PART I, LINE 7:
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EXPLANATION: BLYTHEDALE DETERMINES A PATIENT'S COST USING AVAILABLE COSTDATA AND RATIOS FROM THE MOST RECENTLY FILED NYS ICR. A PROSPECTIVEPATIENT'S GROSS CHARGES ARE ESTIMATED FOR EACH OF THE SERVICES ANDALLOWANCED DOWN TO COST BASED UPON THE RATIO OF COST TO CHARGES. WE THENDISCOUNT THE COST DOWN ON A SLIDING % BASIS IN THE FAP SCHEDULE USING APATIENT'S ADJUSTED GROSS INCOME (AGI) FROM THEIR MOST RECENT TAX RETURNAND TAKING INTO ACCOUNT THEIR NUMBER OF DEPENDENTS / FAMILY SIZE REPORTED.
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PART II, COMMUNITY BUILDING ACTIVITIES:
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BLYTHEDALE IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. NUMEROUS COMMUNITY CONCERNS ARE ADDRESSED, INCLUDING HEALTH IMPROVEMENT (SEE DETAILS UNDER LINE 6 BELOW) AND ACCESS TO CARE. BLYTHEDALE ACTIVELY PARTICIPATES IN THE WESTCHESTER CHILDREN'S ASSOCIATION'S CHILD HEALTH TASK FORCE, WHOSE PRINCIPAL GOAL IS TO MAXIMIZE ENROLLMENT OF ELIGIBLE CHILDREN IN NEW YORK STATE'S MEDICAID AND CHILD HEALTH PLUS PROGRAMS. ADDITIONALLY, THROUGH THE NEW YORK STATE WORKGROUP ON MEDICALLY FRAGILE CHILDREN, BLYTHEDALE HAS WORKED TO ADVOCATE FOR SERVICES TO SUPPORT FAMILIES CARING FOR MEDICALLY FRAGILE CHILDREN AT HOME.
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PART III, LINE 2:
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REVENUE IS RECOGNIZED WHEN THE CLAIM HAS (1) PERVASIVE EVIDENCE OF A PAYMENT AGREEMENT / AUTHORIZATION, RATE SHEET OR CONTRACT (2) SERVICES HAVE BEEN RENDERED (3) PRICE IS FIXED AND DETERMINABLE (4) COLLECTABILITY IS REASONABLE ASSURED. BAD DEBT IS RECOGNIZED IF MANAGEMENT IS UNABLE TO COLLECT THE DEBT AFTER THESE CRITERIA HAVE BEEN MET.BAD DEBTS DO NOT INCLUDE CHARITY CARE, COURTESY DISCOUNTS, SELF PAY ALLOWANCES, OR ALLOWANCES FOR OUTPATIENT SERVICES PROVIDED THAT ARE NOT AUTHORIZED.BAD DEBTS WILL BE RECORDED AND RECOGNIZED IN THE PERIOD IN WHICH IT IS DETERMINED THE DEBT IS UNCOLLECTIBLE. BAD DEBT IS RECOGNIZED AS THE AMOUNT CONTRACTUALLY OBLIGATED AND RECOGNIZED AS REVENUE FOR WHICH ALL AVENUES OF COLLECTION HAVE BEEN EXHAUSTED. ALL WRITE OFFS IN EXCESS OF $10,000 REQUIRE APPROVAL FROM THE CFO PRIOR TO RECORDING ENTRY IN MEDITECH SYSTEM. ALL BAD DEBT ALLOWANCE ENTRIES ARE TO BE CODED USING "XFR PROCEDURE IN MEDITECH.THE FOLLOWING EXAMPLE WILL DEMONSTRATE THE COMPONENTS OF BAD DEBT TO BE RECORDED.TOTAL PATIENT CHARGES: $250,000LESS CONTRACTUAL ALLOWANCES: -$150,000NET REVENUE: $100,000ACTUAL PAYMENTS: -$75,000ACCOUNT BALANCE UNCOLLECTED: $25,000 <==BAD DEBT VALUE AFTER ALLEFFORTS TO COLLECT ARE EXHAUSTED.COMPONENTS OF BAD DEBT REPORTING:THE RESERVE BALANCE SHOULD REFLECT 9.0% OF THE GROSS AR AS RECORDED INSTEP 1. THE VARIANCE FROM THE 12/31 RESERVE BALANCE IS RECORDED ON AMONTHLY BASIS. THE NET OF THE ACTUAL BAD DEBTS + CHANGE IN RESERVE BALANCE FROM 12/31 IS RECORDED AS BAD DEBT EXPENSE IN THE FINANCIAL STATEMENT.
