Billing and collections policy

POLICY TITLE: Billing and Collections
POLICY NUMBER: SYS-RCM-002
CATEGORY: Revenue Cycle Management
RESPONSIBLE DEPT: Single Billing Office
EFFECTIVE DATE: 4/07/2026
REVIEWED DATE: 2/27/2026

Policy

This Policy provides clear and consistent guidelines for conducting billing and collections functions in a manner that promotes compliance, patient satisfaction, and efficiency. UF Health bills patients and submits claims to third party payers on behalf of patients after health care services have been provided. Using billing statements, written correspondence, and phone calls, UF Health will make diligent efforts to inform patients of their financial responsibilities and available financial assistance options, as well as follow up with patients regarding outstanding accounts. Additionally, this Policy requires UF Health to make Reasonable Efforts to determine a patient’s eligibility for financial assistance under UF Health’s Financial Assistance Policy before engaging in Extraordinary Collection Actions to obtain payment.

Purpose

To establish a billing and collections policy that is in compliance with Section 501(r) of the Internal Revenue Code and the regulations promulgated thereunder. This Policy was adopted by the UF Health Board of Directors in June 2016 and is reviewed at least every two years thereafter.

Approved

• April York
  UF Health System Senior VP of Revenue Cycle
• Geoffrey Gardner
  UF Health System Chief Financial Officer

Definitions

The following terms are meant to be interpreted as follows within this Policy:

1. Extraordinary Collection Actions (ECA) – A list of collection activities, as defined by Section 501(r) of the Internal Revenue Code, which healthcare organizations may take against an individual to obtain payment for care, only after Reasonable Efforts have been made to determine whether the individual is eligible for financial assistance. These actions include reporting adverse information to credit bureaus or credit reporting agencies along with actions that require a legal or judicial process.
2. Financial Assistance Policy (FAP) – A separate policy that describes UF Health’s financial assistance program, including the criteria patients must meet in order to be eligible for financial assistance, as well as the process by which individuals may apply for assistance.
3. Reasonable Efforts – A certain set of actions a healthcare organization shall take to determine whether an individual is eligible for financial assistance under a FAP. In general, Reasonable Efforts may include making presumptive determinations of eligibility, for full or partial assistance, as well as providing individuals with written and oral notifications about the FAP and application processes.
4. Business Day – Any day that is Monday through Friday, with the exception of a legal holiday, Saturdays, and Sundays.
5. Calendar Day – Any day of the week, including Saturdays, Sundays, and legal holidays. Note that every Business Day is included as a Calendar Day.

