Patient Responsibility

Health Centers can use the Patient Responsibility master file in File Maintenance to define the Federal Poverty Guidelines for the current year. The guidelines are based on family size and annual income.

When you have entered the Federal Poverty Guidelines in the master file, valid family size, and income information for the patient’s Head of Household (HOH), the patient’s percent of poverty automatically calculates in NextGen® Enterprise PM. The HOH could be the patient or another person.

Patients who fall within the published guidelines are identified in NextGen® Enterprise PM as being 100% of poverty. You can use the guidelines to define additional Poverty Categories in File Maintenance to identify patients who fall outside of guidelines and are identified as being greater than 100% of poverty.

The Patient Responsibility schedules ensure that patients with a specific type of payer are responsible for a portion of their charges. For example, a patient covered under the Ryan White Fund (payer) might be responsible for 25% of their charges based on the poverty category they fall in.

Percent of Poverty is calculated only when the family size and income is current based on the effective date. If the information is expired, the Percent of Poverty is not calculated.

When a HOH refuses to report their income and the Refused to report checkbox is selected on the Family Info window, the following occurs:

• Percent of Poverty and Poverty Category are not calculated and do not have a value in the patient’s chart.
• Percent of Poverty and Poverty Category do not appear on reports.
• The Income Cycle, Verify Date, Effective Date and Expiration Date fields on the Family Info window are optional rather than required.

You can obtain the Federal Poverty Guidelines for the current year from the U.S. Department of Health & Human Services website: http://aspe.hhs.gov/poverty/.