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PART III, LINE 4:
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CHARITY CARE - THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAINCRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE IS NOT PURSUED, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNT OF IDENTIFIED CHARITY CARE PROVIDED AT COST, NET OF ANY REIMBURSEMENTS DURING THE YEARS ENDED DECEMBER 31, 2015 AND 2014, WERE APPROXIMATELY $343,417 AND $547,645, RESPECTIVELY. THE ESTIMATED COST OF THESE CHARITY CARE SERVICES WAS DETERMINED USING A RATIO OF COST TO GROSS CHARGES AND APPLYING THAT RATIO TO THE GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS FOR THE PERIOD.PROVISION AND ALLOWANCE FOR DOUBTFUL ACCOUNTS - TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR DOUBTFUL ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE EXHAUSTED THIRD PARTY BENEFITS RELATIVE TO SERVICESPROVIDED AT THE HOSPITAL AND HAVE NO SECONDARY SOURCE OF COVERAGE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IFNEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLECOLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THEALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL DID NOT CHANGE ITS CHARITY CARE OR UNINSURED DISCOUNTPOLICIES DURING FISCAL YEAR 2015. THE HOSPITAL MAINTAINED AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN 2015 AND 2014 IN THE AMOUNTS OF APPROXIMATELY $892,000 AND $865,000, RESPECTIVELY. THESE AMOUNTS REPRESENT 1.5% AND 1.58% OF NET PATIENT SERVICE REVENUE RESPECTIVELY.
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PART III, LINE 8:
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BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIAL AMOUNTS OF MEDICARE REIMBURSEMENT. IN 2015, THE HOSPITAL FILED A LOW/NO COST UTILIZATION REPORT WITH CMS.
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PART III, LINE 9B:
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COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. ALL PATIENTS HAVING DIFFICULTY PAYING THEIR BILLS ARE DIRECTED TO HOSPITAL STAFF WHO ASSIST THE FAMILY IN COMPLETING A FINANCIAL ASSESSMENT AND TRY TO QUALIFY THE PATIENT FOR ASSISTANCE. ONCE A LEVEL OF FINANCIAL ASSISTANCE IS DETERMINED, THE ACCOUNT BALANCE IS PRORATED FOR CONTRACTUAL ADJUSTMENTS AND THEN PRO-RATED TO COST. FROM COSTS, THE LEVEL OF FINANCIAL ASSISTANCE IS THEN APPLIED, ANY REMAINING BALANCE IS COLLECTABLE AS PATIENT RESPONSIBILITY.PATIENTS ARE SCREENED FOR ELIGIBILTY FOR FINANCIAL ASSISTANCE BEFORECOLLECTION PROCEDURE BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS,DOCUMENTATION IS RECEIVED THAT INDICATES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. BLYTHEDALE DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR CHARITY CARE.IF A PATIENT HAS REQUESTED AND/OR FILLED OUT A FINANCIAL ASSISTANCEAPPLICATION, ALL DEBT COLLECTION ACTIVITIES STOP UNTIL ELIGIBILTY FORFINANCIAL ASSISTANCE CAN BE DETERMINED. BLYTHEDALE'S POLICY PROVIDES THAT WE WILL NOT REFER ANY ACCOUNTS FOR COLLECTION UNTIL IT IS DETERMINED WHETHER THE INDIVIDUAL IS INSURED AND NOT ELIGIBLE FOR FINANCIAL ASSISTANCE.
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PART VI, LINE 2:
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SINCE THE VAST MAJORITY OF ADMISSIONS TO BLYTHEDALE COME BY REFERRAL FROM OTHER HOSPITALS, PARTICULARLY THE LARGE MEDICAL CENTERS IN THEMETROPOLITAN NEW YORK AND HUDSON VALLEY AREA, BLYTHEDALE'S SENSE OF NEED FOR CLINICAL SERVICES LARGELY EMANATES FROM REFERRING HOSPITALS AND THEIR PHYSICIANS. BLYTHEDALE CONTINUOUSLY REVIEWS WITH REFERRING HOSPITALS AND PHYSICIANS THEIR NEEDS FOR SERVICES.HOWEVER, IN ADDITION TO ITS REFERRAL HOSPITALS, BLYTHEDALE ALSO WORKSCLOSELY WITH A VARIETY OF LOCAL AGENCIES, NOTABLY THE WESTCHESTER,ROCKLAND AND PUTNAM COUNTY DEPARTMENTS OF HEALTH TO IDENTIFY COMMUNITY HEALTH PRIORITIES THAT ARE RELEVANT TO BLYTHEDALE'S MISSION AND SERVICES. PARTICIPANTS IN THESE COALITIONS INCLUDE THE MAJOR CHILD AND ADOLESCENT HEALTH-FOCUSED COMMUNITY-BASED ORGANIZATIONS IN WESTCHESTER. BLYTHEDALE ALSO HAS CLOSE WORKING RELATIONSHIPS WITH MANY OF THE SCHOOL DISTRICTS IN WESTCHESTER COUNTY, THROUGH ITS NUTRITION EDUCATION ACTIVITIES, AND THROUGH ARRANGEMENTS WHEREBY BLYTHEDALE STAFF ARE CONTRACTED TO PROVIDEPHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES TO CHILDREN IN THESCHOOLS.
