Initiated 4/02;Revised 4/04Approved 4/04/Effective 4/04 ...



Echo Community Health Care Inc.

Proof of Income Policy

Statement: The mission of ECHC is to provide affordable medical care to all individuals, including the uninsured.

ECHC is able to do this by offering discounted medical services on a “sliding fee scale” that is based on the patient’s steady income*. ECHC follows the Federal Governments’ poverty guidelines, which are updated annually. Obtaining the patients correct “proof of income” is imperative in accurately placing the patient on the appropriate nominal fee or “sliding fee scale”. Verification of “proof of income” is also a requirement in ECHC’s Federal Regulations as a Federally Qualified Healthcare Center. This information must be updated annually with the poverty guidelines and posted in the clinic. (See attached). This policy with attachment is to be housed in the Clinical Policy Manual for all staff to access and in the Finance Policy to be reviewed annually by the Finance Committee.

*Steady income is defined as: Income generated from consistent, scheduled `employment for at least 6 weeks (part time or full time) and does not include daily temporary work.

Impact of not having current and accurate POI in Medical Record

1. Violates Federal Regulations.

2. Jeopardizes the status of the Clinics, e.g., fines can be issued and ultimately, funding could be pulled.

3. Prevents the patients from participating in Prescription Assistance Programs as well as qualifying for x-rays/lab vouchers.

4. Creates confusion, which results in, extra time for nurses, billers, PAP staff, providers and receptionists because charts must be pulled multiple times and scripts and vouchers have to be re-written.

5. Reflects negatively on the performance review of the medical receptionist which can affect the receptionist’s potential salary raise.

Definitions of “Household Income” for ECHC:

• The household includes spouse and dependants.

• Count the # of people living in the household that the patient is responsible for (as defined in this policy).

• Do not count income or number when multiple families live in same household.

• Does not include the income of elderly parents of the adult(s).

• Young adults 18-20 living in the parents home:

▪ Young adult doesn’t work – count parents income.

▪ Young adult works (even if just part time) – don’t count parent income→count only the young adults’ income.

▪ If the patient(s) are parents with young adults in the household – do not count the young adults income.

• Young adults 21 and older living in the parent’s home:

▪ Do not count parents income, even if young adult isn’t working.

▪ Young adult not working – put on “B scale” and collect POI from Work One.

▪ Young adult working – slide fees based on patients’ proof of income.

• Adults living with children:

▪ Adult does not work and is supported by working adult child → do not count adult child’s income. Patient would be slid to “B scale” and POI collected per policy. Exception: count the adult child’s income only if they consent to giving his POI and if the adult child states they want their income to be counted.

• Incarcerated or recently incarcerated individuals:

▪ Individual is living at home again with working spouse → count spouse’s income. The clinic visit for this patient is free. They will qualify for lab and x-ray vouchers if POI shows they are at B scale.

▪ Emancipated Young Adults:

▪ Must show proof of emancipation.

▪ Only count the young adults income and slide fees based on income.

▪ Young teens/adults seeking treatment for STD’s and Pregnancy Testing:

▪ Count the teens income only (if 0 income, place patient on B scale).

▪ Inform teen they need to pay bill at the time of service.

▪ If teen is unable to make payment and the visit is deemed “urgent” by triage: Offer for the teen to talk to the Patient Advocate after the visit.

▪ Ensure the teen that ECHC will keep their visit confidential.

▪ Live –Ins:

▪ Only the patient’s income is counted if they live with someone else, even though it may be a long term arrangement. To determine a possible homeless status, refer to the homelessness policy for determination of homeless or doubled up.

▪ Roommates → only count patients income.

▪ Border’s/Renters → only count patients income.

▪ Dependents of divorced parents:

▪ Divorced parents that share custody of their child or children and live with them 50% of the year or more regardless of tax dependant status can claim them as a dependent on the sliding fee scale.

▪ Divorced parents that can provide documented proof of paying child support can claim them as a dependent on the sliding fee scale. Documented proof of paying child support consists of a printout from the County Clerk’s office.

Definition of Income:

“Income generated by regular employment (not daily temporary work services) as scheduled and consistent employment for a minimum of 6 weeks.” Other sources of income include Social Security Benefits, Disability Benefits, Child Support, Rent income, inheritance, etc.

