Schedule H, Part I, Line 3c
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NOT APPLICABLE AS THE ORGANIZATION DOES FOLLOW FPG TO DETERMINE ELIGIBILITY FOR PROVIDING FEE CARE TO LOW INCOME INDIVIDUALS.
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Schedule H, Part I, Line 6a
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THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE ACCESSED AT: HTTP://WWW.NEBRASKAMED.COM/ABOUT-US/COMMUNITY-BENEFIT-REPORT
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Schedule H, Part I, Line 7
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THESE NUMBERS ARE COMPUTED IN A COST ACCOUNTING SYSTEM THAT PRODUCES A COST FOR EVERY SERVICE THE HOSPITAL PROVIDES. RELATIVE VALUE UNITS, FOR SEVEN CATEGORIES OF EXPENSE, ARE UPDATED ANNUALLY FOR EACH PATIENT SERVICE WHICH KEEPS THE COST ACCOUNTING CURRENT. THESE COSTS PER UNIT VALUES ARE APPLIED TO THE PATIENT UTILIZATION TO COMPUTE THE TOTAL COST. THE COST ACCOUNTED TOTAL IS TIED BACK TO THE HOSPITAL'S FINANCIAL STATEMENTS TO ENSURE SYSTEM INTEGRITY. SCHEDULE H, PART I, LINE 7, COLUMN F THE DENOMINATOR USED TO CALCULATE THE PERCENTAGE IN COLUMN(F) IS FORM 990, PART IX, LINE 25(A).
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SCHEDULE H, Part II
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COMMUNITY BUILDING ACTIVITIES COMMUNITY-BUILDING ACTIVITIES ARE DESIGNED TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. POVERTY, HOMELESSNESS AND ENVIRONMENTAL PROBLEMS ALL CONTRIBUTE TO POOR HEALTH. THE TYPES OF PROGRAMS INCLUDED IN THIS CATEGORY SUPPORT WORKFORCE DEVELOPMENT AND TRAINING PROGRAMS TO PROVIDE EMPLOYMENT AND LEADERSHIP SKILLS TRAINING, JOB SHADOWING FOR STUDENTS INTERESTED IN HEALTH CAREERS AND ECONOMIC DEVELOPMENT SUPPORT GRANTS TO HELP REVITALIZE LOW-INCOME AREAS AND BUSINESSES.
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SCHEDULE H, Part III, Line 2 & 4
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THE ORGANIZATION'S FOOTNOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE SPECIFICALLY COVERING BAD DEBT EXPENSE. THOUGH PATIENT INCOME MAY QUALIFY THEM FOR FINANCIAL ASSISTANCE, THE PATIENT HAS OBLIGATIONS AS WELL TO COMPLETE FINANCIAL ASSISTANCE FORMS AND TO SUBMIT SUPPORTING DOCUMENTATION TO QUALIFY. PATIENTS WHO PROVIDE THIS INFORMATION AND QUALIFY FOR ASSISTANCE WOULD NEVER GO TO BAD DEBT. THEREFORE, IT IS REASONABLE TO STATE THAT OUR BAD DEBT EXPENSE IS FOR THOSE UNWILLING TO PAY OR UNWILLING TO WORK WITH US TO PROVIDE FINANCIAL ASSISTANCE IF AVAILABLE. IF AN ACCOUNT IS COMPLETELY WRITTEN OFF TO BAD DEBT, THE TOTAL COST VIA THE COST ACCOUNTING SYSTEM IS APPLIED. IF ONLY A PORTION OF THE ACCOUNT WAS WRITTEN OFF TO BAD DEBT, THEN BAD DEBT AS A PERCENTAGE OF CHARGE IS THEN APPLIED TO THE TOTAL COST FOR THE ENCOUNTER TO ESTIMATE THE COST ASSOCIATED WITH THE BAD DEBT. THE AMOUNT THAT GOES TO COLLECTIONS IS PATIENT LIABILITY. NOT COLLECTING THESE DOLLARS IS A DIRECT EXPENSE TO THE ORGANIZATION. AS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, IT IS OUR RESPONSIBILITY TO HELP ANYONE WHO PRESENTS THEMSELVES WITH A HEALTH ISSUE; AS SUCH WE HAVE LESS CONTROL OVER WHAT GETS RECOGNIZED AS BAD DEBT. TO COMPUTE BAD DEBT AT COST, MANAGEMENT USED ALL DISCHARGED CASES IN PRIOR FISCAL YEAR WITH BAD DEBT WRITE-OFF. THE WRITE-OFF WAS COMPUTED AS A PERCENTAGE OF CHARGE AND THEN MULTIPLIED BY THE TOTAL COST (DETERMINED BY A DETAILED COST ACCOUNTING METHODOLOGY) TO ESTIMATE THE COST OF BAD DEBT.
