GUAM MEMORIAL HOSPITAL AUTHORITY

REMEDIATION PLAN (ACTION PLAN)

FY 2007

Category:

Self Pay

Premise:

Capture amount due, as predetermined by the provided interpretation of a Self Pay patient.

The goal is to shift the burden of collection from the Business Office/Patient Affairs to that of the Patient Registgration.  It is at this

point in which the Hospital has the opportunity to inform the patient of the pending charges and collect from the patient prior to the

administration of medical services.  Patient Registration is the key to collecting from the patient.

Short Term

Short Term Action:

Responsibility

Resources

Realization Date

COLLECTION OF NONCOVERED BENEFITS

- Obtain a listing of noncovered benefits from highly billed insurance companies.

Chief of Admission / Patient

Obtain the listing of noncovered benefits

Resources exists

Jan-07

- Obtain a listing of elective procedures in order to collect from the patient upfront.

Registration Staff

Responsible to collect the amount from the appropriate patient

within the Hospital

Jan-07

- Maximize use of insurance provided measures to verify insurance coverage.

Responsible to collect the amount from the appropriate patient

Jan-07

*

EXTENSION OF REGISTRATION PROCESS

Prior to the release of the patient from Registration, the patient would be directed

Chief of Admission / Patient

Resources exists

Jan-07

to the Collection Agent who would be responsible to collect from the patient

Registration Staff

within the Hospital

upfront amounts that can be collected upfront, noncovered benefits, deposit for

specific surgeries, etc.

Note: This action plan can only be effective for both Inpatient and Outpatient

patients.  As per federal law, EMTALA prevents the Hospital from collecting

from ER patients.  ER patients are first triaged by the Nurse, registered, seen

by the ER physician, and then discharged.  The Hospital is unable to determine

the amount due until all the ER services have been provided.

PURSUIT OF SMALL CLAIMS

The Hospital has historically deferred this function to contracted collection

Business Office Manager

Must identify staff responsible to file small files claims.

Resources exists

Jan-07

agencies.  Economically, the Hospital would benefit from pursing such

Must research to determine the proper procedure and

within the Hospital

legal pursuits for delinquent patient accounts deemed to be eligible for

formalize into internal SOP.

small claims.

INHOUSE LEGAL COUNSEL

Accounts deemed to be ineligible for small claims but beneficially to pursue

Business Office Manager/

The Hospital is in the process of procuring inhouse

Funding has been

Feb-07

legally would be referred to the Hospital's Inhouse Legal Counsel

Inhouse Legal Counsel

legal counsel.

identified in FY07

Budget

CONTINUATION OF COLLECTION CALLS

The Hospital shall continue it's collection efforts to contact either the patient or

Chief of Admission / Patient

Process is in place and it is now a means to continue

Resources exists

Oct-07

guartantor three to five days after discharge.  Again this is to reinforce the precept

Registration Staff

collection efforts.

within the Hospital

of collecting from the patient before they leave the Hospital as opposed to xxx

number of days after the patient has been discharged.

*

The Hospital is only able to enact such extension of the Registration process at the 1st floor Registration Office due to federal regulations,

specifically the Emergency Medical Treatment and Active Labor Act (EMTALA).  This federal act prevents participating Medicare providers

from inquiring of any Emergency Room patient of their financial ability as it may be an hinderance in the administration of medical treatment.