MOOD CLINICAL P.C. BILLING AND COLLECTIONS POLICY

PURPOSE:

This Billing & Collections Policy (this “Policy”) sets forth the standards and processes by which Mood Clinical, P.C. (together with its affiliates, “Mood Clinical”) conducts its billing and collection practices. It is the goal of this policy to provide clear and consistent guidelines for conducting billing and collection functions in a manner that promotes legal compliance, patient satisfaction, and efficiency. Through the use of billing statements, written correspondence, and phone calls, Mood Clinical will make diligent efforts to inform patients of their financial responsibilities and available financial assistance options (including through Mood Clinical’s Financial Assistance Policy), as well as follow-up with patients regarding outstanding accounts.

Additionally, this policy requires Mood Clinical to make reasonable efforts to determine a patient’s eligibility for financial assistance under Mood Clinical’s Financial Assistance Policy, which include providing patients, when appropriate, with written and oral notifications about the Financial Assistance Policy.

PROCEDURE:

General Billing and Collection Process

Mood Clinical uses the same reasonable efforts and follows the same reasonable process for collecting amounts due for services provided to all patients, including insured, underinsured, or uninsured patients. Collection activities may occur during the preregistration process and will continue until account resolution.

  1. The collection process may include requests for deposits, payment plans, or discretionary settlements.

  2. The collection process may involve the use of outside collection agencies, which may include reporting the outstanding balance to credit reporting agencies.

  3. The collection process is documented in the patient’s account files accessible to parties involved in the collections process.

Insurance Billing

  1. For all insured patients, Mood Clinical will bill applicable third-party payors (based on information provided by or verified by the patient) in a timely manner

  2. If a claim is denied (or is not processed) by a payor due to an error on Mood Clinical’s part, then Mood Clinical will not bill the patient for any amount in excess of what the patient would have owed had the payor paid the claim

  3. If a claim is denied (or is not processed) by a payor due to factors outside of Mood Clinical’s control, then Mood Clinical’s staff will follow-up with the payor and the patient as appropriate to facilitate resolution of the claim. If resolution does not occur after prudent and timely follow-up efforts, then Mood Clinical may bill the patient or take other actions consistent with current regulations and industry standards

Patient Billing

  1. If a patient qualifies for the Financial Assistance Program, they will receive the discount of their billed charge in accordance with the Financial Assistance Policy.

  2. All uninsured patients will be billed directly and timely, and they will receive a statement as part of the organization’s normal billing process

  3. For insured patients, after claims have been processed by third-party payers, Mood Clinical will bill patients in a timely fashion for the patient responsibility portion of their claims as determined by their insurance benefits

  4. All patients may request an itemized statement for their accounts at any time

  5. If a patient disputes his or her account and requests documentation regarding the bill, Mood Clinical staff members will provide the requested documentation in writing within ten (10) days (if possible) and will hold the account for at least thirty (30) days before referring the account for collection

  6. Mood Clinical may approve payment plan arrangements or a negotiated settlement for patients who indicate they may have difficulty paying their balance in a single installment or otherwise

  7. Mood Clinical is not required to accept patient-initiated payment arrangements or negotiated settlements and may refer accounts to a collection agency as outlined below if the patient is unwilling to make acceptable payment arrangements or negotiated settlements or has defaulted on an established payment plan or negotiated settlement

Collection Practices

Mood Clinical may engage in collection actions, including Standard Collection Actions, to collect outstanding patient balances. For the purposes of this Policy, “Standard Collection Action (SCA)” means a list of collection activities that Mood Clinical will take against a patient to obtain payment for care after reasonable efforts have been made to collect payment from a patient and to determine whether the patient is eligible for financial assistance under the Financial Assistance Policy.

  1. General collection activities may include follow-up calls to patients and written collection notices sent to patients

  2. Patient balances may be referred to a third-party for collection at the discretion of Mood Clinical. Accounts will be referred for collections only with the following caveats

    1. There is a reasonable basis to believe the patient owes the debt;

    2. All third-party payors have been properly billed, and the remaining debt is the financial responsibility of the patient (i.e., Mood Clinical will not bill a patient for any amount that an insurance company is obligated to pay);

    3. Mood Clinical will not refer accounts for collection while a claim on the account is still pending payor payment; provided, that Mood Clinical may classify certain claims as “denied” if such claims are stuck in “pending” mode for an unreasonable length of time despite efforts to facilitate resolution;

    4. Mood Clinical will not refer accounts for collection where the patient has applied for financial assistance and Mood Clinical has not yet notified the patient of Mood Clinical’s determination as to whether the patient is eligible for financial assistance (so long as the patient has complied with the timeline and information requests as part of the financial assistance application process); an

    5. Mood Clinical may choose not to collect a patient debt if the total amount due from the patient is $5.00 or less, as this would mean the cost of collection would be more than the amount due.

  3. Before engaging in any SCAs to obtain payment for care, Mood Clinical will take reasonable efforts to determine whether a patient is eligible for financial assistance under Mood Clinical’s Financial Assistance Policy. Prior to initiating SCAs to obtain payment, Mood Clinical will therefor

  4. Provide the patient with a written notice that indicates the availability of financial assistance, provides a copy of the Financial Assistance Policy, lists potential SCAs that may be taken to obtain payment for care, and gives a deadline after which time SCAs may be initiated; an

  5. Attempt to notify the patient orally about the Financial Assistance Policy and how the patient may get assistance with the financial assistance application process.

  6. After making the reasonable efforts noted above to determine the patient’s financial assistance eligibility, Mood Clinical may pursue SCAs against the patient, which may include referring outstanding patient balances to third-parties for collection and/or reporting adverse information to credit reporting agencies and/or credit bureaus.

Customer Service

During the billing and collection process, Mood Clinical will provide quality customer service through the following guidelines:

  1. Mood Clinical will enforce a zero-tolerance standard for abusive, harassing, offensive, deceptive, or misleading language or conduct by its employees and staff; an

  2. Mood Clinical will maintain a streamlined process for responding to patient questions and/or disputes, including contact information for Mood Clinical that will be listed on all patient bills and any collection statements sent