Core procedures

1. Insurance Billing
   1. For insured patients, UF Health will submit insurance claims for payment based on insurance information provided by, or verified by, the patient. Claims will be submitted in a timely manner and consistent with current regulations and industry/payer standards.
   2. Pursuant to Florida Statute 627.6131, for all electronically submitted claims, third-party payers are required to pay, deny, or contest electronically submitted claims within twenty (20) days after receipt of the claim. For all non-electronically submitted claims, third-party payers are required to pay, deny, or contest submitted claims within forty (40) days after receipt of the claim. UF Health Patient Financial Services (PFS) will follow up with payers no later than sixty (60) days from the date of billing regarding claims with no response.
   3. Claims with no payment after ninety (90) days from submission may be escalated with third party payer representatives when UF Health has a contracted relationship. When UF Health has no contract with a third-party payer in place, continuous effort will be made directly with the payer to obtain payment, denial or correspondence related to the services provided to patients. In the event UF Health has determined they exhausted all efforts with the non-contracted payer, UF Health may file a billing complaint through the Federal Independent Dispute Resolution process to report a violation of the protections of the No Surprises Act. UF Health will follow the No Surprises Act and only balance bill patients, when applicable, per guidelines.
   4. Insurance payments will be posted per the third-party payer remittance advice. Balances that are reported to be due from the patient after insurance company adjudication will be billed to the patient. UF Health may only waive a patient’s copayment, coinsurance or deductible, if the conditions defined within CP04.019 - Provision of Free or Discounted Goods and Services, and Waivers of Copayments, Coinsurance or Deductibles to Patients, are met.
   5. If a claim is denied or not processed by a payer due to an error by UF Health or its authorized collection vendor(s), the patient will not be billed for any amount in excess of what the patient would have owed had the payer paid the claim.
   6. If a claim is denied or not processed by a payer due to factors outside of UF Health control, staff will follow up with the payer and patient as appropriate to facilitate resolution of the claim. If resolution does not occur after prudent follow-up efforts, UF Health may bill the patient or take other actions consistent with current regulations and industry standards.
2. Patient Billing
   1. Uninsured patients will be billed directly and timely via a billing statement.
   2. Self-pay discount for Uninsured patients
      1. Uninsured patients who are not eligible for Financial Assistance may be eligible for a self-pay discount off of the gross charges. Please contact our office for the current discount amounts at 888-766-8154 option 1. Any self-pay discount applied will be reversed if insurance coverage is located.
      2. The self-pay discount does not relieve nor forgive point-of-service cash payments that the patient may be required to pay. The discount will not be applied to any of the services excluded from the Financial Assistance Program.
   3. Patients may request an itemized statement for their account at any time. UF Health will comply with itemized statement requests and respond to patients questions concerning their bills in accordance with Florida Statute 395.301.
   4. The initial statement or bill shall be provided within seven (7) days after the claim has been released and balance moved to self-pay or after a request for such statement or bill. If a patient disputes their account and requests documentation regarding the bill, an initial response shall be provided to that patient within seven (7) business days. If this timeline cannot be met, the circumstances will be documented in the patient account, and the patient will be informed of the delay and estimated completion date. Collection activity on the patient account will be suspended for thirty (30) days while the dispute is addressed.
   5. Medical Records will be obtained through the Health Information Management Department following established procedures for requests.
   6. UF Health may approve payment plan arrangements according to acceptable payment plan guidelines, with up to a two (2) year repayment period for patients who indicate they may have difficulty paying their balance in a single payment.
      1. The Revenue Cycle Leadership Team has the authority to make exceptions to this Policy on a case-by-case basis.
      2. UF Health is not required to accept patient-initiated payment arrangements and may refer accounts to a collection agency as outlined below if the patient is unwilling to make acceptable payment arrangements or has defaulted on an established payment plan.
3. Collections Practices
   1. In compliance with relevant laws, and in accordance with the provisions outlined in this Policy, UF Health may engage in collection activities, including ECA, to collect outstanding balances.
   2. General collection activities may include calls to patients regarding unpaid balances.
   3. Patient balances may be referred to a third party for collection. UF Health will maintain ownership of any debt referred to collection agencies, and patient accounts will be referred for collection with consideration of the following:
      1. There is a reasonable basis to believe the patient owes the debt.
      2. Third-party payers have been properly billed, and the remaining debt is patient responsibility. A patient will not be billed for any amount that a contracted insurance company or other payer is obligated to pay by contract or by law.
      3. UF Health will not refer accounts for collection agency activity while a claim is pending payment from a contracted payer, unless the patient fails to meet the requirements or requests from the payer to allow for the claim to be processed or paid.
      4. Accounts will not be referred for collection agency activity where the claim denial was due to a UF Health error. However, the patient portion, including copayments, coinsurance, or deductible amounts, may be referred for collection if unpaid.
