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Buchanan General Hospital will be the primary provider of health care services for our community by utilizing both primary and affiliated services. BGH will provide those services by ensuring value through highly competent staff, certification, state of the art equipment and a culture of safety.


BGH Employment

Buchanan General Hospital has provided high-quality medical care to the people of Buchanan County and the surrounding counties in Virginia, Kentucky and West Virginia. The 134-bed hospital is staffed with skilled physicians of various specialties, and employs over 300 dedicated support staff.

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Financial Assistance Policy & Application

PURPOSE: Buchanan General Hospital, in being consistent with its mission, is committed to providing charity care to persons who have healthcare needs and are unable to pay for medically necessary care, as a result of their financial situation. Buchanan General Hospital strives to ensure the financial capacity of a person in need of healthcare services does not prevent them from seeking or receiving care.

POLICY: Buchanan General Hospital will provide medically necessary health care services to patients without regard to their ability to pay. Care for emergency medical conditions will be provided to individuals regardless of their eligibility under the financial assistance policy or their eligibility for government assistance.

Accordingly, this policy includes the following:

Eligibility criteria for financial assistance, free or discounted,

Basis for calculating amounts charged to patients eligible for financial assistance under this policy,

Method by which patients may apply for financial assistance,

Methods by which the hospital will publicize this policy within the service area, and

Limits on the amount the hospital will charge for medically necessary or emergency care provided to eligible individuals.

Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with Buchanan General Hospital's procedures for obtaining financial information, and to contribute to the cost of their care based upon their ability to pay.

In order to manage its resources and to allow Buchanan General Hospital to provide an appropriate level of assistance to the greatest number of persons in need, the Board of Directors has established guidelines for the provision of charity care and financial assistance.

DEFINITIONS: For the purpose of this policy, the terms below are defined as follows:

Charity Care: Healthcare services provided free of charge, or discounted, as a result of the individual meeting established financial criteria as outlined in hospital policy.

Family: Using the Census Bureau definition, a group of two or more people who reside together and who are related by birth, marriage, or adoption. According to IRS rules, if the patient claims someone as a dependent on their income tax return, they may be considered a dependent for the purposes of the provision of financial assistance.

Family Income: A family's income is determined using the Census Bureau's definition, which uses the following income to compare to the federal poverty guidelines:

Earnings, unemployment compensation, worker's compensation, social security benefits, supplemental social security income, veteran's payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates or trusts, educational assistance, alimony, child support or assistance from any outside source;

Noncash benefits, such as food stamps, do not count as income.

If a person lives with a family, all income of the family members are included;

Documentation required for application for financial assistance include proof of income, as listed above, food stamp award letters, Medicaid approval/denial letters, pay stubs and bank statements. Financial assistance may not be denied for lack of documentation not listed in this policy.

Gross Charges: The total charges at the organization's full established rates for services provided before any discounts or deductions are applied.

Medically Necessary: Necessary services, as defined by Medicare, are reasonable and necessary for the diagnosis or treatment of illness or injury.

PROCEDURES:


A. Services Eligible Under This Policy. For purposes of this policy, charity or financial assistance refers to healthcare services provided by Buchanan General Hospital without charge, or at a discounted rate, to qualifying patients. Please note that some physicians and other providers, including, but not limited to, Radiologists,

Pathologists, Hospital Medicine Providers and Emergency Department providers, may not be employees or agents of Buchanan General Hospital. All Hospital Medicine, Emergency Department and Pathologists adhere to the hospital's financial assistance policies. Radiologists, with the exception of Buchanan Radiology, also participate. The following healthcare services are eligible for charity:

1. Emergency medical services provided in the Emergency Department setting.

2. Services for a condition which, if not promptly treated would lead to an adverse change in the health status of the patient;

3. Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting; and

4. Medically necessary services, evaluated on a case-by-case basis at Buchanan General Hospital's discretion.

B. Eligibility for Charity. Eligibility for charity will be considered for those individuals who are uninsured, ineligible for government assistance or who are unable to pay for their care, based upon a determination of financial need in accordance with this policy. The granting of charity care shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, sexual orientation or religious affiliation.

C. Method by Which Patients May Apply for Charity/Financial Assistance.

1. In order to apply for charity, or financial assistance, all patients (or their guarantor) will be required to complete a

Financial Information Form (attached) which will document all financial resources available to the patient.

2. Buchanan General Hospital will make reasonable efforts to explore alternative sources of payments and coverage from payment programs, and assist patients in applying for such programs.

