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Limitation of Charges/AGB% Discounted Care Rate

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Limitation of Charges/AGB% Discounted Care Rate

Per Internal Revenue Code 501 (r)(5) charges for emergency or other medically necessary care for FAP-eligible individuals under HNMC's FAP will be limited to but not billed more than the amounts generally billed (AGB) to individuals who have insurance covering such care.

A determination of need and/or approval of financial assistance through this program will require the completion of the financial assistance application form. The application will allow the collection of pertinent financial information as outlined under "Methods to Apply for Financial Assistance" on page 1 of the FAP.

Incomplete applications will not be considered. For these applications, HNMC will notify the patient in writing describing the additional information and/or documentation required to make a FAP-eligibility decision. At this time HNMC will suspend any Extraordinary Collection Activities (ECA's) to obtain payment for care. For 501 (r) purposes an individual has up to 240 days from the first post-discharge billing statement to apply for financial assistance.

All calculations encompass all emergency and other medically necessary care delivered by HNMC. HNMC will use the following AGB% and apply to gross charges for these service lines:

Service Line Amount Generally Billed Percentage (AGB %)
Emergency Room 40%
Outpatient Services 38%
Same Day Surgery Services 51%
Inpatient Services 31%
Home Health Care 78%
Hospice Care 77%
Gross charges for care x AGB% = Amounts Generally Billed (AGB) which will be the maximum billable to patient.