Financial Assistance / Patient Collections Policy / Patient Collections Policy Definitions

Patient Collections Policy Definitions

Application Process:  A process by which a patient or their appropriate representative completes a paper or an electronic form that provides VUMC with information on the patient’s income, family size and assets.  All applications will be evaluated on a case-by-case basis by appropriate VUMC representatives taking into consideration medical condition, employment status, and potential future earnings.

Agent:  Third party or collection agency or external legal counsel hired to support VUMC in collection processes.

Bad Debt:  Uncollected patient financial liabilities that have not been resolved at the end of the patient billing cycle and for which there is no documented inability to pay.

Balance:  The outstanding patient financial responsibility that is due to the facility/provider as a result of receiving health services; amount includes deductibles, co-payments, co-insurance, and non-covered services.

Co-Insurance:  An amount the insured patient is required to pay; payment is usually in the form of a stated percentage of medical expenses after a deductible amount is paid.

  • Once any deductible amount and co-insurance is paid, the insurer is responsible for the rest of the reimbursement for covered benefits up to allowed charges; however, individuals could also be responsible for charges in excess of what the insurer determines to be its “usual, customary, and reasonable” reimbursement.
  • Co-insurance rates may differ depending on the type of service.

Co-Pay:  A fixed amount the health insurance plan requires an insured patient to pay when a medical service is received; separate copayment may be required for different services.

Current Balance:  Any patient balance that is accrued within 30 calendar days of patient discharge/service date.

Deductible:  Fixed dollar amount (usually within a calendar year) the insured patient is required to pay before the insurer will cover medical expenses/services; plans may have both individual and family deductibles.

Deposit:  A fixed amount (deposit) patients who are uninsured, or their insurance is not verifiable at the time of services are required to pay for current and future services.

Eligible Past Due Balance:  Any unpaid patient balance 30 calendar days following patient discharge/service date.

Emergency Medical Treatment and Active Labor Act (EMTALA):  U.S. Act of Congress that requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay; Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.

Estimated Patient Liability:  The estimated patient financial responsibility that is due to VUMC for professional and technical charges for health care services the patient received. This amount is determined in compliance with the patient’s insurance benefits for the specific scheduled service and includes deductibles, co-payments, co-insurance, and non-covered services.

Extraordinary Collections Actions (ECA): Actions which require a legal or judicial process, involve selling a debt to another party or reporting adverse information to credit agencies or bureaus. VUMC will determine eligibility for Financial Assistance prior to taking any ECA. Written notice must be provided at least 30 days in advance of initiating specific ECAs and meet informational requirements. As defined under IRS Codes Section 501(r), such actions that require legal or judicial process include:

  • Certain liens
  • Foreclosure on real property
  • Attachment or seizure of a bank account or other personal property
  • Commencement of a civil action against an individual
  • Actions that cause an individual’s arrest
  • Actions that cause an individual to be subject to body attachment
  • Wage garnishment

Financial Assistance or Financial Assistance Discounts: Discounts or elimination of payment for health care services provided to eligible patients with documented and verified financial need. Financial Assistance Discounts provided under this policy include:

  • Financial Assistance: Discounts provided to patients for medical bills based on income guidelines; and
  • Catastrophic Financial Assistance: Discount provided to patients when VUMC unreimbursed eligible medical expenses incurred in a one-year period exceed their annual household income

Financial Counseling:  Information and assistance provided to patients regarding their out-of-pocket liability including those patients without sufficient insurance coverage, or who are unable to pay their estimated/actual liability prior to the treatment, or who have large past due balances.

Financial Counselor:  VUMC representatives responsible for assessing a patient’s liability, identifying and assisting with public funding options (Medicare, Medicaid, etc.), determining if patient is eligible for financial assistance, and establishing payment plans.

Financial Sponsorship:  Alternative payment options for medical services provided by external organizations and VUMC.

Guarantor:  Person or entity legally responsible for payment.  The guarantor typically is the patient or the parents/guardians of the patient.

Patient:  For the purpose of this policy, the person requesting or receiving information on behalf of the patient related to the bill.

Patient Billing Customer Service Staff or Customer Service Representative (CSR):  All VUMC billing staff in communication with a patient or patient representative related to billing.

Patient Communication:  Any form of inquiry or comment received from the patient or patient’s representative via phone calls, face to face interactions, written correspondences, electronic mail and My Health at Vanderbilt portal.

Payment Plan:  A system by which payment for health services is made in installments over a fixed period of time.

Private Pay:  Patient identified as having no insurance coverage or opting out of their insurance coverage for specific services/events.

Screening Process:  A process to determine if a patient qualifies for VUMC Financial Assistance that does not involve completing a financial assistance application. The screening process may be in person or on the telephone and utilizes a Third-Party Vendor.

Support Staff:  On-site VUMC (including the 100 Oaks campus) or VMG or Walk-In Clinic team members supporting the CSR.

Underinsured:  Insured patients who receive Eligible Health Care Services that are determined to be non-covered services or have limited benefit coverage by the insurance provider.  This does not include disease specific or defined benefit plans as they are not considered health care insurance plans.

Uninsured:  Patients identified as having no insurance coverage.  This does not include those patients with faith-based plans as identified by the Affordable Care Act.

Uninsured Discount:  A discount on charges for medical services for patients identified as uninsured. The Uninsured Discount, as documented in the VUMC Discount Policy, is determined based upon the Look-Back Method by determining the average discount provided by VUMC hospitals to Medicare fee-for-service and private health insurers. 

Vanderbilt University Medical Center (VUMC) or Vanderbilt Health:  Vanderbilt University Hospital, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt Psychiatric Hospital, Vanderbilt Medical Group, Vanderbilt Academic and Research Enterprise, Medical Center Administration, Vanderbilt Wilson County Hospital or other similar consolidated health care entity.