Marion General Hospital, Inc.Non-Profit

2021-001 ? Out-of-network charges related to Coronavirus (COVID-19). Criteria ?Conditions under the Provider Relief Funds require out-of-network charges to be adjusted to in-network charges for services related to COVID-19. Condition ? An out-of-network charge was not adjusted to in-network charges on a timely basis. Questioned costs - $-- Context ? For 1 out of 8 out-of-network charges for COVID-19 related claims, we noted that $277 out of a sample of $4,874 of charges were not written down to an in-network rate and were billed to the patient. Effect ? Out-of-network charges were not adjusted to in-network charges resulting in a different financial responsibility amount to an insurance company or patient.Cause ? The timeframe for billing, processing, and resolution of the claim did not allow it to be properly adjudicated. Recommendation ? We recommend the Hospital review out-of-network claims related to COVID-19 to determine adjustments are made to comply with the Provider Relief Fund guidance. Views of Responsible Officials and Planned Corrective Actions ? Management understands the out-of-network charges for COVID-19 and the related compliance. Management is taking appropriate steps to identify any such claims and resolve them in accordance with the changing guidance for the Provider Relief Funds.