Vision of a New Way (VNW) applauds, Stacey Abram’s on MSNBC talking about paying of medical debt. Fair Fight Action paying off $212 million in medical debt. VNW also wishes Stacey Abrams all the best in her campaign for the Georgia governorship.
Good Intentions, But…
Think of hospital organizations as being the school bully demanding your lunch money. With Fair Fight’s buying medical debt from numerous hospital organizations, Fair Fight has in fact paid off the bullies. The $1.34 million in this case relieved the financial stress of thousands of purported debtors, let me emphasize, purported debtors. The truth is the purported debtors likely did not owe the medical debt. The bullies, nonetheless, got what they wanted – the money and of more importance they increased their reimbursement rates. The foremost concern of the bullies is increasing reimbursements rates.
Clearly Fair Fight is in the position to promulgate the truth (facts) concerning medical debt. Fair Fight has been particularly successful elevating the medical debt issue in the country’s consciousness. A notable and worthy campaign issue for you and Georgians. Yes, “Fully eliminating our country’s medical debt crisis” and our country’s spending on health care being reduced an estimated 40 percent, or in dollar terms $1.5 trillion annually can be achieved through hospital organizations’ complying with the Centers for Medicare & Medicaid Services’ (CMS) policy and Internal Revenue Code (IRC) § 501(r). Their compliance will result in all Americans’ lives being improved: access to care, affordability of care, reference: the reduction in spending, being generally healthier, and longer life expectations. Additionally, there is no need for the “Build Back Better Bill” with a reduction in health care spending of $1.5 trillion annually. (See: Additional Information)
Referencing Fair Fight’s web site: hospital organizations’ compliance with CMS policy and IRC § 501(r) means both Fair Fight’s and VNW’s shared goal: “[to] restore the wellbeing of our communities ravaged by medical debt” will have been accomplished. Furthermore, the restoration can begin today, and at no expense – just continue campaigning on the truth (facts)!
Fully eliminating our country’s medical debt crisis will require policy changes. … Until then, Fair Fight…will continue to lead the call to help restore the wellbeing of our communities ravaged by medical debt.
VNW’s Work
After multi-years of advocacy by VNW, Secretary Tommy Thompson (R), U.S. Department of Health & Human Services (HHS), in an exchange of letters, February 19, 2004, provided guidance to Richard J. Davidson, President, American Hospital Association (AHA) “to take action to assist the uninsured and underinsured.”
With this guidance as a tool, I strongly encourage you to work with AHA member hospitals to take action to assist the uninsured and underinsured and therefore, end the situation where, as you said in your own words, “uninsured Americans and others of limited means are often billed and required to pay higher charges.”
It was inspiring working with the HHS staff – conscientious, competent, and dedicated civil servants. VNW provided written testimony to the U.S. Senate Committee on Finance. Again, the committee’s staffers were knowledgeable, competent, and dedicated. VNW worked with HHS Secretary Sebelius’s office. Unfortunately, it was at a time of intense political pressure against the Patient Protection and Affordable Care Act (ACA).
CMS Policy:
Deciphering CMS’ Policy and Accounting Legalese
What is an indigency policy? It is means-testing uninsured and underinsured obligors as to their financial ability-to-pay the hospital organization’s charges and not be forced into “medical indigency.”
What is charity care? It is the value of medical expenses that exceed the obligor’s financial ability-to-pay the hospital organization’s charges so as to not cause the obligor being rendered medically indigent.
What is medical indigency? It is when an obligor’s health insurance coverage, if any, does not provide full coverage for all of their medical expenses and that their medical expenses, in relationship to their income, would make them indigent if they were forced to pay full charges for their medical expenses.
Under CMS policy uninsured and underinsured obligors of limited means are obligated to pay the hospital organization only an amount that does not exceed the obligor’s financial ability-to-pay so as to not cause the obligor being rendered medically indigent – pay only an amount the obligor can afford. Any charges (medical expenses) exceeding an obligor’s financial ability-to-pay is “charity care” and should be treated as such for accounting purposes, and from a morality standpoint, to protect obligors from being rendered “medically indigent.”
