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Maintain IRS 501(r) Compliance, Improve Work Flow While Helping Patients

Driven by hospital demands and a desire to bring to market a fully-integrated solution that appeals to the needs of both patient and provider, USCB America, a leader in Healthcare Revenue Cycle Management, set out to develop Caritas360, an online Charity Care Management Software product, with two distinct and fully-integrated components; electronic Medical Financial Assistance (eMFA) and virtual Charity Care Administration (vCCA).

On the one hand, eMFA is a user friendly web-based application submission platform that allows Patients to easily apply for and submit a medical financial assistance (MFA) application electronically.

The second component, vCCA is a secured cloud-based application that systematically receives all eMFA’s and allows for the manual entry of MFA applications taken by the hospital’s Patient Financial Access (PFA) team over the phone or those received by mail.

Caritas360 Web-Based Medical Billing Software for Charity Care Processing

eMFA – Electronic Medical Financial Assistance Application Submission

Platform designed to enable for real-time submission of an MFA application via a secured web-based session to public and private not-for-profit hospitals and privately owned healthcare facilities.

  • Two-factor authentication access control for returning to eMFA;
  • ‘Save and Return’ capabilities for patient to save work and complete form at a later date;
  • 100% OS and browser agnostic, PC and mobile devices compatibility;
  • Applicant will have the ability to upload documents in support of application;
  • Intuitive and user friendly form-completion flow with easy to understand instructions;
  • eMFA will accommodate a many-to-one submission, enabling a guarantor applicant to submit for MFA on up to ten (10) individual patient medical bills in a single application
Electronic medical financial assistance emfa for improved patient satisfaction
Improve Charity Care time of service processing for hospital revenue cycle manager

vCCA – Cloud-based Virtual Charity Care Administration Office

Designed to systematically accept eMFA application submissions as well as enable efficient manual entry of MFA applications taken over the phone or received in the mail.

  • Two-factor authentication access to vCCA for maximum ePHI security and confidentiality protection;
  • Role-based access and restricted usage;
  • Session time-outs;
  • Seamless integration between eMFA and vCCA;
  • Verification-based integrated workflow; intuitive, web-based interface;
  • Flexible and robust reporting, including batch files to provide documentation support to assist with 990 Schedule H tax filing;
  • Streamlined charity care eligibility determinative processing improving 501(r)(4) compliance;
  • Dynamic dashboards with real-time “in queue” statistics and adjudication metrics;

Future Enhancements

  • Decision-making workflow based on client-specific financial policies;
  • Determinative algorithms based on Federal Poverty Level (FPL) standards coupled with health system-specific criteria for systematic adjudication;
  • Optimized EBW (Exception-Based Workflow) automation;
  • Patient financial health and presumptive charity care eligibility screening
Healthcare compliance software reduces staff overhead by 40%
Secure cloud hospital financial assistance improves patient satisfaction

Security & Data Protection

Protection of information and ePHI are a top priority. Our platform is subjected to rigorous third-party “ethical hacking” and undergoes routine monitoring to discover and mitigate gaps in threat detection.

  • Dual factor authentication (2FA) restricting access to both the eMFA and vCCA, providing a higher level of control access, mitigating the risk of phishing campaigns;
  • IP or IP Range filtering and registration required on vCCA portal to limit access to connections that source from IP’s identified within an “allow list”;
  • Hardening of program and platform against common penetration methods, such as:
    • Enumerating SQL Server Resolution Service
    • UDP Port 1434
    • Anonymous Detection
    • SQL Injection
    • Buffer Overflows
    • Denial of Service Attacks
    • Cookie Exploits and Malicious Cookie Content

Why your Non-Profit Hospital needs an Online Charity Care Administration Solution

The Patient Protection and Affordable Care Act (ACA), enacted March 23, 2010, added new requirements codified under IRS Section 501(r) for tax-exempt organizations that operate one or more hospital.  Specifically, the ACA imposes four new requirements that hospitals must meet to qualify as a tax-exempt facility, they are as follows:

  1. Conducting a community health needs assessment with an accompanying implementation strategy;
  2. Establishing a written financial assistance policy for medically necessary and emergency care;
  3. Complying with specified limitations on hospital charges for those eligible for financial assistance; and
  4. Complying with specified billing and collections requirements.

Meeting the requirements under 501(r)(4) can be a formidable challenge for hospital executives.  It requires the hospital to “establish a widely publicized financial assistance policy (FAP) that identifies eligibility criteria for financial assistance and a policy for providing emergency treatment, regardless of an individual’s eligibility for financial assistance.”2  It is not enough to merely develop a comprehensive written FAP.  Administration, promotion, publication, ease-of-access, awareness across all channels of the organization and consistent application are at the core of any successful financial assistance program.

The ACA requires the IRS to review, at least once every three years, the community benefits activities of the approximate 3,000 charitable hospitals nationwide. According to the IRS, of 2,482 compliance reviews of tax-exempt hospitals completed between 2014 and 2016, the IRS cited 163 (nearly 7%) as potentially non-compliant and are under further examination.  And, results of the IRS’s latest review concluded in February 2019, total of 129 hospitals were referred for compliance checks, of which 125 resulted in referrals for indications of “Healthcare-Financial Assistance Policy issues.

Clearly, the IRS is serious about 501(r) enforcement.  Don’t wait for an audit to discover that some patients did not receive the financial assistance they needed.  Schedule a demonstration of Caritas360 online Charity Care Administration solution today!

Get started today with Caritas360

Save Money. Enhance Patient Experience. Improve Work Flow Efficiency. Eliminate Paperwork. Increase 501(r) Compliance.