HPRS' success has been built on a solid foundation of experience in processing eligibility and the continual refining of procedures that are used to obtain approval for each government program.

HPRS has developed program specific guidelines that assist staff members in the eligibility process. One of the tools that HPRS utilizes to expedite approvals is our Income Assistance Matrix that describes each government program and the focus areas for obtaining eligibility.

HPRS also utilizes bilingual patient correspondence to obtain needed information and to expedite the approval process. Outlined in the following sections is a summary of the systematic process for obtaining eligibility for each government program. The processes summarized below are used in conjunction with intensified training to keep staff skilled in each area of eligibility and their approval rates high above industry standards.

Inpatient Accounts

HPRS is most effective in screening inpatient while these patients or their families are in the hospital. To assist such patients, we establish a central screening system that enables HPRS' advisors to contact these patients or their families before they leave the hospital. It has been our experience that we can maximize reimbursement by screening the patient on the date the services are performed.

HPRS Advisors review the following types of accounts:

• Pre-admissions

• OB

• Outpatient

• Inpatient accounts

• Outpatient accounts

• Transfer accounts after initial denial

Eligibility determination for inpatient (including psychiatric), outpatient, recurring/series and emergency room admissions are identical. As a general rule, HPRS' advisors review, screen and process account referrals in the following manner:

Advisors review all account referrals within twenty-four (24) hours after admission or as soon as circumstances allow. HPRS reviews all of the following types of accounts:

• Self Pay

• Charity

• Under-Insured

• Health Insurance Verification Denials

• Patient Coinsurance and Deductibles

• CIDC

• Medicaid Payor Claim Denials

• SSI/SSDI

If a referred account is determined to be ineligible for any government assistance (i.e. the patient and/or the patient's family is either ineligible due to financial or medical reasons or limits) HPRS will either (i) immediately return the account to the hospital or (ii) complete a financial worksheet for the patient to help the hospital establish a payment plan or a charity application for consideration.

If the patient of a referred account appears to be eligible for one or more government assistance programs, HPRS will restatus the account or change the accounts financial class. We will
immediately begin to establish contact with the patient.

Once communications have been established with the patient/family (via hospital visit, home visit, telephone or written correspondence), HPRS identifies potential eligibility using several techniques including posing a series of questions designed to indicate if certain medical assistance program criteria can be satisfied. HPRS checks to see if the the patient has previously applied for any type of government assistance or has any applications with Medicaid, SSI/SSDI, etc. currently pending.

If an out-of-state Medicaid program may cover the patient, we contact the appropriate state to ensure that the Provider is properly enrolled and to obtain billing addresses, filing deadlines and other relevant information.

If a patient indicates prior treatment or admissions, HPRS will confirm the existence of any outstanding related accounts and any other providers with outstanding bills. This information is necessary to comprehensively identify the scope of the patient's medical situation and therefore the appropriate governmental assistance programs. For this reason, HPRS requests that all related accounts be referred to HPRS for certification.

After determining eligibility, our advisors will assist the patient/family in one or more of the following ways:

• Completing all necessary applications and forms

• Gathering and supplying all verifications, documentation, medical records and evidence

• Signing appropriate authorizations required for certifying the patient

Upon completion of the steps discussed above, our advisors submit each individual application to the proper federal, state or local agency. Every application is submitted in a manner that is most beneficial to the hospitals and their patients.

As soon as the application process is complete, our advisors begin a diligent case maintenance and follow-up procedure. This phase of eligibility processing includes:

• Verbal/written communications with the patient/family; federal, state or local agency; NHIC or other payor; and other informational sources necessary to ensure all requirements for certification are met

• Pursuit of additional information not readily available to a patient/family

• Provide a means of transportation for needy patients/families

When program certification is established for a specific account, our advisors obtain and distribute all pertinent claim filing information to the appropriate facility or provider for agency reimbursement. On out-of-state Medicaid accounts, HPRS will assist in the billing of the appropriate party, if applicable, and follow-up until the claim is processed.

If an account referral is denied erroneously, our advisors investigate the basis for the denial. Then pursue the appropriate appeals procedures for a reversal of decision.

When all efforts to secure medical assistance has been exhausted and the patient/family fails to qualify due to circumstances not previously identified our advisors will notify the appropriate
staff. However, our experience has shown that clients who are granted ‘charity’ status before they have complied with Medicare or Medicaid requirements become ‘uncooperative’ and refuse
to complete their applications for financial assistance.

Outpatient/Emergency Room Accounts

HPRS works hard to maximize the number of patients who qualify for medical financial assistance. We will review accounts admitted for twenty-three (23) hour observation and ambulatory surgical procedures. Many of these accounts incur charges well in excess of
$2,500 or have other related admissions whereby the cumulative financial liability may be significant.

Likewise, HPRS will review other outpatient and emergency room admissions for potential third party financial aid. However, in order to provide maximum health care reimbursement, we believe that we best provide services for patients in these categories by placing a minimum balance for review. Nevertheless, HPRS will review the
following types of patients regardless of the account balance:

• Single Parents with Minor Dependents

• Pregnant Women

• Patients With Multiple (at least three) Accounts

• Children under Age 18

• Patients Who May Require Additional Medical Services (usually surgery)

Once initial contact has been made and screening is complete, we can quickly determine possible eligibility and, if appropriate, submit the patient's application for government assistance.

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