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SCHEDULE H, Part III, Line 8
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OVERALL MEDICARE PATIENTS PRODUCE A NEGATIVE 14% MARGIN ON GROSS CHARGES. THIS IS SPREAD ACROSS MOST OF OUR PRODUCT LINES. OUR HEAVIEST LOSSES ARE FROM THE INPATIENT NEUROLOGY, ONCOLOGY AND CARDIAC PRODUCT LINES AND FROM ONCOLOGY AND SURGERY ON THE OUTPATIENT SIDE. IN GENERAL MEDICARE INPATIENTS DO COVER THE DIRECT COSTS OF PROVIDING THEIR CARE. HOWEVER, THE INDIRECT COSTS TO SUPPORT THE HOSPITAL MUST BE ACCOUNTED FOR AND TURNS THE MARGIN NEGATIVE. THESE NUMBERS ARE COMPUTED IN A COST ACCOUNTING SYSTEM THAT PRODUCES A COST FOR EVERY SERVICE THE HOSPITAL PROVIDES. THE SYSTEM IS UPDATED ANNUALLY AND TIED TO OUR FINANCIAL STATEMENTS TO ENSURE INTEGRITY OF THE PRODUCT LINE PROFITABILITY STATEMENTS.
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SCHEDULE H, Part III, Line 9b
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A PATIENT KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE (ONCE ALL PAPERWORK IS RECEIVED AND APPROVED) ARE FLAGGED IN THE SYSTEM AND MONITORED ACCORDINGLY TO ENSURE FINANCIAL ASSISTANCE IS POSTED TO THE PATIENT ACCOUNT. WHEN THE 12 MONTH APPROVAL EXPIRES, PATIENTS ARE CONTACTED IF SERVICES HAVE BEEN RENDERED WITHIN THE LAST SIX MONTHS TO DISCUSS SUBMITTAL OF NEW INFORMATION FOR CONTINUATION OF ASSISTANCE. IF PATIENTS NO LONGER QUALIFY, OTHER PAYMENTS OPTIONS ARE DISCUSSED PER ORGANIZATIONAL POLICY. REPORTS ARE UTILIZED FOR FOLLOW UP PURPOSES. PATIENTS WHO QUALIFY FOR 100% ASSISTANCE DO NOT RECEIVE GUARANTOR STATEMENTS (BILLS) FROM THE ORGANIZATION. PATIENTS WHO QUALIFY FOR AN 80% OR 60% DISCOUNT WORK WITH CUSTOMER SERVICE OR COLLECTION STAFF TO OUTLINE PAYMENT ARRANGEMENTS ACCORDING TO SET POLICY.