      5. UF Health will not refer accounts for collection agency activity when the patient has initially applied for financial assistance and has not yet been notified of the decision, provided the patient has complied with the information requests defined during the application process.
4. Reasonable Efforts and ECA
   1. Before engaging in ECA, UF Health shall make certain Reasonable Efforts to:
      1. Determine whether an individual is eligible for financial assistance under the FAP:
         1. ECA may begin only when one hundred twenty (120) calendar days have passed since the first post-discharge statement was provided.
         2. At least thirty (30) calendar days before initiating ECA, UF Health shall do the following:
            1. Provide the individual with a written notice that indicates the availability of financial assistance, lists potential ECA that may be taken to obtain payment, and gives a deadline after which ECA may be initiated (no sooner than one hundred twenty (120) calendar days after the first post-discharge billing statement and thirty (30) calendar days after the written notice);
            2. Provide a plain-language summary of the FAP along with the notice described above; and
            3. Attempt to notify the individual verbally about the FAP and how they may receive assistance with the application process.
   2. After making Reasonable Efforts to determine financial assistance eligibility as outlined above, UF Health (or its authorized collection vendor(s)) may take any of the following ECA to obtain payment for care:
      1. Report adverse information to credit reporting agencies and/or credit bureaus.
      2. Commence a legal or judicial process for the purpose of recovering unpaid amounts.
   3. Hospital liens may be recorded to secure payment from third party liability claims (i.e. motor vehicle accidents, workers’ compensation).
   4. If a patient has an outstanding balance for previously provided care, UF Health may engage in the ECA of deferring, denying, or requiring payment before providing additional medically necessary (but non-emergent) care only when the following steps are taken:
      1. UF Health provides the patient with an FAP application and a plain language summary of the FAP.
      2. UF Health provides a written notice indicating the availability of financial assistance and specifying any deadline after which a completed application for assistance for the previous care episode will no longer be accepted. This deadline shall be at least thirty (30) calendar days after the notice date or two hundred forty (240) calendar days after the first post-discharge billing statement for prior care, whichever is later.
      3. UF Health makes a reasonable effort to verbally notify the individual about the FAP and explains how to receive assistance with the application process.
      4. UF Health processes, on an expedited basis, any FAP applications for previous care received within the stated deadline.
   5. UF Health is ultimately responsible for taking reasonable efforts to determine whether an individual is eligible for financial assistance and for deciding whether the organization may proceed with any of the ECA outlined in this Policy.
5. Financial Assistance
   1. All billed patients will have the opportunity to contact UF Health regarding financial assistance for their accounts, payment plan options, and other applicable programs.
   2. UF Health FAP is available in English, Spanish and Chinese. Patients may request a free copy:
      1. In person at:
         1. UF Health Jacksonville Admissions Department
            655 West 8th Street, Jacksonville, Florida 32209
         2. UF Health North Admissions Department,
            15255 Max Leggett Parkway, Jacksonville, Florida 32218
         3. UF Health Jacksonville Financial Eligibility Department
            1833 Boulevard, Jacksonville, Florida 32209
         4. UF Health Shands Hospital and UF Health Shands Children’s Hospital Admissions Department, Room 1331 or Room 1335-1
            1600 SW Archer Road, Gainesville, FL 32610
         5. UF Health Shands Cancer Hospital
            Admissions Department, Room 1319
            1515 SW Archer Road, Gainesville, FL 32608
         6. UF Health Heart & Vascular Hospital and UF Health Neuromedicine Hospital Cashier’s Office, Room 1522
            1505 SW Archer Road, Gainesville, FL 32608
         7. UF Health Shands Psychiatric Hospital
            Admissions Department, Room 1105.5
            4101 NW 89th Boulevard, Gainesville, FL 32606
         8. UF Health Shands Patient Financial Services
            3300 SW Williston Road, Gainesville, FL 32608
         9. UF Health St Johns
            400 Health Park Blvd., St. Augustine, Fl 32086
         10. UF Health Leesburg Hospital
             600 E. Dixie Avenue, Leesburg, FL 34748
         11. UF Health Spanish Plaines Hospital
             1451 Camino Real, The Villages, FL 32162
      2. By calling the Financial Counseling Department toll free at 888-766-8154 option 2
      3. Online at www.ufhealth.org/financial-assistance
6. Customer Service
   1. During the billing and collections process, UF Health will provide quality customer service by implementing the following guidelines:
      1. UF Health will enforce a zero-tolerance standard for abusive, harassing, offensive, deceptive, or misleading language or conduct by its employees or authorized collection vendor(s).
      2. UF Health will maintain a process for patient questions and/or disputes, which includes a toll-free phone number that patients may call and a prominent business office address to which they may write. This information will be listed on all bills and collections statements sent.
      3. After receiving a communication from a patient (by phone or in writing), UF Health staff will return phone calls as promptly as possible (but no more than one (1) business day after the call was received) and will respond to written correspondence within ten (10) days of receipt of the correspondence.
      4. UF Health Customer Service Department will maintain a log of patient complaints that will be available for audit.

Associated policies

UF Health Gainesville

CP04.019 - Provision of Free or Discounted Goods and Services, and Waivers of Copayments, Coinsurance or Deductibles to Patients

UF Health Systemwide

SYS-RCM-001 - Financial Assistance

Keywords

Itemized Statements, Patient Bill, Financial Assistance, Self-Pay Adjustment, Compliance

Revised on

2/27/2026