Schedule H, Part V Section D
|
WE DO NOT HAVE REHABILITATION, FREE STANDING DIAGNOSTIC FACILITIES, OR SKILLED NURSING. OUR OFF SITE DIAGNOSTIC SERVICES ARE INCLUDED ON OUR HOSPITAL LICENSE AND OUR HOSPITAL ANCILLARY SERVICES ARE HOSPITAL BASED AND INCLUDED ON OUR LICENSE.
|
Schedule H, Part III Line 2 & 4
|
TNMC'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.
|
Schedule H, Part I, Line 7 COMMUNITY BENEFIT
|
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 V, Section B, Line 20d Presumptive Eligibility
|
The Nebraska Medical Center (TNMC) is utilizing the scoring mechanism in its EPIC software. The organization is in the process of integrating presumptive eligibility from external vendors. Currently, TNMC is considering if an individual has Medicaid or deceased with no estate to be discretionary charity and qualify that individual.
|
Schedule H, Part I, Line 6a Community Benefit Report
|
THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE ACCESSED AT: WWW.NEBRASKAMED.COM/ABOUT-US/COMMUNITY-BENEFIT-REPORT
|
Schedule H, Part I, Line 7f Column F
|
THE DENOMINATOR USED TO CALCULATE THE PERCENTAGE IN COLUMN(F) IS FORM 990, PART IX, LINE 25(A).
|
Schedule H, Part VI, Line 6 Affiliated Health Care System
|
NEITHER TNMC NOR BMC ARE IN AN AFFILIATED HEALTHCARE SYSTEM.
|
Schedule H, Part II 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.
|
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
|
OVERALL MEDICARE PATIENTS PRODUCE A NEGATIVE 7.67% 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.
|
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
|
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 PAYMENT 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.
|
Schedule H, Part V, Section B, Line 16a FAP website
|
A - THE NEBRASKA MEDICAL CENTER: Line 16a URL: www.nebraskamed.com/patients/billing/financial-counseling;
|
Schedule H, Part V, Section B, Line 16b FAP Application website
|
A - THE NEBRASKA MEDICAL CENTER: Line 16b URL: www.nebraskamed.com/patients/billing/financial-counseling;
|
Schedule H, Part V, Section B, Line 16c FAP plain language summary website
|
A - THE NEBRASKA MEDICAL CENTER: Line 16c URL: www.nebraskamed.com/patients/billing/financial-counseling;
|
Schedule H, Part VI, Line 2 Needs assessment
|
NEBRASKA MEDICINE 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, NEBRASKA MEDICINE 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
|
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE The Nebraska Medical Center (TNMC) AND Bellevue Medical Center (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 TNMC 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 TNMC. 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 TNMC 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 NONCOMPLIANCE WITH THIS EXPECTATION.
|
Schedule H, Part VI, Line 4 Community information
|
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 2021 ESTIMATED CENSUS POPULATION (DERIVED FROM THE US CENSUS BUREAU) FOR THIS LOCAL AREA IS 801,728. THE ESTIMATED RACE BREAKDOWN OF THE POPULATION IS BELOW. *WHITE ALONE 80.70% *BLACK ALONE 5.57% *AMERICAN INDIAN AND ALASKA NATIVE ALONE 0.87% *ASIAN ALONE 2.50% *PACIFIC ISLANDER ALONE 0.10% *TWO OR MORE RACES 2.60% HISPANIC OR LATINO 8.90% THERE ARE SIXTEEN ACUTE CARE AND CHILDREN'S HOSPITALS IN DOUGLAS AND SARPY COUNTY TO SERVE THE LOCAL COMMUNITY. BELLEVUE MEDICAL CENTER, BOYS TOWN NATIONAL RESEARCH HOSPITAL, CHI HEALTH CREIGHTON UNIVERSITY MEDICAL, CENTER - BERGAN MERCY, CHI HEALTH IMMANUEL, CHI HEALTH LAKESIDE, CHI HEALTH MIDLANDS, CHILDREN'S HOSPITAL & MEDICAL CENTER, DOUGLAS COUNTY HEALTH CENTER, MADONNA REHABILITATION HOSPITALS-OMAHA CAMPUS, METHODIST HOSPITAL, METHODIST WOMEN'S HOSPITAL, MIDWEST SURGICAL HOSPITAL, NEBRASKA SPINE HOSPITAL, ORTHONEBRASKA, SELECT SPECIALTY HOSPITAL - OMAHA, THE NEBRASKA MEDICAL CENTER. THERE ARE FIVE DESIGNATED MEDICALLY UNDERSERVED AREAS IN DOUGLAS COUNTY (THREE AREAS) AND SARPY COUNTY (TWO AREAS).
|
Schedule H, Part VI, Line 5 Promotion of community health
|
The Nebraska Medical Center (TNMC) 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. TNMC'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. TNMC ALSO PROVIDES JOB SHADOWING OPPORTUNITIES TO UNDERGRADUATE STUDENTS WHO WISH TO EXPLORE HEALTH CAREERS. ADDITIONALLY, TNMC HAS THE ONLY BIO-CONTAINMENT UNIT IN THE STATE AND ONE OF FEW ACROSS THE NATION, CONTRIBUTING TO DISASTER PREPAREDNESS ABOVE AND BEYOND LICENSURE REQUIREMENTS. MEMBERS OF THE HOSPITAL'S CRITICAL CARE AND TRAUMA STAFF SHARE 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. BELLEVUE MEDICAL CENTER (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. (CHNA) FOR NEBRASKA MEDICINE (WHICH INCLUDES TNMC AND BMC) FOR THE COMPREHENSIVE CHNA PROCESS, A STEERING COMMITTEE COMPRISED OF KEY STAKEHOLDERS FROM AREA HEALTH SYSTEMS, LOCAL COUNTY HEALTH DEPARTMENT REPRESENTATIVES, AND KEY INFORMANTS FROM SEVERAL COMMUNITY AGENCIES WORKED COLLABORATIVELY TO OVERSEE THE PROCESS. THE CHNA STEERING COMMITTEE RETAINED PROFESSIONAL RESEARCH CONSULTANTS (PRC), INC. TO CONDUCT THE SURVEY. PRC IS A NATIONALLY RECOGNIZED HEALTH CARE CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING CHNAS SUCH AS THIS IN HUNDREDS OF COMMUNITIES ACROSS THE UNITED STATES SINCE 1994. INPUT FROM COMMUNITY STAKEHOLDERS KEY INFORMANT FOCUS GROUP DISCUSSIONS INCLUDED REPRESENTATION FROM ALL OF THE ASSESSED COUNTIES. FOCUS GROUP PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO PROVIDE INPUT REGARDING VULNERABLE OR MEDICALLY UNDERSERVED POPULATIONS, MINORITIES, AND/OR POPULATIONS WITH CHRONIC DISEASE. ONE HUNDRED SIXTY-THREE COMMUNITY STAKEHOLDERS, INCLUDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND BUSINESS AND COMMUNITY LEADERS PARTICIPATED IN FOCUS GROUP SESSIONS. A FULL LIST OF PARTICIPATING KEY INFORMANT FOCUS GROUPS AND THEIR AREAS OF EXPERTISE CAN BE FOUND HERE: WWW.NEBRASKAMED.COM/ABOUT-US/COMMUNITY-HEALTH-IMPROVEMENT
|
Schedule H, Part VI, Line 7 State filing of community benefit report
|
NE
|