A woman in her fifties was riding in a vehicle operated by her daughter. An accident with another vehicle occurred and the woman was treated at a local community hospital for a severe concussion and broken wrist and then released. The intake nurse noted that the patient's insurer has no contract with the hospital. The hospital treated her anyway.

You are a manager in the Patient Financial Services Office. Just over a month later, one of your financial representatives comes to you regarding a call she just took from this same woman who recently received services. The woman is complaining that the hospital is overcharging her. The individual's insurance has paid a portion of the bill, but the hospital is not under contract with the payer. Thus, there is a remaining balance. This individual is claiming that her insurance has paid for this service and that only the co-payment should be charged.

QUESTIONS:

From the first point of contact, how important do you think it is for the intake person to notify the patient prior to receiving services of whether they are participants in the patient's insurance plan?

There are regulations you should be concerned about. Please research, explain, and cite your sources. Based on what you have learned in your research and readings, let's discuss the following:

As the manager, you review the account. What important issues or previous actions should you look for and address first with your staff?

As the manager, how important are the cash flows and sources of revenue necessary for planning and control of the department budget? Explain.

What would you tell this client, and how would you explain to staff members your rationale behind the caller receiving this bill?

Would you consider this balance a charity case? Why or why not? Please share what circumstances might lead you to consider this a charity case?