Release of All Claims

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.

Definitions:

• 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)

Procedure:

1. Discretionary Adjustment request is entered.
2. Request received by VTH director’s office.
3. 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.
4. Form will be sent to owner for signature.
5. Once received, the signed form will be uploaded to the patient’s medical record and the discretionary adjustment approved on Form Builder.
6. Discretionary Adjustment is completed in the health information system.
7. 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.