policy & procedure - atlanticare...effective: 1/1/16 reviewed: revised: review cycle: annual...

38
Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r) Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015 Page 1 of 38 Policy & Procedure Subject: Financial Assistance Category: Patient Rights and Organizational Facility Scope: ARMC Locations: Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ, Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ, Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ, Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ, Satellite Emergency Department, Hammonton, NJ. Department: Finance PURPOSE: To inform patients of the availability of Financial Assistance that provides patients the opportunity to apply for Health Insurance Marketplace, Medicaid, Charity Care, New Jersey Property- Liability Insurance Guaranty Association (PLIGA), Violent Crimes Fund, AtlantiCare Regional Medical Center (ARMC) discount charges program and the uninsured discount. Also, to comply with NJ Public Law 1992, c.160 regarding Charity Care and reduced charge Charity Care for indigent patients; NJ Public Law 2008, c.60 and IRC Section 501 (r). PROCEDURE: 1. All patients will be informed regarding the availability of Financial Assistance. Financial Assistance is available for all medically necessary care, both emergent and non-emergent. 2. ARMC’s Financial Assistance policy will be available in English and in the primary language of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5 percent of the community served by ARMC. 3. ARMC’s Financial Assistance Policy is available via our website, www.atlanticare.org/PLS, which includes but is not limited to the Financial Assistance Policy – Plain Language Summary, Financial Assistance Policy, Billing and Collections Policy, Discounted Charges Information, Federal Poverty Level Guidelines, Charity Care application, and Charity Care checklist. Our website also includes links to NJ Family Care and Social Security Disability websites. 4. Signs will be posted in the hospital based registration areas such as central registration, admissions, emergency departments, financial services offices, and common waiting areas that will inform patients of the availability of Financial Assistance for all medically necessary care, both emergent and non-emergent. 5. The Financial Assistance Policy will be available upon request and without charge at the various hospital based registration sites listed in the heading of this policy, by calling the Business Office Customer Service office at 609- 272-2500, visiting the www.atlanticare.org/PLS website or by a written request to:

Upload: others

Post on 15-Aug-2020

5 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 1 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

PURPOSE: To inform patients of the availability of Financial Assistance that provides patients the opportunity to apply for Health Insurance Marketplace, Medicaid, Charity Care, New Jersey Property- Liability Insurance Guaranty Association (PLIGA), Violent Crimes Fund, AtlantiCare Regional Medical Center (ARMC) discount charges program and the uninsured discount. Also, to comply with NJ Public Law 1992, c.160 regarding Charity Care and reduced charge Charity Care for indigent patients; NJ Public Law 2008, c.60 and IRC Section 501 (r). PROCEDURE:

1. All patients will be informed regarding the availability of Financial Assistance. Financial Assistance is available for all medically necessary care, both emergent and non-emergent.

2. ARMC’s Financial Assistance policy will be available in English and in the primary language of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5 percent of the community served by ARMC.

3. ARMC’s Financial Assistance Policy is available via our website, www.atlanticare.org/PLS, which includes but is not limited to the Financial Assistance Policy – Plain Language Summary, Financial Assistance Policy, Billing and Collections Policy, Discounted Charges Information, Federal Poverty Level Guidelines, Charity Care application, and Charity Care checklist. Our website also includes links to NJ Family Care and Social Security Disability websites.

4. Signs will be posted in the hospital based registration areas such as central registration, admissions, emergency departments, financial services offices, and common waiting areas that will inform patients of the availability of Financial Assistance for all medically necessary care, both emergent and non-emergent.

5. The Financial Assistance Policy will be available upon request and without charge at the various hospital based registration sites listed in the heading of this policy, by calling the Business Office Customer Service office at 609-272-2500, visiting the www.atlanticare.org/PLS website or by a written request to:

Page 2: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 2 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

ARMC Finance Offices Attn: Business Office Customer Service 65 W. Jimmie Leeds Rd Pomona, NJ 08240

6. A Plain Language Summary of this policy will be provided to all patients as part of the intake process at all hospital based registration and financial services sites. The Plain Language Summary shall be printed in English and in the primary language of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5 percent of the community served by ARMC.

