McDuffie Regional Medical Center: Financial Arrangements.

Financial Arrangements

McDuffie Regional Medical Center’s daily room rate includes many services important to your recovery and comfort. Nursing care, meals, local telephone service and television are included in your room rate. However, there are some charges not included.

Additional charges are made for services ordered by your Physician such as x-rays, laboratory tests, medications, medical supplies, operating room, anesthesia, emergency room or other diagnostic and therapeutic services.

These additional charges apply to all patient services, both inpatient and outpatient. Your attending physician and other consulting physicians will bill you separately for their services.

You may make arrangements for the payment of your Hospital bill either before or at the time of, or at discharge from your treatment and/or stay.

During the registration process, you were asked to sign the statement of Financial Responsibility and the Assignment of Benefits Statement (s). The Financial Responsibility Statement is an agreement that acknowledges your financial responsibility to pay for all services rendered, including those not covered by insurance, Medicare, and Medicaid. The Assignment of Benefits Statement (s) is an agreement authorizing payment directly to the Hospital of all benefits payable under any insurance policies, Medicare and
Medicaid.

Insurance and Managed Care Plans
It is most important that full details regarding insurance coverage be given. Please bring your current insurance card or a copy of it. We will file your claim for you, with benefits assigned to the Hospital. Any portion of the bill not covered by insurance is your responsibility. Patient Account Representatives can be made available to you to assist with payment arrangements.

Medicare
To confirm your eligibility for benefits, your identification card must be presented when you are registered. Co-insurance, deductibles, and other non-covered charges, not paid by Medicare are the patient’s financial responsibility. Inpatient services which are not reasonable and medically necessary for the diagnosis, or
treatment of the patient are provided for the convenience of the patient, his or her family, or a physician (i.e.
services that can be provided at home or nursing home; physician is busy when patient is physically ready for discharge; patient waiting placement in long term care facility; the patient is waiting on family to arrive for transportation home, etc) are not covered and cannot be billed to medicare. If continued hospital stay is determined not medically necessary, the Patient or patient representative involved in care, will be notified of noncoverage by use of Medicare Denial Letter and patient becomes financial responsible for the noncovered services. Patient Account Representatives are available to assist you with payment arrangements. Medicare normally covers semi-private accommodations. If you are a Medicare patient and elect private accommodations, you may be required to pay the difference between the private and semi-private rate.

Medicaid and Georgia Better Healthcare
A “Medical Assistance Eligibility Certification” for the month in which you are treated must be presented at the time of registration. Medicaid will not pay for a private room regardless of “medical necessity”. Unless the attending or primary care Physician, as well as the patient, complies with policies regarding necessary prior authorizations, the patient cannot be registered under Medicaid. Some treatments are considered by Medicaid to be non-covered. You will be advised of this after the appropriate medical exam has been performed. Any non-covered, not medically necessary treatment will be the personal responsibility of the patient and or patient representative. The patient and or representative will be notified of the noncovered services by use of Insurance/Medicaid Denial Letter. Patient Account Representatives are available to assist with payment arrangement.

Medicaid is secondary to any and all third party coverage and applicable insurance must be assigned to the Hospital as primary carrier. Medicaid regulations do not permit the Hospital to give an itemized statement to the patient or others for the purpose of collecting unassigned third party payment. Medicaid requires that we notify them of any person requesting a statement.

Workers’ Compensation
Before assignment of benefits can be accepted, the Hospital must be furnished a letter or telephone call of confirmation with complete billing instructions by either your employer or the insurance carrier for treatment related to on-the-job injuries.

Indigent Care
If you believe you qualify for indigent care assistance because you cannot pay your bill, please tell the Registrar. To be considered, you must supply financial and employment information about members residing in your household. This may include income tax returns, W-2s, copies of your Social Security, Veterans, retirement, or child support checks to verify your indigency. The application should be made before you leave the Hospital.

Billing and Statements
At your request, you may obtain a fully itemized statement. Periodically you will receive notification from us regarding the status of your outstanding insurance claim. Accounts with patient responsibility balances will receive a monthly statement until the account is paid in full.

If you have any questions concerning payment of your bill while you are a patient, please call and ask to speak to the Patient Account Representative assigned to you.

For your convenience we accept Visa, Mastercard, Discover and American Express.

The Hospital’s ability to continue to provide treatment and services is dependent upon the patient’s willingness to meet their financial obligations.

An Important Message from Medicare...

Your Rights While You Area A Medicare Hospital Patient

You have the right to receive all the hospital care that is necessary for the proper diagnosis and treatment of your illness or injury. According to Federal law, your discharge date must be determined solely by your medical needs, not by “DRG’s” or Medicare payments.

You have the right to be fully informed about decisions affecting your Medicare coverage and payment for your hospital stay and for any post hospital services.