3. It is preferred, but not required, that a request for charity, and a determination of financial need, occur prior to rendering of non-emergent services. However, the determination may be done at any point in the collection cycle within 120 days of the first billing statement. If the hospital receives incomplete applications, the patient will be contacted by phone, or mail, if necessary, to obtain required information. The need for financial assistance shall be re-evaluated at each subsequent time of service to determine if additional information is relevant to the eligibility of the patient for charity.

D. Eligibility Criteria and Amounts Charged to Patients.

Once a patient has been determined to be eligible for financial assistance, the patient shall not receive any further bills based on undiscounted charges and will not be charged more than the amounts generally billed (AGB) by the hospital for
emergency or other medically necessary care. Buchanan General Hospital determines and reviews the AGB, at least annually, by using the overall claims method. The basis for the discount will be determined as follows:

1. Patients whose family income is at or below 200% of the Federal Poverty Guidelines (FPL) are eligible for a complete charity write-off.

2. For patients who do not meet the guidelines under this financial assistance policy, a prompt pay discount may be available under a prompt pay discount policy.

E. Communication of the Charity Program to Patients and the Community. Notification concerning charity and financial assistance available at Buchanan General Hospital may be communicated in patient bills, posting in the Emergency Department, registration areas, and hospital website. The AGB calculation, Financial Assistance Policy and application may be obtained at the hospital business office or registration area, located at 1535 Slate Creek Road, Grundy, VA 24614; or the hospital's website: www.bgh.org; or by phone request at (276) 935-1129.

F. Relationship to Collection Efforts. Buchanan General Hospital's collection efforts will consider those patients who may qualify for charity, a patient's good faith effort to apply for other assistance, and a patient's good faith effort to comply with his or her payment agreements.

For patients who qualify for discount/charity, and who are cooperating in good faith to resolve their discounted hospital bills, Buchanan General Hospital may extend payment plans, and cease collection efforts, as appropriate. The hospital does not impose extraordinary collection actions, such as garnishments, liens or other legal actions on patients without first making reasonable efforts to determine whether that patient is eligible for charity care, or financial assistance, under this financial assistance policy. Actions that may be taken in the event of nonpayment are described in a separate billing and collection policy which may be

provided upon request in the business office of the hospital.

SUMMARY OF BUCHANAN GENERAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY

Buchanan General Hospital offers a financial assistance policy for patients who are unable to pay for medically necessary are. Patients whose family income is at or below 200% of the Federal Poverty Guidelines are eligible for a complete write-off and will not be charged more than the amount generally billed to insurance companies.

This policy may not apply to providers not employed by the hospital.

Individuals may request free copies of the Financial Assistance Policy, the application form and translations of the documents; or receive assistance with completing the form, by visiting the hospital website,
POLICY: Buchanan General Hospital will provide medically necessary health care services to patients without regard to their ability to pay. Care for emergency medical conditions will be provided to individuals regardless of their eligibility under the financial assistance policy or their eligibility for government assistance.

Accordingly, this policy includes the following:

Eligibility criteria for financial assistance, free or discounted,

Basis for calculating amounts charged to patients eligible for financial assistance under this policy,

Method by which patients may apply for financial assistance,

Methods by which the hospital will publicize this policy within the service area, and

Limits on the amount the hospital will charge for medically necessary or emergency care provided to eligible individuals.

Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with Buchanan General Hospital's procedures for obtaining financial information, and to contribute to the cost of their care based upon their ability to pay.

In order to manage its resources and to allow Buchanan General Hospital to provide an appropriate level of assistance to the greatest number of persons in need, the Board of Directors has established guidelines for the provision of charity care and financial assistance.

DEFINITIONS: For the purpose of this policy, the terms below are defined as follows:

Charity Care: Healthcare services provided free of charge, or discounted, as a result of the individual meeting established financial criteria as outlined in hospital policy.

Family: Using the Census Bureau definition, a group of two or more people who reside together and who are related by birth, marriage, or adoption. According to IRS rules, if the patient claims someone as a dependent on their income tax return, they may be considered a dependent for the purposes of the provision of financial assistance.

Family Income: A family's income is determined using the Census Bureau's definition, which uses the following income to compare to the federal poverty guidelines:

Earnings, unemployment compensation, worker's compensation, social security benefits, supplemental social security income, veteran's payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates or trusts, educational assistance, alimony, child support or assistance from any outside source;

Noncash benefits, such as food stamps, do not count as income.

If a person lives with a family, all income of the family members are included;

Documentation required for application for financial assistance include proof of income, as listed above, food stamp award letters, Medicaid approval/denial letters, pay stubs and bank statements. Financial assistance may not be denied for lack of documentation not listed in this policy.

Gross Charges: The total charges at the organization's full established rates for services provided before any discounts or deductions are applied.