7. Patients can obtain forms free of charge and/or apply for any Financial Assistance program at any of the following locations without an appointment.

a. ARMC Health Plex, 1401 Atlantic Ave, Atlantic City, NJ, 08401. Monday through Friday, 7:30am to 4:00pm. Go to 1st Floor – Outpatient registration and ask for the Financial Assistance Dept.

b. ARMC Mainland Campus, 65 W. Jimmie Leeds Rd., Pomona, NJ, 08240. Monday through Friday, 8:00am to 5:00pm. Go to Hospital Lobby Information Desk and ask for Financial Assistance Dept.

c. ARMC Health Park at Hammonton, 219 N. White Horse Pike, Hammonton, NJ, 08037. Wednesdays only, 8:00am – 4:00pm. During Summer Wednesday and Thursday 8:00am to 4:00pm. Go to Emergency Room Registration Desk and ask for Financial Assistance Dept.

8. ARMC staff will screen patients for Health Insurance Marketplace, Medicaid, Medicaid Presumptive Eligibility, New Jersey Property- Liability Insurance Guaranty Association (PLIGA), Catastrophic Illness in Children Relief Fund and Violent Crimes Fund. If a patient does not qualify for any of these programs they can apply for the Charity Care, Discounted Charges or Uninsured Discount programs.

9. Charity Care (Public Law 1992, c.160 )- A patient who wants to apply for Charity Care as defined by Public Law 1992, c.160 regarding Charity Care for indigent patients shall be interviewed by a hospital employee at the bed side

Page 3: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 3 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

or at any location listed in item #7, and provided a checklist of documentation needed to assess eligibility for charity care.

a. This will be done by ARMC’s Financial Counseling Services personnel.

b. The patient will be screened for the Charity Care program which covers patients with a family income less than 300% of the federal poverty level and less than $7,500 in assets for a single person or $15,000 in assets for a family of 2 or more.

i. The Charity Care application process ensures we have all documentation required per the Charity Care section of the Hospital Service Manual N.J.A.C 10:52-11,12,13 which includes:

1. Proper identification for patient and all family members;

2. Proof of New Jersey Residence as of the date of service

a. Emergency Charity Care is an exception to the residency requirement: a patient who receives service in the emergency room and meets all other criteria, then that specific date(s) of service that started with the emergency room visit will be covered.

3. Proof of income for at least one month prior to date of service;

4. Proof of assets as of the date of service.

ii. When the patient presents all required documents, signatures will be obtained on all required forms and all documents copied.

iii. Upon completion and approval of the application, the patient will be given a Charity Care Approval Card or authorization to receive service.

Page 4: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 4 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

iv. All charity care applications will be scanned and retained for future reference which includes audits conducted by the state.

v. It is the policy of ARMC to subsidize and not balance bill patients who qualify for Charity Care.

vi. Patients determined to be eligible for Charity Care can be approved for a period of up to twelve months from the first date of service related to the application.

vii. Patients will have two years from the initial service date to apply for Charity Care assistance.

viii. Incomplete Charity Care applications are returned to the applicant with a written denial explaining the reason for denial and details of additional documentation needed to obtain approval.

10. Discounted Charges (IRC Section 501 (r)) – Discounted Charges are available to: (i) insured patients whose insurance does not pay for services at 100% of cost; and (ii) uninsured patients who are unable to satisfy the residency requirements of the Uninsured Discount; provided those patients:

a. apply for this discount and provide a minimum of two pay stubs to verify their income is 400% of the federal poverty level or less to be eligible.

b. The Discounted Charges program calculates the maximum amount a patient owes by multiplying the Amounts Generally Billed (“AGB”) Percentage times Gross Charges.

i. AGB means the amounts generally billed for emergency or other medically necessary care calculated using the “Look-Back method” as set forth in Treas. Reg. § 1.501(r)-5. Using this method, ARMC determines the AGB by multiplying the Gross Charges for any emergency or other medically necessary care it provides to an Financial Assistance Policy-eligible individual by a percentage of Gross Charges called an AGB Percentage. ARMC calculates the AGB Percentage annually based on all claims allowed by Medicare, Medicare Advantage and private health insurers over a 12-month period, divided by the sum of associated gross charges for those claims.