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SCHEDULE H, PART VI, LINE 2
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NEEDS ASSESSMENT NMC USES DISEASE INCIDENCE AND PREVALENCE DATA, LEADING CAUSES OF DEATH, COMMUNITY HEALTH STATUS RESEARCH AND SUPPLY AND DEMAND ANALYSIS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. ADDITIONALLY, NMC ENGAGED PROFESSIONAL RESEARCH CONSULTANTS (PRC) TO PERFORM A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN COLLABORATION WITH THE LOCAL HEALTH SYSTEMS AND COUNTY HEALTH DEPARTMENTS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE NMC AND BMC EMPLOY FINANCIAL COUNSELORS, CUSTOMER SERVICE STAFF AND COLLECTION STAFF, ALL OF WHOM ARE TRAINED IN ASSISTING OUR PATIENTS WITH RESOLUTION OF PATIENT LIABILITY. DEPENDING UPON INDIVIDUAL PATIENT NEEDS, PAYMENT ARRANGEMENTS OR FINANCIAL ASSISTANCE MAY BE OFFERED TO ASSIST OUR CUSTOMERS WITH RESOLUTION OF PATIENT BALANCES. ADDITIONALLY, THE ORGANIZATION WORKS WITH OUR SELF PAY POPULATION TO PURSUE COVERAGE THROUGH STATE, FEDERAL OR LOCAL PROGRAMS. CHARITY CARE POLICY: THIS POLICY OUTLINES THE GUIDELINES PATIENT FINANCIAL SERVICES (PFS) WILL USE TO ENSURE ADEQUATE AND APPROPRIATE FOLLOW UP IS COMPLETED IN ORDER FOR QUALIFYING PATIENTS TO RECEIVE CHARITY CARE. PFS WILL WORK WITH PATIENTS TO FIND PAYMENT SOLUTIONS WHEN AVAILABLE. THIS POLICY IS WRITTEN TO ENSURE A FAIR AND COMPREHENSIVE SYSTEM OF DISTRIBUTING CHARITY CARE TO FINANCIALLY BURDENED PATIENTS WITHIN THE AVAILABLE RESOURCES OF NMC IN A MANNER THAT DOES NOT DISCRIMINATE BASED ON RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, RELIGION OR AGE. POLICY: A. CHARITY CARE IS AVAILABLE WHEN ALL OTHER RECOVERY SOURCES HAVE BEEN EXHAUSTED. B. CHARITY CARE IS PROVIDED TO PATIENTS WHO HAVE DEMONSTRATED INABILITY TO MEET THEIR FINANCIAL OBLIGATION TO NMC. C. CHARITY CARE WILL NOT BE APPROVED FOR ELECTIVE AND/OR COSMETIC CARE. D. CHARITY CARE MAY BE APPROVED IN THE INSTANCE OF CATASTROPHIC CARE AS DEFINED. 1. THIS COULD BE OCCASIONED BY A PERSONAL CATASTROPHE OR UNAVOIDABLE CRISIS AFFECTING AN INDIVIDUAL WHO WOULD OTHERWISE BE ABLE TO PAY FOR SERVICE, OR A PERSON WHO HAS INCOME ABOVE POVERTY LEVEL BUT IS STILL NOT ABLE TO PAY THE ENTIRE COST OF SERVICE. 2. A PATIENT GENERALLY MAY QUALIFY FOR CATASTROPHIC CHARITY CARE IN INSTANCES WHERE THE PATIENT LIABILITY IS IN EXCESS OF 25% OF ANNUAL HOUSEHOLD INCOME. E. ALL TRANSPLANT AND IRP PATIENTS MUST MEET WITH A TRANSPLANT FINANCIAL COUNSELOR TO SECURE FINANCIAL CLEARANCE. TRANSPLANT AND IRP PATIENTS MUST PASS FINANCIAL SCREENING (ACCESS-FIC-082) OR MUST BE APPROVED VIA THE TRANSPLANT VARIANCE POLICY (FN 21) CHARITY APPROVAL FOR OTHER SERVICES PRIOR TO CONSIDERATION FOR TRANSPLANT DOES NOT MEET THIS REQUIREMENT. F. PRIOR APPROVAL FOR CHARITY CARE DOES NOT APPLY FOR FUTURE ELECTIVE OR COSMETIC PROCEDURES. GUIDELINES: A. IDENTIFICATION PROCESS 1) THE HOSPITAL MAINTAINS A SEPARATE POLICY IN ORDER TO ASSURE COMPLIANCE WITH THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA) AND A SEPARATE PATIENT RIGHTS AND ORGANIZATIONAL ETHICS POLICY. THIS CHARITY CARE POLICY IS SUBJECT TO THE TERMS OF THOSE POLICIES. 