Under CMS policy there is no such thing as “medical debt” – let me repeat the facts (the truth). Any hospital organization’s charges (medical expenses) exceeding an obligor’s financial ability-to-pay so as to not cause the obligor being rendered medically indigent is “charity care.” Simply stated, obligors of limited means do not owe the hospital organization any amount they cannot afford.
CMS’ policy was promulgated, February 19, 2004. Think about the financial and clinical carnage Georgia’s hospital organizations have wrought upon Georgians over the soon to be past eighteen years. The facts are irrefutable: “nearly 70% of individuals filing for personal bankruptcy cite medical debt as the reason.” How many obligors just endured? How many Georgians of limited means did not seek care as a result of the state’s hospital organizations’ failing to comply with CMS’ policy?
Secretary Tommy Thompson Asserted:
Your letter suggests that HHS regulations require hospitals to bill all patients using the same schedule of charges and suggests that as a result, the uninsured are forced to pay “full price” for their care. That suggestion is not correct and certainly does not accurately reflect my policy. The advice you have been given regarding this issue is not consistent with my understanding of Medicare’s billing rules. To be sure that there will be no further confusion on this matter, at my direction, the Centers for Medicare & Medicaid Services and the Office of Inspector General have prepared summaries of our policy that hospitals can use to assist the uninsured and underinsured. This guidance shows that hospitals can provide discounts to uninsured and underinsured patients who cannot afford their hospital bills and to Medicare beneficiaries who cannot afford their Medicare cost-sharing obligations. Nothing in the Medicare program rules or regulations prohibit such discounts. … (Emphasis added)
Centers for Medicare & Medicaid Services Summary:
Questions On Charges For The Uninsured
Q1: Can a hospital waive collection of charges to an indigent, uninsured individual?
A1: Yes. Nothing in the Centers for Medicare & Medicaid Services’ (CMS’) regulations, Provider Reimbursement Manual, or Program Instructions prohibit a hospital from waiving collection of charges to any patients, Medicare or non-Medicare, including low-income, uninsured or medically indigent individuals, if it is done as part of the hospital’s indigency policy. By “indigency policy” we mean a policy developed and utilized by a hospital to determine patients’ financial ability to pay for services. By “medically indigent,” we mean patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and that their medical expenses, in relationship to their income, would make them indigent if they were forced to pay full charges for their medical expenses. (Emphasis added)
In addition to CMS’ policy, the Office of Inspector General (OIG) advises that nothing in that agency’s rules or regulations under the Federal anti-kickback statute prohibits hospitals from waiving collection of charges to uninsured patients of limited means, so long as the waiver is not linked in any manner to the generation of business payable by a Federal health care program – a highly unlikely circumstance.
CMS: Definition (Policy) for Charity Care (Financial Assistance)
Indigency Policy – means-test uninsured and underinsured obligors as to their financial ability-to-pay the hospital organization’s charges and not be forced into “medical indigency.”
Charity Care – The value of medical expenses that exceed the obligor’s financial ability-to-pay the hospital organization’s charges so as to not cause the obligor being rendered medically indigent.
Medically Indigent – Obligors whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and that their medical expenses, in relationship to their income, would make them indigent if they were forced to pay full charges for their medical expenses.
Existing Technology
The determination, decisioning, of the amount an obligor can afford can be accomplished in seconds at admission. To eliminate conflicts of interest and protect stakeholders the decisioning should be accomplished by an independent third-party credit expert. The experts employing today’s credit management technology to achieve transparent, objective, and replicable decisions. Such technology is common and has been used by lenders for decades. A specific decisioning algorithm can be implemented at an individual hospital, county, or state level to determine the amount an obligor of limited means can afford out-of-pocket.
VNW would welcome any opportunity to meet or speak with your campaign and address any questions.
Thank you in advance for your work on behalf of all Georgians, stay healthy & best regards,
/S/
Roger Berliner
Advocate
Vision of a New Way
1063 Snowdon Ct
Asheboro, NC 27203
336-672-1230 Office
336-460-0330 Cell
roger.berliner@visionofanewway.org
Additional Information: