Financial assistance is for patients who have limited or no health insurance; demonstrate financial need; reside in the primary service area of MHS. Financial assistance is not an insurance program.
4. A request will be made that the patient apply for Medical Assistance or alternate source of coverage through existing public programs, but failure to apply will not disqualify them from Financial Assistance.
5. A patient must complete the Financial Assistance application and supply all requested documentation.
6. Depending on the individuals need, either free care or reduced patient financial obligations to MHS may be offered. MHS does not have the authority to waive any charges that are not billed by MHS.
7. Each patient has the opportunity to apply for assistance at all times throughout his or her relationship with MHS: Prior to treatment, throughout treatment, and up to the resolution of his or her account.
8. Outstanding balance letters are mailed to patients residences and they include information about MHS’s financial assistance program. A copy of the facility financial assistance application will be included with the Final Notice letter if not requested by the patient sooner.
9. If the individual fails to submit the Charity Care application within 120 days of the first billing statement the facility has the option to proceed with collection process. At least 30 days prior to initiating collection process a written notice will be provided indicating if individual does not submit the application or pay the amount due by indicated deadline the account will be sent to a collection agency.  The facility has the discretion to consider for charity care without completion of charity care application. MHS and their collection agencies do not engage in extraordinary collection actions.
10. An individual who is determined to be eligible for financial assistance under this policy shall not be required to pay more for emergency medical care and other medically necessary than the amounts generally billed (AGB) to individuals who have insurance covering such care. This AGB limit shall be used by MHS to determine the maximum amount that an individual may be liable to pay after such individual is determined to be eligible for financial assistance.  MHS uses the prospective method as described in regulation 1.501(r)-5(b)(3).

Online Financial Assistance Application

How to apply for Financial Assistance (Charity Care)

1. Patients must complete the Financial Assistance Application and provide appropriate income verification(s). This information can be provided one of the 4 ways below:
   • Online completion of the application with uploaded income verification.
   • Print the form and drop it off at one of our facilities.
   • Mailed to Madison Healthcare Services, Attn: Business Office, 900 2^nd Ave, Madison, MN 56256
   • Faxed to 320-598-3470

Reasonable effort will be taken to request and assist in completing application, including meeting with individual and assisting in process.

Assistance with application is available by contacting the business office staff at 320-598-7536 or in person at MHS 900 2^nd Ave, Madison, MN 56256.

2. The CFO and/or Revenue Cycle Director will review the application and have the authority to approve or deny charity care assistance.
   1. When an application for charity care is approved:
      1. The Patient Account Manager will “write off” the discounted amount as charity care.
      2. A letter will be sent to the patient or estate notifying them that their application was approved, the amount discounted and the remaining balance due from patient if any.

• Charity Care information will be kept on file for year-end audit, cost report and surveys.

1. When application for charity care is denied:
   1. A denial letter will be sent to the patient.
   2. Regular collection efforts will resume.
2. Financial assistance calculation
   1. Total income is less than 100% Federal Poverty Guidelines (FPG) = 100% financial assistance
   2. Total income is greater than 100% FPG but less than 200% FPG = 75% financial assistance 25% patient responsibility.
   3. Total income is greater than 200% FPG but less than 300% FPG = 50% financial assistance 50% patient responsibility.
   4. Total income is greater than 300% FPG = no financial assistance.