|City and County of San Francisco
Department of Public Health
POPULATION HEALTH AND PREVENTION
COMMUNITY BEHAVIORAL HEALTH SERVICES
Billing and Collections Office
1380 Howard Street, 5th Floor
San Francisco, CA 94103
415.255-3400 FAX 415.255-3567
POLICY/PROCEDURE REGARDING: Client Billing
|Issued By: Jo Ruffin, LCSW
Deputy Director of Health for Mental Health Services
Date: June 18, 1999
The purpose of this policy is to provide guidelines for billing the patient payment portion of county mental health services.
State Dept. of Mental Health (DMH) Requirements
The Welfare & Institutions Code Sections 5709 and 5710, and the California Code of Regulations, Title 9, Division 1, Subchapter 3, Article 3, Section 524, both state that fees shall be charged in accordance with a uniform fee schedule adopted by the Director of DMH and that client fees shall be charged in accordance with the ability to pay, but not in excess of actual costs. The State adopted the "Uniform method for Determining Ability to Pay" (UMDAP) as the method used for determining the annual client liability for mental health services received from County mental health systems. The State Revenue Policy & Procedures manual contains the specifications for implementing UMDAP.
CBHS Policy 2.03-8, "Payor Financial Information (PFI) Form & UMDAP for Life Support Services Form" contains information on completing the financial screening forms used for determining the UMDAP amount of patient liability, the procedure for making therapeutic adjustments, and the SFMHP guidelines for meeting the State requirements.
Who will be billed
Clients who receive mental health services from any San Francisco Mental Health Plan (SFMHP) provider, including clinics, contracted providers, and the practitioner provider network, and who are determined to have an UMDAP liability per CBHS policy 2.03-8, will be billed for the patient portion of the cost of these services unless they are included in one of the exceptions described below.
San Francisco county residents who have Full Scope Medi-Cal benefits, as indicated on the California Medi-Cal Eligibility Data System (MEDS), or are verified as current county General Assistance recipients, as indicated in the SF Department of Human Services system (DHS), receive free care. All others, including most under-insured and uninsured clients, will be charged using the current State UMDAP fee schedule. The only exceptions are AB3632, Healthy Families program participants, Healthy Workers benefit recipients, and clients who are members of health care plans we have contracts with, will be charged according to State and CBHS policy/procedures. The Healthy Families program and/or other health care plan participation may require collection of a co-payment amount that is charged on a per visit basis, up to the plans maximum deductible amount, instead of an annual UMDAP liability amount. Refer to CBHS Policy /Procedure 3.03-14 and 3.03-15. For AB3632 clients, only planned services that are listed on the clients IEP are exempt from UMDAP. Unplanned services, such as Crisis Intervention and Stabilization, Emergency or Urgent Care, and Hospitalizations are billed subject to UMDAP and third party billing requirements. Refer to CBHS Policy/Procedure 3.04-5.
Clients will not be denied services even if they owe money or are unable to pay at the time services are delivered.
Clients are billed the lesser of either their account balance, which represents the cost of client billable services at Board of Supervisors Rates less third party payments and adjustments, or their UMDAP liability amount.
The CBHS Billing Unit was assigned responsibility for generating client billing statements at least once a month from the computerized mental health billing information system. Effective July 26, 1999, a report containing billing statement information will be sent to each Reporting Unit where a client is in treatment. Reports will be sorted by Primary clinician name and list all his/her clients. For clients who are seen in the practitioner provider network, the monthly report will be sent to the CBHS Consumer Relations Office.
Each county mental health program site will develop a system for collecting client payments. Responsibilities will be determined by the Program Director and may include clinical and staff support positions. Primary and back-up Clinic staff persons will be designated as "Site Cashiers". They are responsible for assisting clients in billing matters and for processing payments received at the clinic site. CBHS Policy 2.03-18, "Handling Patient Payments at Outpatient and Day Treatment Programs" contains the instructions for processing payments received at a clinic.
Clinic staff will be responsible for researching and answering their clients billing questions. Account information may be obtained from the billing information systems Financial and Account modules, client receipts, account ledgers, etc. Clinic staff can request assistance from the central CBHS Billing Unit for billing matters that they cannot resolve. Each clinician is responsible for addressing their clients concerns or any issues that arise related to billing, payments, or collections. There will be clinical supervision of each Programs client billing processes.