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PART VI, LINE 3:
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CONSISTENT WITH ITS MISSION AND STATE REQUIREMENTS (NEW YORK STATE PUBLIC HEALTH LAW 2807(K) (9-A), BLYTHEDALE HAS DEVELOPED GUIDELINES THAT DELINEATE THE CIRCUMSTANCES AND PROCEDURES UNDER WHICH FREE OR REDUCED COST CARE IS AVAILABLE. THESE GUIDELINES ARE MADE AVAILABLE TO ALL FAMILIES UPON REGISTRATION, AND HOSPITAL STAFF PROVIDE COUNSELING AS NECESSARY. INTERPRETATION SERVICES ARE AVAILABLE FOR PATIENTS NEEDING INFORMATION IN LANGUAGES OTHER THAN ENGLISH. PATIENTS ARE ALSO NOTIFIED OF BLYTHEDALE'S CHARITY CARE FINANCIAL ASSISTANCE POLICIES THROUGH NOTICES IN ENGLISH AND SPANISH POSTED IN THE HOSPITAL'S LOBBY AND IN PATIENT REGISTRATION AND WAITING AREAS. IN ADDITION, BLYTHEDALE'S PATIENT ASSISTANCE FUNDS HELPS PROVIDE CHILDREN WITH VARIOUS ITEMS (I.E., EQUIPMENT, CLOTHING, ETC.) WHERE FAMILY RESOURCES ARE LIMITED AND INSURANCE DOES NOT COVER.
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PART VI, LINE 4:
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AS A SPECIALTY CHILDREN'S HOSPITAL SERVING CHILDREN WITH A BROAD RANGE OF DIAGNOSES, BLYTHEDALE'S SERVICE AREA IS WIDESPREAD, WITH PATIENTS COMING FROM THE ENTIRE SOUTHERN PORTION OF NEW YORK STATE AS WELL AS ADJACENT AREAS OF NEW JERSEY AND CONNECTICUT: WESTCHESTER (60%), BRONX (16%), QUEENS/KINGS (7%), ROCKLAND COUNTY (6%), NEW YORK CITY (4%), LONG ISLAND (2%), ALL OTHER (6%).THE HOSPITAL IS LOCATED IN A SUBURBAN COUNTY (WESTCHESTER) THAT IS PART OF THE GREATER NEW YORK METROPOLITAN AREA. BLYTHEDALE'S PATIENT POPULATION REFLECTS THE ETHNIC AND RACIAL DIVERSITY OF ITS LARGE SERVICE AREA, AS ILLUSTRATED BY ITS INPATIENT POPULATION: ASIAN (4%); BLACK OR AFRICAN-AMERICAN (19%); HISPANIC OR LATINO (24%); WHITE (45%); OTHER (8%). TO ADDRESS THIS DIVERSITY, THE HOSPITAL PROVIDES STAFF TRAINING IN CULTURAL DIVERSITY, INTERPRETER SERVICES, DIETARY VARIETY AND OTHER ACCOMMODATIONS TO SUPPORT FAMILIES FROM DIFFERENT CULTURAL BACKGROUNDS WHILE THEIR CHILDREN ARE PATIENTS AT BLYTHEDALE.