You have the right to request a review by a Peer Review Organization of any written Notice of Noncoverage that you receive from the hospital stating that Medicare will no longer pay for your hospital care. Peer Review Organizations (PRO) are groups of doctors who are paid by the Federal Government to review medical necessity, appropriateness and quality of hospital treatment furnished to Medicare patients. The phone number and address of the PRO for your area are:

GEORGIA MEDICAL CARE FOUNDATION
57 EXECUTIVE PARK DRIVE SOUTH, SUITE 2000
ATLANTA, GEORGIA 30329
(404) 982-0411 OR 1-800-982-0411

Talk To Your Doctor About Your Stay In the Hospital

You and your doctor know more about your condition and your health needs than anyone else. Decisions about your medical treatment should be made between you and your doctor. If you have any questions about your medical treatment, your need for continued hospital care, your discharge, or your need for possible post-hospital care, don’t hesitate to ask your doctor. The hospital’s patient
representative or social worker will also help you with your questions and concerns about hospital services.

If Your Think You Are Being Asked to Leave the Hospital To Soon

Ask a hospital representative for a written notice of explanation immediately if you have not already received one. This notice is called a “Notice of Noncoverage.” You must have this Notice of Noncoverage if you wish to exercise your right to request a review by the PRO.

The Notice of Noncoverage will state either that your doctor or the PRO agrees with the hospital’s decision that Medicare will no longer pay for your hospital care.

If the hospital and your doctor agree, the PRO does not review your case before a Notice of Noncoverage is issued, but the PRO will respond to your request for a review of your Notice of Noncoverage and seek your opinion. You cannot be made to pay for your hospital care until the PRO
makes its decision, if you request the review by noon of the first work day after you receive the Notice of Noncoverage.

If the hospital and your doctor disagree, the hospital may request the PRO to review your case. If it does make such a request, the hospital is required to send you a notice to that effect. In this situation, the PRO must agree with the hospital or the hospital cannot issue a Notice of Noncoverage. You may request that the PRO reconsider your case after you receive a Notice of Noncoverage, but since the PRO has already reviewed your case once, you may have to pay for at least one day of hospital care before the PRO completes this reconsideration.

IF YOU DO NOT REQUEST A REVIEW, THE HOSPITAL MAY BILL YOU FOR ALL THE COSTS OF YOUR STAY BEGINNING WITH THE THIRD DAY AFTER YOU RECIEVE THE NOTICE OF NONCOVERAGE. THE HOSPITAL, HOWEVER, CANNOT CHARGE YOU FOR CARE UNLESS IT PROVIDES YOU WITH A NOTICE OF NONCOVERAGE.

How to Request A Review of the Notice of Noncoverage
If the Notice of Noncoverage states that your PHYSICIAN agrees with the hospital’s decision...

You must make your request for review to the PRO by noon of the first work day after you receive the Notice of Noncoverage by contacting the PRO by phone or in writing.

The PRO must ask for your views about your case before making its decision. The PRO will inform you by phone and in writing of its decision on the review.

If PRO agrees with the Notice of Noncoverage, you may be billed for all costs of your stay beginning at noon of the day after you receive the PRO’s decision.

Thus, you will not be responsible for the cost of the hospital care before you receive the PRO’s
decision.

If the Notice of Noncoverage state the PRO agrees with the hospital’s decision.

You should make your request for reconsideration to the PRO immediately upon receipt of the Notice of Noncoverage by contacting the PRO by phone or in writing.

The PRO can take up to three working days for receipt of your request to complete the review. The PRO will inform you in writing of its decision on the review.

Since the PRO has already reviewed your case once, prior to the issuance of the Notice of Noncoverage, the hospital is permitted to begin billing you for the cost of your stay beginning with the third calendar day after you receive your Notice of Noncoverage even if the PRO has not completed its review.

Thus, if the PRO continues to agree with the Notice of Noncoverage, you may have to pay for at least one day of hospital care.

NOTE: The process described above is called “immediate review”. If you miss the deadline for this
immediate review while you are in the hospital, you may still request a review of Medicare’s decision to no longer pay for your care at any point during your hospital stay or after you have left the hospital. The Notice of Noncoverage will tell you how to request this review.

Post Hospital Care
When you doctor determines that you no longer need all the specialized services provided in a hospital, but you still require medical care, he or she may discharge you to a skilled nursing facility or home care. The discharge planner at the hospital will help arrange for the services you need after your discharge. Medicare and supplemental insurance policies have limited coverage for skilled nursing facility care and home health care. Therefore, you should find out which services will or will not be covered and how payment will be made. Consult with your doctor, hospital discharge planner, patient representative and your family in making preparations for care after you leave the hospital. Don’t hesitate to ask questions.