Nursing Home Financial Policy

I. Introduction

The purpose of this Nursing Home Financial Policy is to establish clear and comprehensive guidelines for the financial transactions and obligations between our facility, our residents, their families, and any third-party payers. This policy is designed to ensure that all financial dealings are conducted transparently, with respect to the dignity and rights of our residents. The scope of this policy encompasses all financial interactions related to billing, payment, financial assistance, resident funds management, refunds, cancellations, and dispute resolution.

II. Billing Procedures

A. Billing Cycle

Invoices are issued monthly and reflect the costs of services provided during the previous month. This cycle ensures residents and their families have a consistent timeline for financial planning and payments. The billing statements will detail charges incurred, payments received, and any outstanding balances to provide a comprehensive overview of each resident's financial account with us.

B. Included Services

Our basic rate includes a wide range of services essential to the care and well-being of our residents. These services are comprehensive, designed to meet the daily needs of our residents, and include:

24-hour nursing care
Room and board
Basic utilities (excluding telephone and cable television)
Daily meals (including special diets)
Housekeeping and laundry services
Social and recreational activities
Basic personal hygiene supplies

Additional services available that are not included in the basic rate are as follows:

Service	Charge Amount
Private Room Upgrade
Specialized Nursing Care
Physical Therapy
Occupational Therapy
Speech Therapy
Medication Management
Personal Escort Services
Beauty and Barber Services
Telephone Service
Cable Television

C. Third-Party Billing

We recognize that many of our residents rely on insurance, Medicare, Medicaid, or other third-party payers to cover the costs of their care. To facilitate this process, we follow a structured procedure to ensure timely and accurate billing:

Obtain and verify the resident's insurance or payer information upon admission and periodically thereafter.
Submit claims to the identified third-party payer directly after the end of each billing cycle.
Coordinate with the third-party payer to resolve any disputes or questions regarding coverage.
Provide residents and their families with detailed statements showing the amounts billed to third-party payers, the payments received, and any outstanding balances due.
Assist residents and their families in understanding their benefits and in navigating the billing process with third-party payers.

III. Payment Policies

A. Payment Due Dates

Payments for the monthly invoice are due within 30 days of the invoice date. This grace period allows families and residents ample time to review their billing statements, address any concerns, and arrange for payment. Should the payment due date fall on a weekend or public holiday, the payment will be considered timely if received on the next business day.

B. Accepted Payment Methods

To accommodate the diverse preferences and needs of our residents and their families, we accept a variety of payment methods. These include:

Checks
Credit Cards
Direct Bank Transfers
Money Orders

C. Late Payment Penalties

In the event that a payment is received after the due date, a late payment fee of 1.5% per month on the outstanding balance will be applied. This policy is in place to encourage timely payments and ensure that we can continue to provide the highest quality of care to our residents. We understand that circumstances can arise which may cause delays in payment; therefore, we encourage residents or their families to contact our financial department to discuss any potential payment issues as soon as they arise.

IV. Financial Assistance

A. Eligibility Criteria

Our financial assistance program is designed to support residents who find themselves in financial hardship, ensuring that all residents have access to the care they need. Eligibility for financial assistance is based on financial need, which is determined by assessing the resident's income, assets, and the financial capacity of their responsible party or family. This program is intended for residents who do not have sufficient insurance coverage, are ineligible for Medicare or Medicaid, or have exhausted their insurance benefits.

B. Application Process

Applying for financial assistance involves a thorough but straightforward process:

Request a financial assistance application form from our financial department.
Complete the application form, providing detailed information on financial status, including income, assets, and liabilities.
Submit the completed application along with all required documentation, such as recent tax returns, bank statements, and proof of income.
Await notification of receipt of your application from our financial department.

C. Determination Process

Once an application for financial assistance is received, it undergoes a comprehensive review process:

Initial Review: Our financial assistance team conducts an initial review to ensure that all necessary documentation has been provided.
Assessment: The application and supporting documents are carefully assessed to determine the applicant's financial need.
Decision: A decision on the financial assistance application is made based on the assessment of financial need.
Notification: Applicants are notified of the decision in writing, including detailed information on the financial assistance awarded and any conditions attached to the assistance.

V. Resident Funds Management

A. Handling Resident Funds

We acknowledge the importance of managing our residents' personal funds with the utmost care and integrity. Residents may choose to entrust their personal funds to our facility for safekeeping. These funds are maintained in a secure account, separate from the facility’s operating accounts, ensuring transparency and security. Residents have the option to access their funds during normal business hours for personal expenses, with transactions recorded to maintain accurate account balances.

B. Interest-bearing Accounts

For residents who entrust their funds with us, we offer the option to place these funds in an interest-bearing account. Interest is accrued at the prevailing market rate and is credited to the resident’s account quarterly. This practice is in line with our commitment to serve the best interests of our residents, allowing their funds to grow while in our care.

C. Statement and Reporting

Residents or their designated representatives receive monthly statements detailing the transactions made and the current balance of their personal funds. These statements also include any interest earned during the period. We ensure transparency and accuracy in our reporting to keep residents fully informed of the status of their funds.

VI. Refund and Cancellation Policy

A. Refund Conditions

Refunds are issued under the following conditions:

Overpayment: Any overpayment on a resident’s account will be refunded within 30 days of identification.
Early Departure: In the case of a resident’s early departure or transfer to another facility, a prorated refund will be issued for any prepaid services not rendered.
Service Cancellation: If a specific service is canceled by either party, a refund will be issued for any advance payments made for that service.

B. Cancellation Fees

Cancellations initiated by residents or their families are subject to the following:

If cancellation occurs less than 30 days before the scheduled admission date, a fee equivalent to one week’s basic service rate will be charged.
For early contract termination, a fee equivalent to 30 days of the basic service rate will be applied, unless otherwise agreed upon due to extenuating circumstances.

VII. Dispute Resolution

In the event of a dispute regarding billing, payments, or any financial matter, residents or their representatives are encouraged to contact our financial department to initiate a dispute resolution process. The process includes a review of the dispute, a meeting (if necessary) to discuss the issue, and a resolution phase where efforts will be made to resolve the dispute amicably. We are committed to fair and transparent handling of all disputes, with the goal of maintaining trust and satisfaction among our residents and their families.

VIII. Policy Review

This Financial Policy is subject to periodic review and update to ensure it remains relevant and aligned with best practices and regulatory requirements. The review process occurs annually, or more frequently if significant changes in regulation or our operational environment necessitate. Any modifications to the policy will be communicated to residents and their families in writing, ensuring continued transparency and understanding of our financial practices.