2) FINANCIAL COUNSELORS AUTHORIZED BY NMC WILL IDENTIFY PATIENTS REQUIRING FINANCIAL SCREENING. B. VERIFICATION OF INSURANCE ELIGIBILITY AND BENEFITS 1) THE PATIENT WILL EXECUTE AN ASSIGNMENT OF INSURANCE BENEFITS ON BEHALF OF THE HOSPITAL. 2) VERIFICATION OF ELIGIBILITY, BENEFITS, AND PAYER SOURCE WILL BE PERFORMED IN A TIMELY MANNER ACCORDING TO PATIENT FINANCE AND ACCESS SERVICES DEPARTMENTAL PROCEDURES. C. FINANCIAL COUNSELING 1) FINANCIAL COUNSELORS AND CONTRACTED VENDORS WILL ASSIST PATIENTS REQUIRING FINANCIAL ASSISTANCE. 2) FINANCIAL COUNSELORS AND VENDORS WILL ASSIST PATIENTS IN SEEKING REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT AS WELL AS ASSISTING PATIENTS WITH APPLICATIONS OR MAKING APPOINTMENTS TO QUALIFY FOR GOVERNMENT PROGRAMS. 3) PATIENTS ARE RESPONSIBLE FOR FOLLOW UP MEETINGS WITH AN AGENCY THAT MAY PROVIDE FINANCIAL RESOURCES FOR HEALTH CARE SERVICES. CHARITY ASSISTANCE MAY BE TERMINATED AT ANY TIME DUE TO NON COMPLIANCE WITH THIS EXPECTATION.
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SCHEDULE H, Part VI, Line 4
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WE SERVE MANY COMMUNITIES, INTERNATIONAL, REGIONAL, STATE AND LOCAL OMAHA. THE STATISTICS BELOW DESCRIBE OUR LOCAL OMAHA COMMUNITY DEFINED AS DOUGLAS AND SARPY COUNTIES IN NEBRASKA. THIS LOCAL AREA REPRESENTS APPROXIMATELY 70% OF OUR INPATIENT AND OUTPATIENT DISCHARGES AND VISITS. THE 2017 ESTIMATED POPULATION FOR THIS LOCAL AREA IS 743,059. THE ESTIMATED RACE BREAKDOWN OF THE POPULATION IS BELOW. WHITE NON-HISPANIC 541,007 72.81% BLACK NON-HISPANIC 71,827 9.67% ASIAN NON-HISPANIC 25,878 3.48% HISPANIC 85,971 11.57% ALL OTHERS 18,376 2.47% THERE ARE ELEVEN HOSPITALS IN NEBRASKA TO SERVE THE LOCAL COMMUNITY. METHODIST HOSPITAL, METHODIST WOMEN'S HOSPITAL, LAKESIDE HOSPITAL, BERGAN MERCY MEDICAL CENTER, MIDLANDS HOSPITAL, CREIGHTON MEDICAL CENTER, CHILDREN'S HOSPITAL, IMMANUEL HOSPITAL, NEBRASKA ORTHOPAEDIC HOSPITAL, BMC AND NMC. THERE ARE FOUR DESIGNATED MEDICALLY UNDERSERVED AREAS IN DOUGLAS COUNTY (THREE AREAS) AND SARPY COUNTY (ONE AREA.) DOUGLAS COUNTY MEDIAN HOUSEHOLD INCOME, (2012-2016) = $56,003 PERSONS BELOW POVERTY LEVEL, PERCENT (2012-2016) = 12.40% (69,641 BASED ON 2016 POPULATION ESTIMATE) SARPY COUNTY MEDIAN HOUSEHOLD INCOME, (2012-2016) = $72,269 PERSONS BELOW POVERTY LEVEL, PERCENT (2012-2016) = 5.8% (10,523 BASED ON 2016 POPULATION ESTIMATE)
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SCHEDULE H, Part VI, Line 5
