FAP English Financial Assistance Program Policy | Page 5

a. Determination of eligibility of FAP and the charitable adjustments to be applied once approved are based on the guarantor’ s Federal Poverty Level( FPL), as defined by the Health and Human Services Department. b. If a FAP copay is due, guarantors are required to pay the assigned copay values listed in Copay Table in Item 7. a. i of this policy. c. Inpatient stays qualifying for FAP will be made effective for FAP from admit date through discharge date except for portions of the stay that may be covered by insurance. d. Approval or denial notification is sent to the guarantor. a. If FAP application is denied, Financial Assistance Specialist will contact the guarantor with information regarding payment arrangement options. e. Patients determined eligible for financial assistance with visits during the following 6 months, and who indicate that their financial circumstances have not changed, may be granted financial assistance for a current admission without the full financial evaluation process. a. If the guarantor has another hospital-based service at a Renown location within the approval dates, the guarantor is to notify Renown Financial Assistance at 775-982-5747 to apply the FAP approval to additional accounts. b. Renown Patient Financial Assistance must be notified of any changes in income or household size during the 6-month * approval period to maintain eligibility. c. If a patient indicates his / her financial circumstances have changed, then the changing factors should be evaluated to assess the impact on the previous determination of eligibility. A complete application and determination must be made after six months *. i. * For services provided at Women’ s Health – 975 Ryland: The eligibility period is equal to the pregnancy term( including labor and delivery at the hospital) f. A payment, denial, or benefit summary from any payer source must be secured prior to applying the finalized FAP adjustment. g. Guarantors denied for FAP may qualify for a Prompt Pay discount of 20 % off the remaining guarantor balance if the patient pays the remaining balance in full within 30 days of FAP decision notification. h. Medicare beneficiaries that are ineligible for FAP may qualify for a Medicare Bad Debt under Renown Medicare Bad Debt Policy.

i. The basis for calculating amounts charged to patients is initiated by clinical documentation based on healthcare services rendered. Based upon that documentation, charges are applied automatically, or by clinical chart review staff. In most instances, Health Information Management coding specialists also review the account for coding purposes as well. Once all charges are captured, validated, and a claim is generated with final balance due for the account, the Financial Assistance application can then be finalized.

7. Copayment

a. Guarantors are subject to a co-pay amount based on their specific Federal Poverty Level and assets. Federal Poverty Levels are determined by HHS. i. Co-Pay Table