Page 5: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 5 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

ii. Gross Charges means ARMC’s full, established price for medical care that ARMC consistently and uniformly charges patients before applying any contractual allowances, discounts, or deductions.

c. If the result of this calculation is:

i. Less than the amount the patient owes, the patient will only be responsible for the amount of the discounted charges calculation

ii. More than the amount the patient owes, the patient will be responsible for amount indicated by their insurance company.

d. A free copy of the Discounted Charge Calculation and AGB Percentage is available in the same manner as paper copies of this Policy and is also available on our website www.atlanticare.org/PLS.

11. Uninsured Discount (NJ Public Law 2008, c.60)– An Uninsured patient who is defined as a patient who has no insurance coverage for their medically necessary services and is not eligible for any State, Federal and local programs and qualifies for “a” or “b” below will qualify for an Uninsured Discount that will adjust their patient liability to no more than 115% of Medicare reimbursement.

a. A New Jersey resident qualifies for both emergent and non-emergent services.

b. A United States of America resident outside of New Jersey qualifies for emergent services only.

Patients will be screened by a hospital employee at the time of service for qualification for the Uninsured Discount.

12. If a patient qualifies for Financial Assistance under this Policy;

a. The patient will not be charged more for emergency care or other medically necessary care than the AGB for such care; and

Page 6: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 6 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

b. In the case of all other medical care, the patient will be charged less than the Gross Charges for such care.

c. An uninsured patient will be charged the lesser of AGB or 115% of Medicare for all services received.

13. Billing and Collections – see the Billing and Collections Policy for procedures. . The Billing and Collections Policy sets forth the actions ARMC may take if a bill for medical care is not paid. A free copy of the Billing and Collections Policy is available in the same manner as paper copies of this Policy and also available on our website www.atlanticare.org/PLS.

14. Any questions regarding this policy can be directed to the ARMC Business Office Customer Service department at 609-272-2500.

15. A listing of all providers associated with ARMC is in Appendix A, indicating whether or not their services are covered under this Financial Assistance Policy.

a. The provider listing will be updated by adding new or missing information, correcting erroneous information, and deleting obsolete information quarterly.

b. If the only change made to the FAP is to update the provider list the FAP need not be adopted by an authorized body again.

Page 7: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 7 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Appendix A 

The followng physicians/ groups will comply with AtlantiCare Regional Medical Center's Financial Assistance Policy effective 1/1/2017 

GROUP PRACTICE  LAST NAME  FIRST NAME  TITLE  FIELD OF STUDY 

APG Anesthesiology  Ailes  Angela  CRNA  Anesthesiology 

Albani  Peter  CRNA  Anesthesiology 

Bendetti  Erika  CRNA  Anesthesiology 

Beyers  Maria Leah  CRNA  Anesthesiology 

Bissell  Deanna  CRNA  Anesthesia ‐ CRNA 

Bobcowski  Christopher  CRNA  Anesthesiology 

Bogdan  Megan  CRNA  Anesthesiology 

Branco  Andrea  CRNA  Anesthesia 

Corcory  Hollie  CRNA  Anesthesiology 

Costabile  Jessica  DO  Anesthesiology 

Creamer  Eunice  CRNA Certified Registered Nurse Anesthet 

Davidov  Mark  MD  Anesthesiology 

Deiter  Jessica  CRNA  Anesthesiology 

DeVente  Robert  CRNA  Anesthesiology 

Droney  Timothy  MD  Anesthesiology 

Fadugba  Olawale  MD  Anesthesiology 

Fisgus  John  MD  Anesthesiology 

Gayeski  David  MD  Anesthesiology 

Giberson  Christopher  CRNA  Anesthesiology 

Giberson  Nicholle  CRNA  Anesthesiology 

Giegerich  Patricia  CRNA  Anesthesiology 

Gilligan  Brendan  MD  Anesthesiology 

Greenleaf  Steven  CRNA  Anesthesiology 

Gregory  Stephen  CRNA  Anesthesiology 

Hargrove  Klisa  CRNA  Anesthesiology 

Incandela  Nicholas  MD  Anesthesiology 

Jacobsen  Regina  CRNA  Anesthesiology 

Kasica  Patricia  DO  Anesthesiology 

Page 8: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 8 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Lauletta  Ellen  CRNA  Anesthesiology 

