Billing Policies

These policies include all Capital City Surgery Center entities that bill patients for services. This includes center affiliated Ambulatory Surgery Centers, anesthesia entities, laboratories, and physician practices.

Patient Balances

  1. The Center has created a price master for all services rendered to patients. All services shall be billed at these list prices.
  2. Discounts to these list prices may be made in the following circumstances:
  1. Where a specific contract exists between an entity of the Center and an insurance company, the difference between the list price (charged price) and the contract price will be considered a contractual adjustment. This will be adjusted at the time the payment is received;
  2. For payments prior to or on the day of service. These will be considered a prompt payment discount. This “cash payment” amount will be established along with the publication of the price master.
  1. Except in the case of 2(b) above, invoices (bills) will be sent at list price, without regard to any contractual adjustments.
  2. The Center will bill an insurance company on behalf of the patient and will accept assignment of the benefit to be paid to the Center. This does not transfer responsibility for payment from the patient to the insurance company, it is only done for the patient’s convenience.
  3. After the payment from the insurance company(ies) has been received and any contractual adjustments made, the remaining total balance will be billed to the patient.
  4. Any subsequent adjustment (reduction) to the balance will only be made in the case of:
  1. Determination that the patient qualifies for a charity write off. Such determination will be made in accordance with the charity care policy;
  2. Where the cost of collection will exceed the payment (small balance write off).
  1. Patients who are unable to pay the balance in full may request a payment plan. Payment plans will be determined based upon the total patient balance and the age of the balance. To request consideration for a payment plan, the patient may contact the center or call 1-855-360-2430.

Patient Statements

  1. Every effort will be made to verify and determine insurance company benefits to be paid for the patient’s occasion of service.
  2. The patient will be informed of their resultant responsibility for their charges prior to the day of service. They will be requested to pay this amount on the day of service or, in certain circumstances, they may be asked to enter into a payment agreement.
  3. If the patient has insurance that is anticipated will cover the charges for these services, a courtesy billing will be made to the insurance company(ies).
  4. After the insurance company has:
  1. Adjudicated the claim;
  2. Rendered payment according to the contract; and,
  3. Identified the contractual adjustment.
    A statement for the remaining balance will be sent to the patient.
  1. For 4 sequential months after this first statement, the patient will receive an additional statement requesting payment in full (5 statements total). Patients may be contacted regarding their outstanding balance during this period.
  2. After the 5th statement, the patient will be contacted with a final phone call.
  3. If payment has not been made in the following 30 day period, the Center reserves the right to seek more aggressive collections measures including utilizing a third party agency dedicated to collection efforts.

Charity Care

  1. The center provides elective services. As such, patients are not obligated to receive services through a Center provider. Further, similar services are available through other providers, some of which have a mandate to serve those without the ability to pay for such services.
  2. The Center, as a responsible member of the local healthcare community, commits to providing services to its fair share of those unable to pay for such services.
  3. The decision to provide services to those unable to pay will be made at two distinct points in time:
  1. Patients referred from specific social services organizations through a member of the medical staff, will have any patient responsibility balances removed as charity care.
  2. The entity will rely upon the social service organization to provide sufficient documentation as to the patient’s inability to pay. This documentation does not have to be onerous or voluminous but shall be reasonably complete;
  3. For all other patients, a bill in the full amount of the patient’s responsibility will be sent to the patient. This often may be after the patient’s insurance coverage has paid their portion. The determination to adjust the bill amount for charity care will only be made after this initial bill has been rendered.
  1. Note, for patients receiving Medicaid benefits, subject to the state’s Medicaid plan provisions on co-payments, the Medicaid payments and related Medicaid contractual adjustments will be considered payment in full. Such adjustments are not to be confused as charity care.
  2. To qualify for charity care, the patient must submit the prior year’s tax return and a recent pay stub to the Revenue Cycle Services office. Such information will be kept confidential and will not be included in the patient’s medical record.
  3. Patients with incomes of less than 140% of the current year’s HHS Federal Poverty Guidelines will be determined to be eligible for charity care.
  4. Requests for consideration of may be made by contacting the center or by calling 1-855-360-2430.

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