1 / 10

MEDICAL FLOW CHART

MEDICAL FLOW CHART. ELIGIBILITY CHECKLIST. YES. NO. Hospital Notice SDCL 28-13-34.1. Application for Poor Relief SDCL 28-13-32.3 & 32.4. Residency Requirement SDCL 28-13-3 & 28-14-2.1. Post- Secondary Student SDCL 28-13-27(6)(b). Veteran or Indian Health Services

yazid
Download Presentation

MEDICAL FLOW CHART

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MEDICAL FLOW CHART

  2. ELIGIBILITY CHECKLIST YES NO Hospital Notice SDCL 28-13-34.1 Application for Poor Relief SDCL 28-13-32.3 & 32.4 Residency Requirement SDCL 28-13-3 & 28-14-2.1 Post- Secondary Student SDCL 28-13-27(6)(b) Veteran or Indian Health Services SDCL 28-13-1.3(5) Emergency vs. non-emergency admissions SDCL 28-13-33 Ability to purchase Health Insurance SDCL 28-13-27(c)(d) Hospital must exhaust all avenues of payment SDCL 28-13-33.2

  3. Hospital Notice SDCL 28-13-34.1 County Manual 2100 Was Hospital Notice Received? NO Deny Pursuant to SDCL 28-13-34.1 YES NO Was the Notice Received within 15 days? YES NO • Does the Notice Contain • Name & last known address of patient and responsible party • Name of Attending physician • Nature & degree of severity of illness • Anticipated diagnostic or therapeutic services required • Location of services provided • Estimated reimbursement for services • Statement that hospital asked if Veteran or Indian Health Services Proceed to Next Step YES

  4. SDCL 28-13-32.3 & 32.4 Application for Poor Relief County Manual 2300 & 3000 Did Hospital submit application within 1 year from discharge date? Or Did patient request assistance within 2 years from discharge date? Deny SDCL 28-13-32.3 & 28-13-32.4 NO YES Application pending- County is unable to determine indigency as defined 28-13-1.3 Has the patient made an application? NO YES Proceed to next step

  5. Residency Requirement SDCL 28-13-3 & 28-14-2.1 County Manual 1300 Was applicant resident of county 60 days prior to hospitalization? Was applicant’s prior resident outside state of South Dakota ? NO YES NO YES • Does applicant have evidence of residence by any of the following ? • Personal Presence • Fixed and permanent abode(home) • Intention to remain • Local bank account • Driver’s license address in county • Automobile registration • Enrollment of children in local school • Voter registration Recommended to confer with county of prior residency (refer to SDCL 28-14-2.1) • 28-13-8 Residency continued until lost by new residency • 28-13-14 Residency not established by • health care facility • Nursing home or assisted living • Jails/prisons • Halfway houses • Other temporary living situations

  6. Post- Secondary Student SDCL 28-13-27(6)(b) County Manual 3200 Was applicant post-secondary student at a time of hospitalization ? Proceed to next step NO YES Proceed to next step Is insurance offered at school (Contact admission or visit https://myhealth.sdbor.edu ) NO YES Deny SDCL 28-13-27(6)(b) NO Did the student take health insurance offered? Deny SDCL 28-13-1.3(1) YES

  7. Veteran or Indian Health Services SDCL 28-13-1.3(5) County Manual 2410 & 2420, Chapter 6 & 7 Is the individual Native American or a Veteran? Proceed to next page NO YES Was or is applicant eligible for services with VA or IHS? Proceed to next page NO YES NO Deny SDCL 28-13-1.3 Did hospital request reimbursement within 72 hours? YES If Veteran is able to enroll in VA but chosen not to Deny SDCL 28-13-1.3(1) or 28-13-27(6)(b) NO • Was Request for Payment denied for the following: • non-emergency • Hospital failed to apply

  8. Emergency vs. non-emergency admissions SDCL 28-13-33 County Manual 2000 and 2600 • Was the visit scheduled? • Some identifying factors • UB02 Admission box 14 coded as 1 or3 • Emergency room services listed on bill • Medical records Were the services pre-approved by the county? YES NO Deny SDCL 28-13-33 NO NO • Do services meet definition of “emergency” as defined in SDCL 28-13-27(2)? • The need for emergency care is expected to result in death, additional serious jeopardy to individual’s health. Proceed to next page YES ? SDCL 28-13-37.1 County may request review by Department of Social Services

  9. Ability to purchase Health Insurance SDCL 28-13-27(c)(d) County Manual 1700 & 4400 Does applicant have insurance? NO Does individual have pre-existing condition? YES YES NO Is hospitalization for non-covered service that are pre-existing? Proceed to next page NO YES Determine ability to purchase insurance Determine ability to pay

  10. SDCL 28-13-33.2 Hospital must exhaust all avenues of payment including accepting reasonable monthly payments County Manual 2400 & 2500, Chapter 8 Does patient state that has ability to make payment? Is payment considered reasonable? See county manual Tab 2500 YES YES NO NO • Has hospital exhausted all avenues? • Indian Health Services • Veteran • Medicaid • Medicare • Social Security Disability YES Process ability to pay Deny SDCL 28-13-33.2 Hospital must exhaust all avenues of payment including accepting reasonable monthly payment from individual YES

More Related