Lent  Carol  CRNA  Anesthesiology 

Levitch  David  MD  Anesthesiology 

Liccini  Mark  DO  Anesthesiology 

Lynch  Bryan  CRNA  Anesthesiology 

Mackinlay  Paula  CRNA  Anesthesiology 

Manaresi  Kristyn  CRNA  Anesthesiology 

Marable  Denise  MD  Anesthesiology 

Martin  Sheryel  MD  Anesthesiology 

Martin  Steven  CRNA  Anesthesiology 

Mazurek  Dean  CRNA  Anesthesiology 

Mazzoni  Christina  CRNA  Anesthesiology 

Mendelsohn  Laura  CRNA  Anesthesiology 

Moskowitz  Richard  PAC  Anesthesiology 

Murphy  Edward  CRNA  Anesthesiology 

O'Connell  Frank  MD  Anesthesiology 

Panarello  Michael  PAC  Anesthesiology 

Parra  Suzanne  CRNA  Anesthesiology 

Pericic  Romeo  MD  Anesthesiology 

Radcliff  Nina  MD  Anesthesiology 

Reganato  Darren  CRNA  Anesthesiology 

Riccobono  Elizabeth  DO  Anesthesiology 

Sangani  Neha  CRNA  Anesthesiology 

Schmidheiser  Mark  MD  Anesthesiology 

Schrenk  Susan  CRNA  Anesthesiology 

Schuman  Michael  CRNA  Anesthesiology 

Sesay  Margaret  CRNA  Anesthesiology 

Shah  Sudha  MD  Anesthesiology 

Sodhi  Vinita  MD  Anesthesiology 

Spence  Anna  CRNA  Anesthesia ‐ CRNA 

Stamm  Ryan  PAC  Anesthesiology 

Sulit  Armando  MD  Anesthesiology 

Sykes  Robert  CRNA  Anesthesiology 

Wang  Qin  MD  Anesthesiology 

Page 9: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 9 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Whitson‐West  Janine  DO  Anesthesiology 

Yao  Su‐lin  MD  Anesthesiology 

Yoa  Mark  MD  Anesthesiology 

Zalman  Richard  MD  Anesthesiology 

Zhu  Yun  MD  Anesthesiology 

AtlantiCare Behavioral Health, APG ABH  Ashfaq  Mohammad  MD  Psychiatry 

Bhuyan  Ruprekha  MD  Psychiatry 

Botros  Lamia  MD  Psychiatry 

Corvari  Steven  MD  Psychiatry 

Daclan  Maria Teresa  MD  Psychiatry 

Fenyar  Bonnie Ann  MD  Psychiatry 

Friel  David  MD  Psychiatry 

Huang  David  MD  Psychiatry 

Iqbal  Syed  MD  Psychiatry 

Julius  Rose  DO, MPH  Psychiatry 

Momodu  Inua  MD, MPH  Psychiatry 

Newman  Suzanne  MD  Psychiatry 

Okao  Ewaen  MD  Psychiatry 

Ortega  Adela  MD  Psychiatry 

Oyejide  Catherine  MD  Psychiatry 

Pandya  Shilin  DO  Psychiatry 

Poellnitz  Stephanie  MD  Psychiatry 

Pokalo  Mariann  PhD  Psychology 

Sastry  Gayathri  MD  Psychiatry 

Srinivasan  Rekha  MD  Psychiatry 

AtlantiCare Cancer Care Institute  Chawla  Neha  MD  Hematology and Oncology 

DiCerbo  Beverly  APN  Hematology and Oncology 

Herman  Marianne  APN  Hematology and Oncology 

Lorenzetti  John  MD  Breast Surgery/Disease 

Sandilya  Vijay  MD  Hematology and Oncology 

AtlantiCare Center for Perioperative Medicine  Bernardo  Gregory  MD  Internal Medicine 

Catalina  Gabriel  DO  Internal Medicine 

Driscoll  Eric  DO  Internal Medicine 

Moody‐Tidcombe  Laurie  APN  Anesthesia 

Page 10: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 10 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