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COMMUNITY BUILDING ACTIVITIES AND PROMOTION OF HEALTH NMC RECOGNIZES THE COMMUNITY BENEFIT OF ADDRESSING ROOT CAUSES OF POOR HEALTH IN ORDER TO IMPROVE COMMUNITY HEALTH. THE HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES THROUGHOUT THE PAST YEAR DESIGNED TO ADDRESS THESE ROOT CAUSES. INCLUDED IN THIS TOTAL ARE THE HOSPITAL'S EFFORTS TO SUPPORT THE MID-AMERICA HOSPITAL ALLIANCE (MAHA); AN ALLIANCE OF RURAL AND CRITICAL ACCESS HOSPITALS IN THE REGION OF WHICH THE HOSPITAL IS A FOUNDING MEMBER. THE HOSPITAL SPENDS TIME COORDINATING RESOURCES TO ENSURE SMALLER, RURAL HOSPITALS CAN HAVE ACCESS TO THE EXPERTISE AND SERVICES OF A LARGE ACADEMIC MEDICAL CENTER. NMC PROVIDES HUMAN RESOURCE CONSULTING SERVICES TO HELP THESE SMALLER INSTITUTIONS ADDRESS WIDESPREAD HEALTH CARE WORKFORCE SHORTAGES IN RURAL AREAS. THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROGRAMS INTENDED TO DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. MANY HOSPITAL STAFF MEMBERS GIVE EDUCATIONAL PRESENTATIONS ON THE HEALTH PROFESSIONS AND PROVIDE MOCK INTERVIEW TRAINING TO AREA STUDENTS. NMC ALSO PROVIDES JOB SHADOWING OPPORTUNITIES TO UNDERGRADUATE STUDENTS WHO WISH TO EXPLORE THE HEALTH CAREERS. ADDITIONALLY, THE HOSPITAL HAS THE ONLY BIO-CONTAINMENT UNIT IN THE STATE, CONTRIBUTING TO DISASTER PREPAREDNESS ABOVE AND BEYOND LICENSURE REQUIREMENTS. MEMBERS OF THE HOSPITAL'S CRITICAL CARE AND TRAUMA STAFF SHARE THE EXPERTISE BY PARTICIPATING IN COMMUNITY COALITIONS TO IMPROVE SAFETY AND REDUCE ACCIDENTS AMONG CHILDREN, TEENS, AND SENIORS. THE HOSPITAL WORKS TO ENCOURAGE ECONOMIC GROWTH AND DEVELOPMENT BY SUPPORTING AN ECONOMIC DEVELOPMENT PARTNERSHIP AIMED AT THE DEVELOPMENT OF NEW BUSINESS IN THE CITY'S URBAN AREAS. BMC HAS PARTICIPATED IN, AND HOSTED A NUMBER OF EVENTS DESIGNED TO PROMOTE A HEALTHIER COMMUNITY. IN ADDITION TO FINANCIAL SUPPORT OF SEVERAL COMMUNITY-BASED CHARITABLE ORGANIZATIONS AND THE LOCAL CHAMBER OF COMMERCE, THE HOSPITAL'S LEADERSHIP TEAM IS ACTIVE ON COMMUNITY BOARDS. OTHER INFORMATION NMC IS A NONPROFIT HOSPITAL MEETING THE REQUIREMENTS OF REVENUE RULING 69-545. IN SUMMARY, THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS WITHOUT REGARD TO ABILITY TO PAY, THE HOSPITAL ALSO HAS A BOARD COMPRISED OF MEMBERS FROM THE COMMUNITY, THEY HAVE AN OPEN MEDICAL STAFF POLICY, THEY ACCEPT PATIENTS PAYING THEIR BILLS WITH MEDICAID AND MEDICARE, AND THEY USE THE SURPLUS OF THEIR FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH.
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SCHEDULE H, Part VI, Line 6
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NEITHER NMC NOR BMC ARE IN AN AFFILIATED HEALTHCARE SYSTEM.
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SCHEDULE H, Part VI, Line 7
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NMC AND BMC FILE A COMMUNITY BENEFIT REPORT WITH THE NEBRASKA HOSPITAL ASSOCIATION ANNUALLY.
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