Collection Action

(1) Obtaining Information. Hospitals and Community Health Centers must have written Credit and Collection Policies that comply with 114.6 CMR 10.09. (a) Inpatient Services. 1. Non-Emergency Admissions. A Hospital shall make reasonable efforts to obtain the financial information necessary to determine responsibility for payment of the Hospital bill from the patient or Guarantor prior to the date of the patient admission. 2. Emergency Admission. A Hospital shall make reasonable efforts, after the patient is admitted and as soon as reasonably possible, to obtain the financial information necessary to determine responsibility for payment of the Hospital bill from the patient or Guarantor. If the patient or Guarantor is unable to provide the information needed, and the patient consents, a Hospital shall make reasonable efforts to contact the relatives, friends and Guarantor and the patient for additional information while the patient is in the Hospital. 3. Requirements for Obtaining Additional Information During the Patient’s HospitalStay. A Hospitalshall identify the department that is responsible for obtainingthe informationfromthe patient, and explain any clinical approval process required in contacting the patient for additional information. If no clinical approval process is required prior to contacting patients, the Credit and Collection Policy must so specify. 4. Requirements for Obtaining Information at the Time of the Patient’s Discharge. If a Hospital has not obtained sufficient patient financial information to assess the ability of the patient or the patient Guarantor to pay for Hospital services prior to the date ofdischarge, the Hospital shall make reasonable efforts to obtain the necessary information at the time of the patient's discharge. (b) Outpatient Services. 1. Non-Emergency Service. A Hospital or Community Health Center shall make reasonable efforts, prior to treatment, to obtain the financial information necessary to determine responsibility for payment of the bill from the patient or Guarantor. 2. Emergency Service. A Hospital or Community Health Center shall make reasonable efforts, as soon as reasonably possible, to obtain the financial information necessary to determine responsibility for payment of the bill from the patient or Guarantor. (c) Verification of Patient-Supplied Information. 1. Inpatient. A Hospital shall make reasonable efforts to verify the patient-supplied information prior to the patient discharge. The verification may occur at any time during the provision of services, at the time of the patient discharge or during the collection process. 2. Outpatient. A Hospital or Community Health Center shall make reasonable efforts to verify patient-supplied informationat the time the patient receives the services. The verification of patient-supplied information may occur at the time the patient receives the services or during the collection process. (2) Populations exempt from Collection Action. (a) A Hospital or Community Health Center shall not bill patients receiving governmental benefits under the Emergency Aid to the Elderly, Disabled and Children program, participants in the Healthy Start program, or participants in the CenterCare Program. However, the Hospital or Community Health Center may initiate billing for a patient who alleges that he or she is a participant in any of the programs listed in 114.6 CMR 10.04, but fails to provide proof of such participation, or who fails to sign a condensed Free Care application. Upon receipt of satisfactory proof that a patient is a participant in any of the above listed programs, and receipt of the signed condensed Free Care application,the HospitalorCommunity Health Center shall cease its collection activities. (b) Participants in the Children’s MedicalSecurityPlanwhose Family Income is equal to or less than 200% of the Federal Poverty Income Guidelines are also exempt from collection action. The Department of Public Health (DPH) may issue periodic notices to the Hospitals and Community Health Centers regarding billing of the participants in the Children’s Medical Security Plan. However, the Hospital or Community Health Center may initiate billing for a patient who alleges that he or she is a participant in the Children’s Medical Security Plan, but fails to provide proof of such participation, or who fails to sign a condensed Free Care application. Upon receipt of satisfactory proof that a patient is a participant in the Children’s Medical Security Plan and receipt of the signed condensed Free Care application, the Hospital or Community Health Center shall cease its collection activities. (c) If a Hospital or Community Health Center provides inpatient or outpatient services to a person who meets the standard for full Free Care, pursuant to 114.6 CMR 10.03 and 10.04, such person shall be exempt from Collection Action. (d) If a Hospital orCommunityHealth Center provides inpatient or outpatient services to a person who meets the standard for partial Free Care, pursuant to 114.6 CMR 10.03 and 10.04, such person shall be exempt from Collection Action for the portion of his or her Hospital or Community Health Center bill that exceeds the Deductible. (e) If a Hospital or Community Health Center provides inpatientor outpatient services to a person who meets the standard for Medical Hardship, pursuant to 114.6 CMR 10.03 and 10.04, the Hospital or Community Health Center shall exempt such person from Collection Action with respect to the amount of the bill that exceeds the Medical Hardship contribution, calculated pursuant to 114.6 CMR 10.03(3). (3) Deposits and Payment Plans. (a) The HospitalorCommunityHealthCenter shall not require pre-admission and/or pretreatment deposits from patients who require Emergency Care or who are determined to be eligible for full Free Care. (b) Hospitals and Community Health Centers may request a deposit from patients eligible for partial Free Care. Deposits will be limited to 20% of the Deductible amount up to $500. All remaining balances will be subject to the payment plan conditions established in 114.6 CMR 10.05(3)(d). (c) Hospitals and Community Health Centers may request a deposit from patients eligible for Medical Hardship. Deposits will be limited to 20% of the Medical Hardship contribution up to $1,000. All remaining balances will be subject to the payment plan conditions established in 114.6 CMR 10.05 (3)(d). (d) Payment Plans. A patient who has a balance of$1,000 or less, after initial deposit, must be offered a one- year payment plan with a minimum monthly payment of $25. A patient who has a balance of more than $1,000, after initial deposit, must be offered at least a two-year payment plan. (4) Reasonable Collections Efforts. (a) To be considered a reasonable collection effort, in compliance with 114.6 CMR 10.05, a Hospital or Community Health Center must make the same effort to collect accounts for Emergency Care for Uninsured Patients as it does to collect accounts from any other patient classifications. The minimum requirements before writing off an account to the Pool include: 1. an initial bill to the party responsible for the patient’s personal financial obligations, 2. subsequent billings, telephone calls, collection letters, personal contact notices, computer notifications, and any other notification method that constitutes a genuine effort to contact the party responsible for the obligation, 3. documentation of alternative efforts to locate the party responsible for the obligation or the correct address on billings returned by the postal office service as “incorrect address” or “undeliverable,” 4. sending a final notice by certified mail for balances over $1,000 where notices have not been returned as “incorrect address” or “undeliverable.” (b) If after reasonable attempts to collect a bill, the debt for Emergency Care for an Uninsured Patient remains unpaid for more than 120 days, the billmaybe deemed uncollectible and billed to the Pool. (c) The patient’s file must include all documentation of the Provider’s collection effort including copies of the bill(s), follow-up letters, reports of telephone and personal contact, and any other effort made.