AtlantiCare Infectious Disease Clinic  Kilroy  Kelly  APN  Infectious Diseases 

Eble  Elizabeth  APN  Infectious Diseases 

Thayer  Lorraine  APN  Infectious Diseases 

Atlanticare Special Care Center  Castro‐Chevere  Nancy  MD  Family Practice 

Digenio  Ines  MD  Family Practice 

Keiner  Lisa  DO  Family Practice 

Rogers  Jill  APN  Family Practice 

Westcott  Robin  APN  Family Practice 

AtlantiCare Regional Medical Center, Dept. of Clinic Services  Bhatt  Darshan  APN  Internal Medicine 

Mazur  Kimberly  MD  Internal Medicine 

Patel  Tejalkumar  APN  Internal Medicine 

Roeske  Jessica  DO  Internal Medicine 

Timms  Brian  DO  Internal Medicine 

Jefferson Neurological Surgery  DeFamio  Christina  APN  Neurosurgery 

Eller  Jorge  MD  Neurosurgery 

Gupta  Gaurav  MD  Neurosurgery 

Jabbour  Pascal  MD  Critical Care 

Rosenwasser  Robert  MD  Neurosurgery 

Stidd  David  MD  Neurosurgery 

Tjoumakaris  Stavropoula  MD  Neurosurgery 

Townsend  Jenna  PAC  Neurosurgery 

Appendix A 

The followng physicians/ groups will NOTcomply with AtlantiCare Regional Medical Center's Financial Assistance Policy effective 1/1/2017 

GROUP PRACTICE  LAST NAME  FIRST NAME  TITLE  FIELD OF STUDY 

Absecon Island Internal Medicine LLC  Curnow  Hidalberto  DO  Internal Medicine 

AC Best Docs, LLC  Ratner  Eric  MD  Pain Medicine 

Salvage  Robert  MD  Pain Medicine 

Accent Head and Neck Group  DeLorio  Nicola  DO  Otolaryngology 

Adolescent Partial Hospital  Griinke‐Mazzatta  Sheila  DO  Psychiatry 

Page 11: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 11 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Adult Intervention Services  Goldblum‐Graff  Diane  APN  Psychiatry 

Advance Care Obstetrics Gynecology Infertility  Carfagno  Salvatore  DO  Obstetrics & Gynecology 

Grencavich  Rachel  CNM  Obstetrics & Gynecology 

Advocare Mainland Pediatric Associates  Amir  Sabah  MD  Pediatrics 

ElGenaidi  Mona  MD  Pediatrics 

Aesthetic Horizons Plastic Surgery Center  Birmingham  K. Lesley  MD  Plastic and Reconstructive Surgery 

Alan Feldman, MD,  Feldman  Alan  MD  Gynecology 

Allergy and Asthma of South Jersey PA  Coifman  Robert  MD  Allergy 

American Sleep and Pulmonary Medicine  Alobeidy  Salaam  MD  Pulmonary Disease 

Francesco  Barbara  APN  Pulmonary Disease 

Anthony G. Campo, Jr., M.D.  Campo  Anthony  MD  Dermatology 

Antonio Grafilo  Grafilo  Antonio  MD  General Surgery 

APG Cape May Court House  Lee  Edward  MD  Internal Medicine 

APG Cardiology  Carreno  Wilfredo  MD  Cardiology 

Desai  Rashmikant  MD  Cardiology 

Dobbins  Shannon  APN  Cardiology 

Elnahal  Mohamed  MD  Cardiology 

Ghayal  Mahesh  MD  Cardiology 

Jayasinghe  Swarna  MD  Cardiology 

Khan  Ejaz  MD  Cardiology 

Merchant  Yatish  MD  Cardiology 

Nascimento  Tome  MD  Cardiology 

Oldroyd  Diane  APN  Cardiology 

Patel  Mayuri  MD  Cardiology 

Patel  Vineshkumar  MD  Cardiology 

Robbins  Inga  MD  Cardiology 

Sanyal  Saugato  MD, MBA  Cardiology 

Sateri  Rochelle  APN  Cardiology 

Schroeder  Donna  APN  Cardiology 

Shetty  Sanjay  MD  Cardiology 

Singh  Vibhuti  MD  Interventional Cardiology 

Vankawala  Viren  MD  Cardiology 

Williams  Lindsey  APN  Cardiology 

APG Critical Care  Adams  William  DO  Critical Care 

Page 12: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 12 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Amin  Sandeep  PAC  Critical Care 

