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HomeMy WebLinkAboutMHIDD-303 Contracted Service Providers Bad Debt Reimbursement1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Contracted Service Providers Bad Debt Reimbursement PROCEDURE NUMBER: MHIDD-303 Effective Date: January 1, 2005 Date Revised: October 16, 2020 Reference: 55 Pennsylvania Code Chapter 4305, Liability for Community Mental Health and Intellectual Disability Services INTRODUCTION: Pursuant to the MH/IDD/EI Fiscal Regulations and Procedures, the following steps must be followed prior to consideration of payment for bad debts incurred by a contracted service provider for services rendered. MH/IDD/EI will utilize Chapter 4305, "Liability for Community Mental Health and Intellectual Disability Services" as promulgated by the Department of Human Services, effective 2016, as a guide for this procedure. PROCEDURE: The MH/IDD/EI Administrator or designee, through the service providers, is responsible for collection of individual liability payments and both must have on file a procedure and criteria to identify and establish when a debt for individual services is delinquent. Once a debt has been identified as delinquent, the service provider should determine whether the individual or responsible relative or third party is liable for payment. The collection procedure for delinquent debts will be as follows: 1. The provider will attempt to establish a payment plan with the liable person who is unable to pay the bill within a reasonable time period. 2. An account is considered past due if a bill was sent and payment was not received within 90 calendar days and a request for adjustment of liability has not been received or no payment plan has been agreed to and followed. 3. The collection process will be as follows: 2 a. The provider will attempt to collect a past due account by mailing or emailing three (3) successive statements notifying the liable person that the account is past due and requesting payment. The statements will be mailed or emailed in ten (10) day intervals. During a period not to exceed 45 calendar days after mailing or emailing the first statement, effort will be made to contact the liable person via telephone or by personal contact concerning the past due account. b. If the requirements in subsection (a) have been completed and the past due account exceeds $150, the past due account may be referred to a private collection agency familiar with the collection of debts arising from medical or social services for collection. c. If the requirements in subsection (a) have been completed and the past due account amount is $150 or less, the past due account may be written off. MH/IDD/EI Reimbursement: If after completing the above three (3) steps, the account remains unpaid, the provider may submit a bill, in the amount of the delinquency, to the MH/IDD/EI Administrator. A cover letter should be attached describing the provider's efforts to collect the payment and documentation should be included. This billing should be separate from the provider's regular monthly billing in order to avoid confusion and possible delays in payment. The MH/IDD/EI Administrator will review the invoice and, if approved, will process for payment, if applicable, based upon the availability of funding. When the MH/IDD/EI Program reimburses the provider for the individual’s bad debt, the debt becomes a "write-off". By approving a write-off, the MH/IDD/EI Administrator is certifying that the requirements of Chapter 4305 have been met and the account is deemed uncollectible from the individual. Individual Eligibility for Continuation or Resumption of Services: When an individual's bad debt is "written off" by MH/IDD/EI, as a result of the individual's continued unwillingness to pay the debt, the individual immediately becomes ineligible for MH/IDD/EI services. If the individual's case is active, it will be closed. If the individual's case is inactive, the "write-off" will be noted in the record and information regarding the individual's bad debt will be included in the record. The individual will remain ineligible for services until one (1) of the following occurs: 1. The individual pays the provider or MH/IDD/EI for the amount of the outstanding debt (or the amount “written off”). If the individual pays the provider, the provider will then reimburse the MH/IDD/EI program. 2. The individual agrees, in writing, to a reasonable payment plan and makes at least one (1) timely payment. The plan must be approved in advance by the provider’s Director or the MH/IDD/EI Administrator. If services are resumed, and the individual misses a payment in accordance with the terms of the payment plan, the individual will immediately become ineligible for continued services, and the MH/IDD/EI Program Office will notify the respective Case Manager who will then immediately notify the provider of this action. 3 3. The Case Manager determines that the denial of services would result in increased costs to the Commonwealth and requests the individual's case to remain active. The Case Manager will send a memo to the MH/IDD/EI Administrator requesting that service continue. The memo will be initialed by the Case Management Supervisor indicating approval and knowledge of the situation. The MH/IDD/EI Administrator will make a final decision and provide the appropriate documentation which will be sent to the Case Manager, the individual and the provider.