price estimates and calculation of patient responsibility amounts

1: Price Estimates and Calculation of Patient Responsibility Amounts November 6, 2008

3: Florida Statutes: Chapter 395.301 Florida Statutes requires hospitals (prior to provision of non-emergency medical services) to give its patients written, good-faith estimates of reasonably anticipated charges for their treatment. Estimates must be provided within seven business days after receipt of written requests by the patients or their legal guardians. Orlando Health provides those estimates to our patient population currently via the phone for inquiries of �price shopping� and for our uninsured patients via a written estimate.

4: The Way We Were�or kind of still are! For True Self Pay: Patient calls Self Pay desk to inquire of pricing or physicians office attempts to schedule patient who is uninsured. Self pay Financial Counselor gets procedure and/or code to give estimate. Estimate is given over the phone for price shoppers and a written is mailed if requested. For patients being scheduled for a procedure the physician office must inform us if the procedure is medically urgent or not. Requirements: If procedure is considered medically urgent: A Financial Statement on the patient will be completed and qualifications for financial assistance will be reviewed. If we agree medical urgency is correct (confer with medical director on suspicious urgency) then patient is requested to pay charges with self pay discount in place If unable to pay we then try to collect as much as possible up front and then set up arrangements for EFT for remaining balance. Account notes for PA follow-up are formatted for an easy find. $$$$Pre-reg$$$$ If procedure is not considered medically urgent: A Financial Statement on the patient will be completed on the patient and qualifications for financial assistance will be reviewed. Patient will be asked to pay charges with self pay discount in place If unable to pay we will ask the patient to reschedule the procedure until a funding source is available or they qualify for assistance of some sort. Requirements: If procedure is considered medically urgent: A Financial Statement on the patient will be completed and qualifications for financial assistance will be reviewed. If we agree medical urgency is correct (confer with medical director on suspicious urgency) then patient is requested to pay charges with self pay discount in place If unable to pay we then try to collect as much as possible up front and then set up arrangements for EFT for remaining balance. Account notes for PA follow-up are formatted for an easy find. $$$$Pre-reg$$$$ If procedure is not considered medically urgent: A Financial Statement on the patient will be completed on the patient and qualifications for financial assistance will be reviewed. Patient will be asked to pay charges with self pay discount in place If unable to pay we will ask the patient to reschedule the procedure until a funding source is available or they qualify for assistance of some sort.

5: The Way We Were�or kind of still are! For Insured Patients: Patient�s do contact us to check on co-pays and deductibles for procedures. A Managed Care matrix is utilized to give patient estimated information over phone. For most OP/IP procedures with a managed care contract, the information is easily identified on our payer matrix. Co-insurance and percentage deductibles are our biggest pain point. Current process goes back to same process as true Self Pay with an attempted calculation with data received on 271. If there is a high deductible (over $2000) then we look at the medical urgency and reschedule if possible. Pre-registration collection team contacts patients prior to arrival to collect co-pay/deductible prior to arrival. Patient is fast tracked with payment in full (still view ID and script for safety) If patient cannot make payment, we attempt to set up arrangements for down payment and auto payment. If medically urgent, we attempt to collect something on patient prior to service and PA follow-up notes. Pre-registration collection team contacts patients prior to arrival to collect co-pay/deductible prior to arrival. Patient is fast tracked with payment in full (still view ID and script for safety) If patient cannot make payment, we attempt to set up arrangements for down payment and auto payment. If medically urgent, we attempt to collect something on patient prior to service and PA follow-up notes.

6: The Way We Are�and Getting Stronger! New matrix for self pay and managed care being utilized. Estimate is given over the phone for price shoppers and a written is mailed if requested. For patients being scheduled for a procedure the physician office must inform us if the procedure is medically urgent or not. Requirements: If procedure is considered medically urgent: A Financial Statement on the patient will be completed and qualifications for financial assistance will be reviewed. And we agree then patient is requested to pay charges with self pay discount in place If unable to pay we then try to collect as much as possible up front and then set up arrangements for EFT for remaining balance. If procedure is not considered medically urgent: A Financial Statement on the patient will be completed on the patient and qualifications for financial assistance will be reviewed. Patient will be asked to pay charges with self pay discount in place If unable to pay we will ask the patient to reschedule the procedure until a funding source is available. Requirements: If procedure is considered medically urgent: A Financial Statement on the patient will be completed and qualifications for financial assistance will be reviewed. And we agree then patient is requested to pay charges with self pay discount in place If unable to pay we then try to collect as much as possible up front and then set up arrangements for EFT for remaining balance. If procedure is not considered medically urgent: A Financial Statement on the patient will be completed on the patient and qualifications for financial assistance will be reviewed. Patient will be asked to pay charges with self pay discount in place If unable to pay we will ask the patient to reschedule the procedure until a funding source is available.

7: The Way We Are�and Getting Stronger! Each of our major payers has a page that is populated with basic contracted details as well as one with SP calculations Staff can only populate the �red� boxes Green represents fixed calculations- addition or subtraction of areas. The formula prints on an estimation letter that can be scanned and/or mailed to the patient for documentation. ESTIMATED is always used in our scripting for the patients.Each of our major payers has a page that is populated with basic contracted details as well as one with SP calculations Staff can only populate the �red� boxes Green represents fixed calculations- addition or subtraction of areas. The formula prints on an estimation letter that can be scanned and/or mailed to the patient for documentation. ESTIMATED is always used in our scripting for the patients.

8: Estimation Letter Example Date of Estimate/Service: _______ ESTIMATE OF PATIENT RESPONSIBILITY Dear __________, Thank you for choosing Orlando Health, Inc. for your healthcare needs and requesting an estimate of hospital charges for ___________________ at _ ____________________. Please keep in mind that this estimate is based on current information as provided by your insurance carrier ___________. The agreement your employer has with _____________ and their negotiated contract rate with Orlando Health, Inc. has determined that the patient responsibility would be $ _________________. Your actual amount may exceed this estimate. In addition to the hospital fee, you may also receive a bill from physicians furnishing services to the patient, including but not limited to the radiologists, cardiologists, pathologists, anesthesiologists, and other independent contractors that are not employees or agents of Orlando Health, Inc. If you have any questions, please contact our Pre-Registration department at 321.841.8920 or the facilities� Patient Business Manager at _________________. Sincerely, _________________________________ _________________________________________________ Witness Date Patient or Patient�s Agent / Representative Date ________________________________________ Print name of Signature above Estimation letters are currently used and patient is told multiple times that these are estimates for their care and charges could fluctuate. Estimation letters are currently used and patient is told multiple times that these are estimates for their care and charges could fluctuate.

9: Where We Are Going Signed new contract for Benefits (270-271) on September 30, 2008. Kick off meeting to be held next week to begin installation process over next 12 weeks. Information will flow real-time to pre-registration as well as all Emergency Departments. Dashboard will house information on patients for each registrar. Pricing estimator also purchased and will be live in 1st quarter of calendar year. Estimator will have CDM and Contract information to formulate and produce a better calculation to give to our patients before, during or after their services are complete. Educating the patient is our number one goal this year. This includes education on: What their responsibilities are prior to service Why their responsibilities are what they are Who to contact to gather further information (IE: benefits dept at work or Customer Service number to payer) We feel this is one key in providing excellent Customer Service to our patients. Educating the patient is our number one goal this year. This includes education on: What their responsibilities are prior to service Why their responsibilities are what they are Who to contact to gather further information (IE: benefits dept at work or Customer Service number to payer) We feel this is one key in providing excellent Customer Service to our patients.

10: Questions? Contact information: craig.pergrem@orlandohealth.com