Balsys  Andrew  APN  Critical Care 

Dean  Sarah  APN  Critical Care 

Drogo  Joseph  APN  Critical Care 

Hamaty  Edward  DO  Pulmonary Disease 

Lichardi  Michael  PAC  Critical Care 

Piller  Kristi  APN  Critical Care 

APG Family Medicine  Berlin  William  DO  Family Practice 

Bushay  Stephen  MD  Family Practice 

Chew  Jason  DO  Family Practice 

Corrales  Michelle  MD  Family Practice 

Delice  Anael  DO  Family Practice 

Eremus‐Foster  Jane  APN  Family Practice 

Eye  Patrick  APN  Family Nurse Practitioner 

Ganiel  Jolene  APN  Family Practice 

Gelzunas  Ronald  DO  Family Practice 

Grife  Robert  MD  Family Practice 

Haflin  Mary Ann  MD  Family Practice 

Hutchison  Melissa  MD  Family Practice 

Jones‐Mudd  Kimberly  DO  Family Practice 

Kulin  John  DO  Occupational Medicine 

Loughlin Pherribo  Donna  DO  Family Practice 

Renza  Richard  DO  Family Practice 

Salvo  Anthony  MD,FAAFP  Internal Medicine 

Vaccaro  Carl  DO  Internal Medicine 

APG Hospitalists  Abbasi  Danish  MD  Internal Medicine 

Ablett  Christine  APN  Internal Medicine 

Ahmad  Israr  MD  Internal Medicine 

Ahmad  Naheed  MD  Internal Medicine 

Ahmed  Naseer  MD  Internal Medicine 

Babar  Jawad  MD  Internal Medicine 

Bakr  Mohamed  MD  Internal Medicine 

Baptist  Justin  MD  Internal Medicine 

Belete‐Levin  Senayit  MD  Internal Medicine 

Page 13: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 13 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Bhimani  Siddharth  DO  Internal Medicine 

Brubaker  Tammie  APN  Internal Medicine 

Daneshvar  Behdokht  MD  Internal Medicine 

Degapudi  Bhargavi  MD  Internal Medicine 

DiBruno  Donna  DO  Internal Medicine 

Elahi  Abdul  MD,MPH  Internal Medicine 

Faunce  Viviana  APN  Internal Medicine 

Griffith  Heidi  MD  Internal Medicine 

Hasni  Syed  MD  Internal Medicine 

Hocbo  Aileen  MD  Internal Medicine 

Hussain  Arif  MD  Internal Medicine 

Iqbal  Javid  MD  Internal Medicine 

Jaleel  Syed  MD  Internal Medicine 

Kane  Tina  APN  Internal Medicine 

Kelly  Brendan  DO  Internal Medicine 

Kern  Lisa  APN  Internal Medicine 

Kessler  Alex  DO  Internal Medicine 

Khorsandi  Shiba  MD  Internal Medicine 

Lal  Vikram  DO  Internal Medicine 

Macchiavelli  Anthony  MD  Internal Medicine 

Marwaha  Rohit  MD  Internal Medicine 

Ngu  Michael  MD  Internal Medicine 

Nwotite  Ezinne  MD  Internal Medicine 

Onwuka  Mary  MD  Internal Medicine 

Patel  Hardik  MD  Internal Medicine 

Patel  Hasitkumar  MD  Internal Medicine 

Patel  Manoj  MD  Internal Medicine 

Patel  Mehul  MD  Internal Medicine 

Picciotti  Alana  APN  Internal Medicine 

Popescu  Adrian  MD  Internal Medicine 

Racherla  Saraswathi  MD  Internal Medicine 

Rahman  Aqsa  MD  Internal Medicine 

Rahmani  Ghulam  MD  Internal Medicine 

Rahn  Mary Lou  APN  Internal Medicine 

Page 14: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 14 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Rathod  Kokila  APN  Internal Medicine 