Non cash benefits such as food stamps and housing subsidies do not count as

income.

Examples of Sources to be used for “Proof of Income”:

▪ (3) Recent pay stubs. This is mandatory proof for employed individuals. (Patients may choose to refuse to give POI and will not be eligible for sliding fee services if they refuse to submit POI.

▪ check stubs from child support

▪ previous year’s tax return

▪ Social Security printout showing monthly payment (We must have the award letter sent annually and not just the bank statement).

**In the event that a patient does not have recent pay stubs, their prior years’ tax return *may* be used. However, by the patients 2nd visit, they should provide pay stub documentation. If the patient does not have pay stubs their second visit, the front office will instruct the patient it is a requirement if they are working to have current POI on record. The front office must note this in eClinical on the appointment screen using the browser button in the billing notes.

If unemployed, the patient must obtain a copy of their work history verification from the local employment office. (Work One)

Income Verification Process:

1. First Visit: Ask for income verification. If patient doesn’t have POI on the first visit services will be slid according to the income information the patient reports to the Medical receptionist. Collect sliding fee amount prior to visit. (Refer to P.O.S. policies, as needed). Patients are informed they must bring their proof of income at the next visit in order to qualify for slid services. The medical receptionist indicates the pt. was instructed on bringing POI at the next visit on the billing area of the patient appointment screen and eClinical will alert the patient’s POI is not up to date. Patient is given a copy of the billing policy pamphlet. See medical receptionist manual for a more detailed explanation of the steps involved in this process.

2. Second Visit: Obtain proof of income. If patient still does not provide POI, they are considered self pay. They do not qualify for sliding fee scale visits or lab/x-ray vouchers. eClinical system is not updated so it will show their POI is expired and a reminder will come up with each visit to request POI. Explain to the patient that if they bring in POI within 3 business days, the lab and diagnostic tests can be replaced with vouchers as appropriate. If POI is provided, the eClinical patient Information Screen is updated and POI is initialed, dated and scanned into Patient Documents. Offer the patient the option of speaking to the Patient Advocate or to a social worker if assistance is needed on the cost of the office fees.

3. If patients bring in POI in-between visits, update the eClinical patient information and date, initial and scan the POI into the Patient Documents, which will then indicate the sliding fee the patient qualifies for on the payer screen and show their POI as being current. The medical receptionist must make sure the patients name is on each page of POI before the POI is scanned in.

4. Updated POI is required annually (every 12 months) for current income and sliding fee scale identification. Patients with changes in POI or Insurance status in-between the annual requirement will have the changes noted in eClinical patient information.

Insurance Visits

1. Patients with insurance may refuse to submit their proof income information; the receptionist must still enter income on the payer information screen as reported income. The receptionists need to inform the patient of the need to bring in POI to qualify for sliding fee benefits if needed.

2. Medicaid patients may have a spend down or deductible. This cannot be slid according to state regulation.

3. The Medicare co-insurance can be slid as long as the patient provides the proper POI and only in the situations where 20% of total charges exceeds their qualifying scale.

4. Income verification: income is verified every twelve (12) months. The patient should be instructed to notify us when a change in their income occurs. With each reported income change, proof of said change is required.

5. Anytime there is insurance or POI change the Patient Information in eClinical is updated and the new information; insurance cards, POI, etc is scanned into Patient Documents. Medical receptionist’s initial and date the proof of income when patient submits it prior to scanning into the Patient Documents.

Consent to Treat, Acknowledgement of Notice of Privacy Practices and Patient Agreement:

Patient must have a copy of the forms to review and then signatures are obtained for Patient’s Consent to Treat, Acknowledgement of Notice of Privacy Practices and Patient Agreement :upon in initial visit to ECHC and annually on the first visit of the calendar year.

Outreach Visits:

1. There is no fee attached to outreach visits even if they have income and insurance.

2. When patients seen in outreach come into the clinic, follow the steps outlined above to determine insurance and income status. Enter new information in the eClinical.

Competency:

Successful completion of Proof of Income Competency Test is required by all New Medical Receptionist before the end of their orientation and POI Review and competency testing is done annually thereafter.

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