Release of All Claims
Last Updated: 8/4/2022
Purpose/ Applicability: To outline the process of utilizing a release of all claims form when a discretionary adjustment request exceeds $500
Scope: Instances where a VTH discretionary fund request is greater than $500.
- Discretionary Adjustment: An adjustment made to a client’s bill when a procedure had an unexpected outcome or untoward result (not a medical complication or wrong estimate), and the faculty feels that the client should not pay all or part of the bill. (VTH Policy Bill303 Discretionary Adjustment)
- Discretionary Adjustment request is entered.
- Request received by VTH director’s office.
- If the request is greater than $500, the Associate Hospital Director will discuss with clinical staff involved in case and compose a release of all claims form.
- Form will be sent to owner for signature.
- Once received, the signed form will be uploaded to the patient’s medical record and the discretionary adjustment approved on Form Builder.
- Discretionary Adjustment is completed in the health information system.
- If the client refuses to sign, the decision shall be recorded in a client communication in the health information system and the client will be expected to pay remaining balance.