Medically Necessary: Necessary services, as defined by Medicare, are reasonable and necessary for the diagnosis or treatment of illness or injury.

PROCEDURES:

A. Services Eligible Under This Policy. For purposes of this policy, charity or financial assistance refers to healthcare services provided by Buchanan General Hospital without charge, or at a discounted rate, to qualifying patients. Please note that some physicians and other providers, including, but not limited to, Radiologists,

Pathologists, Hospital Medicine Providers and Emergency Department providers, may not be employees or agents of Buchanan General Hospital. All Hospital Medicine, Emergency Department and Pathologists adhere to the hospital's financial assistance policies. Radiologists, with the exception of Buchanan Radiology, also participate. The following healthcare services are eligible for charity:

1. Emergency medical services provided in the Emergency Department setting.

2. Services for a condition which, if not promptly treated would lead to an adverse change in the health status of the patient;

3. Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting; and

4. Medically necessary services, evaluated on a case-by-case basis at Buchanan General Hospital's discretion.

B. Eligibility for Charity. Eligibility for charity will be considered for those individuals who are uninsured, ineligible for government assistance or who are unable to pay for their care, based upon a determination of financial need in accordance with this policy. The granting of charity care shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, sexual orientation or religious affiliation.

C. Method by Which Patients May Apply for Charity/Financial Assistance.

1. In order to apply for charity, or financial assistance, all

patients (or their guarantor) will be required to complete a

Financial Information Form (attached) which will document all financial resources available to the patient.

2. Buchanan General Hospital will make reasonable efforts to explore alternative sources of payments and coverage from payment programs, and assist patients in applying for such programs.

3. It is preferred, but not required, that a request for charity, and a determination of financial need, occur prior to rendering of non-emergent services. However, the determination may be done at any point in the collection cycle within 120 days of the first billing statement. If the hospital receives incomplete applications, the patient will be contacted by phone, or mail, if necessary, to obtain required information. The need for financial assistance shall be re-evaluated at each subsequent time of service to determine if additional information is relevant to the eligibility of the patient for charity.

D. Eligibility Criteria and Amounts Charged to Patients.

Once a patient has been determined to be eligible for financial assistance, the patient shall not receive any further bills based on undiscounted charges and will not be charged more than the amounts generally billed (AGB) by the hospital for

emergency or other medically necessary care. Buchanan General Hospital determines and reviews the AGB, at least annually, by using the overall claims method. The basis for the discount will be determined as follows:

1. Patients whose family income is at or below 200% of the Federal Poverty Guidelines (FPL) are eligible for a complete charity write-off.

2. For patients who do not meet the guidelines under this financial assistance policy, a prompt pay discount may be available under a prompt pay discount policy.

E. Communication of the Charity Program to Patients and the Community. Notification concerning charity and financial assistance available at Buchanan General Hospital may be communicated in patient bills, posting in the Emergency Department, registration areas, and hospital website. The AGB calculation, Financial Assistance Policy and application may be obtained at the hospital business office or registration area, located at 1535 Slate Creek Road, Grundy, VA 24614; or the hospital's website: www.bgh.org; or by phone request at (276) 935-1129.

F. Relationship to Collection Efforts. Buchanan General Hospital's collection efforts will consider those patients who may qualify for charity, a patient's good faith effort to apply for other assistance, and a patient's good faith effort to comply with his or her payment agreements.

For patients who qualify for discount/charity, and who are cooperating in good faith to resolve their discounted hospital bills, Buchanan General Hospital may extend payment plans, and cease collection efforts, as appropriate. The hospital does not impose extraordinary collection actions, such as garnishments, liens or other legal actions on patients without first making reasonable efforts to determine whether that patient is eligible for charity care, or financial assistance, under this financial assistance policy. Actions that may be taken in the event of nonpayment are described in a separate billing and collection policy which may be

provided upon request in the business office of the hospital.

SUMMARY OF BUCHANAN GENERAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY

Buchanan General Hospital offers a financial assistance policy for patients who are unable to pay for medically necessary are. Patients whose family income is at or below 200% of the Federal Poverty Guidelines are eligible for a complete write-off and will not be charged more than the amount generally billed to insurance companies.

This policy may not apply to providers not employed by the hospital.

Individuals may request free copies of the Financial Assistance Policy, the application form and translations of the documents; or receive assistance with completing the form, by visiting the hospital website, www.bgh.org, by phone request at 276-935-1129 or by visiting the hospital business office or registration area at 1535 Slate Creek Road, Grundy, VA 24614.
www.bgh.org, by phone request at 276-935-1129 or by visiting the hospital business office or registration area at 1535 Slate Creek Road, Grundy, VA 24614.

Financial Assistance Policy


Financial Assistance Application