The CBHS Billing Unit provides assistance to Clinics and conducts staff training on PFI completion, interpreting Financial and Account screens in the billing information system, and client billing procedures. Please contact the PFI & Patient Accounts Supervisor by phone at 255-3534 for information or send your request to "Hotline" via Insyst e-mail. You may also leave a message on the Billing Inquiry Line by calling, 255-3557. You will receive a response within 24 hours.
SFMHP clients who are seen at a County Mental Health Clinic or at a Contract Provider clinic and have an account balance due over $500.00 will receive a monthly billing statement. Statements will not be sent to clients who owe less than $500.00 of annual UMDAP liability. For them, the completed PFI will serve as their annual UMDAP billing statement. Clinics will be responsible for tracking and collecting payments on these accounts. A monthly report containing information about these clients account and UMDAP balances, payments received and amount due, will be sent to the Clinics Program Director.
SFMHP clients who receive services from the Practitioner Provider Network (PPN) and have an UMDAP liability will be billed on a monthly basis, the lesser of either their account balance or their UMDAP liability prorated to a monthly amount. PPN clients account balances includes the cost of services received by the client and paid by the SFMHP to their Provider.
Clients who are no longer being seen in SFMHP system will be sent a billing statement at least once. A determination to pursue further collection efforts or not, will be made by the Program Director of the last clinic the client was being seen in or by Consumer Relations administrative staff for clients who were seen in the Practitioner Provider network. The Billing Unit will be notified in writing by the Care Manager or Program Director, or by Consumer Relations staff if an account should be written off or if further collection efforts should be made.
Clients or their Responsible Party may pay at their Clinic site or mail payments to: CBHS Billing Unit, P. O. Box 420450, SF, CA 94142. Payments received at the Clinic sites will be processed according to CBHS policy/procedure 2.03-18. The CBHS Billing Unit enters all payment and adjustment information into the computerized billing system.
Clients or their Responsible Party can make financial arrangements for paying off their account or UMDAP balance. CBHS Billing Unit or Clinic staff initiates a "Payment Plan" form with the client or Responsible Party to document these financial agreements (see attachment 1). The original form is attached to the clients completed PFI and mailed to the central CBHS Billing Unit. A copy of the form is also kept in the clients clinic chart, for reference.
State Revenue Policy and Procedures require an annual UMDAP balance to be paid off within a period of one year. Unpaid UMDAP balances accrue into the following years and become a part of the total account balance due.
Delinquent or Past Due Accounts
An account will be considered "Past Due" if no payment is received within 90 days of their initial client billing statement date.
A monthly Delinquent Accounts Report will be generated for each Reporting Unit (RU) listing "Past Due" accounts. The RU Program Director will receive the report for discussion with the clients Care Manager or primary clinician. The report will be sent to the CBHS Consumer Relations office for clients receiving treatment in the Practitioner Provider network. They make the determination on whether the account should be subjected to further collection efforts or written off as a bad debt. The CBHS Billing Unit is notified in writing by the Program Director or by Consumer Relations of what actions need to be taken on the accounts listed.
If clinically indicated, the debt may be written off as a Therapeutic Adjustment. In this case, the "UMDAP Adjustment" form (see Attachment 2) must be completed, approved by the Program Director or Consumer Relations staff, and sent to the CBHS Billing Unit. A financial arrangement for paying the bill may also be worked out with the client or their Responsible Party, if one has not yet been made.
Delinquent accounts may be referred to the City & County of SF, Bureau of Delinquent Revenue, especially if efforts to resolve the past due account have failed or if the accounts Responsible Party does not wish to cooperate in resolving the matter.
Billing Statements will continue to be sent to the client or Accounts Responsible Party until the CBHS Billing Unit is notified, in writing, to discontinue sending them. In addition, a completed UMDAP Adjustment form is completed and attached to the request if the account balance is to be written off.
Problem Resolution Procedure used for Client Account Disputes
The formal Grievance and Appeals Process is utilized for unresolved Client billing disputes. Please refer to CBHS Policy 3.11-03 for information on completing and filing the Grievance Form, MHS 316.
Contact Person: Maria J. Poulo, Project Director
CBHS Billing & Collections Office, 255-3536
Administrative Manual Holders
All CBHS Programs
CBHS Program Monitors
CBHS policies and procedures are distributed by the Quality Management Section, Lucy Arellano, 415-255-3687