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PART VI, LINE 5:
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BLYTHEDALE OFFERS A NUMBER OF COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SPECIAL PROGRAMS FOR DEVELOPMENT OF THE PEDIATRIC PROFESSIONAL COMMUNITY: FIRST RESPONDER TRAINING PROGRAM: BLYTHEDALE, IN COORDINATION WITH THEWESTCHESTER REGIONAL EMS OFFICE, WESTCHESTER COUNTY DEPARTMENT OFEMERGENCY SERVICES, AND THE NYS EMS FOR CHILDREN PROGRAM, HASDEVELOPED A SPECIAL PEDIATRIC CME SERIES FOR FIRST RESPONDERS OF THEWESTCHESTER EMS REGION. THIS YEAR THE PROGRAM CENTERED ON RESPIRATORY EQUIPMENT AND CARE OF THE PEDIATRIC PATIENT. THE CLASS WAS GIVEN BY THE RESPIRATORY CARE STAFF FROM BLYTHEDALE. THE SERIES COVERS SUBJECTS VITAL TO FIRST RESPONDS, INCLUDING TRAUMATIC BRAIN INJURY, AUTISM, TECHNOLOGY AND CARE.NUTRITION EDUCATION: IN A MAJOR INITIATIVE TO HELP REDUCE THE PREVALENCEOF CHILDHOOD OBESITY AND PREVENT ITS LONG TERM NEGATIVE HEALTH EFFECTS,BLYTHEDALE IS REACHING OUT TO SCHOOL DISTRICTS THROUGHOUT WESTCHESTER ANDSURROUNDING COUNTIES WITH ITS EAT WELL BE WELL SCHOOL BASED NUTRITIONEDUCATION PROGRAM. THE EAT WELL, BE WELL PROGRAM, SUPPORTED BY KOHLS DEPARTMENT STORES, IS DESIGNED TO PROVIDE SCHOOL STAFF AND STUDENTS WITHTHE TOOLS NECESSARY TO HELP CHILDREN DEVELOP HEALTHY EATING HABITS THROUGHA COMPREHENSIVE CURRICULUM DEVELOPED BY BLYTHEDALE'S REGISTEREDDIETICIANS. TO DATE THIS PROGRAM HAS REACHED MORE THAN 110,000 STUDENTS,AS WELL AS OVER 5,500 PARENTS AND SCHOOL STAFF IN SCHOOLS THROUGHOUTWESTCHESTER, ROCKLAND AND PUTNAM COUNTIES, WITH INFORMATION ON HOW TO MAKEFOOD AND LIFESTYLE CHOICES THAT WILL PROMOTE HEALTHY LIVING FOR ALIFETIME. THIS PAST YEAR THE PROGRAM WAS PROVIDED IN 23 SCHOOLS (OFTENMORE THAN ONE VISIT) AND 16 SCHOOL DISTRICTS, TO 17,595 K-8 STUDENTS AND1,233 ADULTS. IN 2015, BLYTHEDALE CONTINUED ITS VITAL COMMUNITY SERVICE AS A CERTIFIED TRAINING CENTER FOR THE AMERICAN HEART ASSOCIATION (AHA) IN BOTH PEDIATRIC ADVANCED LIFE SUPPORT (PALS) AND BASIC LIFE SUPPORT (BLS). IN ADDITION TO BRINGING THESE VITAL PROGRAM OUT INTO THE COMMUNITY, THE HOSPITAL OFFERED A VARIETY OF COURSES ON-SITE. IN 2015, 3,956 PEOPLE WERE TRAINED IN CPR, PALS AND FIRST AID THROUGH BLYTHEDALE'S TRAINING CENTER. IN ADDITION, 109 PARENTS AND CAREGIVERS WERE TRAINED LAST YEAR. OF THIS NUMBER, 6 PARENTS WERE TAUGHT IN SPANISH AND 2 PARENTS WERE TAUGHT IN CREOLE. WE HAVE 120 INSTRUCTORS REGISTERED WITH OUR TRAINING CENTER. 109 EMPLOYEES WERE TAUGHT IN BLS AND 36 EMPLOYEES WERE RENEWED IN PALS. WE HAVE INSTRUCTORS ALIGNED WITH US FROM TAPPAN ZEE HS, CLARKSTOWN NORTH AND SOUTH HS, BYRAM HILLS HS, EASTCHESTER HS, SCARSDALE MS, MERCY COLLEGE, BRONX COMMUNITY COLLEGE DOBBS FERRY PD, POUND RIDGE PD, MT VERNON FD, GREENBURGH FD, HARSDALE FD, LAKE MOHEGAN FD PM PEDIATRICS, SHELTERING ARMS (FORMERLY EPISCOPAL SOCIAL SERVICES), EDWIN GOULD FAMILY SERVICES, JCCA, JANSEN HOSPICE, 3A SOLUTIONS, HISPANOAMERICANA DE EDUCADORES INFANTILES. 8 CLASSES ARE HELD ANNUALLY AT 9TH DISTRICT DENTAL ASSOCIATION.SERVICES TO THE PROFESSIONAL COMMUNITY: BLYTHEDALE ALSO PROVIDES CLINICAL TRAINING FOR SCORES OF PROFESSIONAL STUDENTS IN A WIDE RANGE OF FIELDS, INCLUDING MEDICINE, NURSING, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY AND SOCIAL WORK. BLYTHEDALE ALSO SPONSORS SPECIALIZED COURSES ON PEDIATRIC ISSUES FOR AREA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS.
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PART VI, LINE 7, REPORTS FILED WITH STATES
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NY
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