CSR Training Manual

To give real service
you must add
something which
cannot be bought
or measured with
money, and that
is sincerity and
integrity.
~ Don Alden Adams
FINANCIAL SERVICES POLICY
& PROCEDURES MANUAL
BILLING — FEE DISCOUNTS
Policy: Fee discounts are to be based on the federal poverty guidelines published
annually in the Federal Register as required or such other basis adopted
by the Corporation with the intent of reducing barriers to service and
complying with the requirements of our state funding sources.
Procedure
1. All applicants for service will be required to complete a Client Registration
Form. Based on the financial data provided by each client on the
Client Registration Form, a discount will be applied consistently, without
discrimination, to all applicants for whom a particular procedure is to be
performed.
2. Federal poverty guidelines and applicable State statutes shall be used
to determine discounts for all services performed, as required by the
State Funding.
3. The following definition of “Members of Household” is to be utilized in
applying the poverty guidelines:
All members listed on federal tax return, including minor children,
head of household, spouse of head of household, or domestic partner
of the head of household (not listed on return) will be counted
with the following exception: For adults receiving services and living
with their parents, no matter what their age, only the income of the
adult receiving services will be counted.
4. Discount schedules assigned to applicants are not intended to limit the
usual and customary fees associated with third party reimbursements for
services.
5. Discounts shall apply only to those services not covered by a third
party payer.
6. In the event a client’s financial status changes, the client must complete
a new Client Registration Form. A fee discount can be reviewed at
the request of the client or clinician at any time.
7. SMA Healthcare’s discount rate will be adjusted from time to time
based on revisions to the Federal poverty guidelines and applicable State
statutes.
8. Staff recommendations for fee discount revisions will be presented to
the Personnel and Finance Committee and State funding sources as required
by contract.
FINANCIAL SERVICES POLICY & PROCEDURES MANUAL cont.
BILLING — APPLICATION OF FEE DISCOUNTS
Policy
1. SMA Healthcare provides discounted services to clients who are uninsured or under-insured and meet poverty
guidelines utilizing the following definition of Members of Household:
All family members listed on federal tax return, including minor children, head of household, spouse of head of
household, or domestic partner of the head of household (not listed on return) will be counted with the following
exception: for adults receiving service and living with their parents, no matter what their age, only the income
of the adult receiving services will be counted.
2. Clients who qualify for alternative programs or services within the county or state which pay for care, or who have
third party insurance are not eligible for discounted care. These include entities that have contracted with SMA to
provide services to clients including FACT Team clients and their contracts are managed by the Accounting Manager
in charge of contracts.
3. In order to qualify for a potential discount, a client shall enter his or her basic financial information on the appropriate
section of the Client Registration Form and sign and date the form. Clients may also be asked to provide proof
of income. (Note: Although it is no longer mandatory that the client submit proof of income to establish a need for
a fee discount, SMA may request to have this documentation to substantiate any financial aid).
4. A Customer Service Representative or administrative support staff will enter this information into AVATAR.
5. Clients will asked to verify / attest the information given is correct as printed on the Financial Assessment Form
and sign and date the form.
6. Clients under the age of 18 will not sign any financial forms. The parent or
guardian will complete the financial information on the client registration form and sign and date the form. The parent
or guardian will be asked to verify / attest the information given is correct as printed on the Financial Assessment
From and sign and date the form.
BILLING — FEE SCHEDULE
Policy: Fee schedules will be maintained by SMA Healthcare at a level which ensures maximum levels of reimbursement
from third party and other payors including Medicaid, Medicare, and others without acting as a barrier
to service delivery.
Procedure
1. Fee schedules will be reviewed from time to time to ensure that the usual and customary charge associated with
various procedures equals or exceeds the amounts reimbursed by third party and other payors including Medicaid,
Medicare, and others.
2. Fees for procedures will be increased immediately to meet or exceed amounts eligible for reimbursement by third
party and other payors including Medicaid, Medicare, and others upon notification from those payors of revisions to
payment schedules which result in increases in reimbursement for various fees.
3. The Board of Directors and other interested parties will be notified of these increases within one month of their
implementation as directed by contract.
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CSR TRAINING MANUAL