Adjusted Gross Income: Adjusted gross income (AGI) is gross income minus adjustments to income. AGI is a measure of income calculated from your gross income and used to determine how much of your income is taxable.
Alternate Charity Process: A patient’s eligibility for VUMC Financial Assistance determined by criteria demonstrating financial need other than information provided by the patient and/or their family. Additional information received after qualification via the Alternate Charity Process may not change the determination.
Amounts Generally Billed (AGB): IRS Section 501(r) requires hospitals to limit the amounts charged for emergency and other medically necessary care provided to individuals eligible for financial assistance to no more than the amounts generally billed (AGB) to insured individuals. The AGB calculation is updated annually.
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 and family size. 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.
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.
Discharge Medications: Broadly defined as patient prescriptions or patient use items sold by VUMC’s Retail Pharmacy and necessary for the continued care of the patient after discharge from a VUMC hospital, physician office or other clinical location.
Eligible Health Care Services: Services which are emergent and other medically necessary care. See Appendix A for a list of services excluded from Eligible Health Care Services.
Estimated Patient Liability: The estimated patient financial responsibility that is due to VUMC for professional and technical charges for Eligible 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 Collection Actions (ECAs): 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 charity eligibility prior to taking any extraordinary collection action. 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:
External 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 an external vendor to review a Patient’s family size and household income to assess financial need.
Family: The patient, the patient’s married or common-law spouse (regardless of whether s/he lives in the home) and all the patient’s children (natural or adoptive) under the age of eighteen (18) who live at home. If the patient is under the age of 18, “Family” includes the patient, his or her natural or adoptive parents (regardless of whether they live in the home), and the parent’s other children (natural or adoptive) under the age of 18.
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 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.
Federal Poverty Guidelines (FPG): Federal Poverty Guidelines published annually by the U.S. Department of Health and Human Services and in effect at the date(s) of service for which financial assistance may be available.
Look-Back Method: The methodology specified by IRS Code Section 501(r) and selected by VUMC to determine AGB. A hospital facility determining AGB under the Look-Back method may use claims for all medical care allowed during a prior 12-month period for the calculation of AGB.
Private Pay: Patient identified as having no insurance coverage or opting out of their insurance coverage for specific services/events. This does not include patients with Faith-Based coverage as identified by the Affordable Care Act.
Professional Charges: Health care provider charges generated from a patient’s visit to a healthcare facility. Examples of healthcare providers are Medical Doctors, advanced practice nurses, anesthesiologists, dentists, etc.
Retail Pharmacy: A VUMC-contracted pharmacy licensed as a retail pharmacy by the State of Tennessee to sell or distribute medications to patients. The provision of medications from a retail location is a separate, point-of-sale patient transaction subject to its own billing process separate and apart from a clinic visit or hospital encounter.
Technical Charges: Charges generated from a patient’s visit to a hospital or hospital designated facility. The hospital bill lists the services a patient received such as procedures, visits, tests, medicines and supplies.
Underinsured: Insured patients who receive Eligible Health Care Services that are determined to be noncovered services or have limited benefit coverage by the insurance provider. This includes patients with faith-based plans as identified by the Affordable Care Act. This does not apply to disease specific or defined benefit plans as these are not considered health care insurance coverage 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.
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.