Ray  Amit  MD  Internal Medicine 

Raymond  Rebecca  APN  Internal Medicine 

Reddy  Sriharshan  MD  Internal Medicine 

Rondanina  Richard  MD  Internal Medicine 

Rush  Cheryl  APN  Internal Medicine 

Salman  Tayyaba  MD  Internal Medicine 

Samuels  Elizabeth  DO  Internal Medicine 

Santora  Joseph  DO  Internal Medicine 

Siddiqui  Durdana  MD  Internal Medicine 

Silver  Jordan  MD  Internal Medicine 

Sohaib  Muhammad  MD  Internal Medicine 

Sun  Qi  MD  Internal Medicine 

Szulc  Magdalena  MD  Internal Medicine 

Tran  Brian  MD  Internal Medicine 

Ventura  Kenilia  MD  Internal Medicine 

Zampino  Dominick  DO,FACP  Internal Medicine 

Zia  Shahzad  MD  Internal Medicine 

APG Internal Medicine  Almanzar  Randy  MD  Family Practice 

Amin  Anila  MD  Internal Medicine 

Atkinson, III  James  MD  Internal Medicine 

Bayer  Deborah  DO  Infectious Diseases 

Bennett  Holly  APN  Internal Medicine 

Chaikin  Harry  MD  Internal Medicine 

Farside  Amy  APN  Internal Medicine 

Goldman  Daniel  MD  Internal Medicine 

Lieberman, III  Alexander  MD  Internal Medicine 

Lipshutz  Robert  DO  Internal Medicine 

Novotny  Gregory  DO  Internal Medicine 

Paradela Ephrem Hector  MD  Internal Medicine 

Patel  Arvind  MD  Internal Medicine 

Patel  Neha  MD  Internal Medicine 

Pickart  Anhthu  PAC  Family Practice 

Page 15: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 15 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Rosenthal  Leslie  MD  Internal Medicine 

Sciullo  Brittany  APN  Family Practice 

Slotoroff  Jon  DO  Internal Medicine 

Twardzik  Jennifer  DO  Internal Medicine 

APG Internal Medicine Galloway South  Ciallella  Gina  APN  Internal Medicine 

Ganzon‐Zampino  Gilda  MD  Internal Medicine 

Kim  Duk Hee  MD  Internal Medicine 

Kirchner  Brian  MD  Internal Medicine 

APG Manahawkin  Slaven  Timothy  DO  Cardiology 

APG Multi‐Specialty  Anderson  Kurt  APN  Bariatric Surgery 

Attiya  Rafael  MD  General Surgery 

Bazylewicz  Stephanie  PAC  Bariatric Surgery 

Carone  Nicole  PAC  General Surgery 

Corbitt  Rachelle  APN  Neurology 

Corcoran  Matthew  MD  Endocrinology 

Domer  Gregory  MD  Vascular Surgery 

Fancher  Tiffany  MD  Colon and Rectal Surgery 

Gallagher  Denyse  APN  Endocrinology 

Gandhi  Shefali  DO  Neurology 

Hunter  Kevin  MD  Neurology 

Korya  Dani  MD  Neurology 

Mazauskas  Janet  APN  Internal Medicine 

Onopchenko  Alexander  MD  Bariatric Surgery 

Panait  Lucian  MD  Bariatric Surgery 

Patel  Samir  MD  Bariatric Surgery 

Shah  Taral  MD  Endocrinology 

Sykes  Mariah  PAC  Bariatric Surgery 

Szpiech  Maria  MD  Endocrinology 

Tahmoush  Albert  MD  Neurology 

Wilson  Margaret Jo  APN  Endocrinology 

Zeidwerg  David  DO  Neurology 

APG OB/GYN  Armitage  Susan  CNM  Obstetrics & Gynecology 

Bergen  Blair  MD  Obstetrics & Gynecology 

Bridges  Yvette  MD  Obstetrics & Gynecology 

Page 16: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 16 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Ciceron  Asuncion  MD  Obstetrics & Gynecology 

Dadura  Jeanne  CNM  Obstetrics & Gynecology 

George‐Cook  Shirley  CNM  Obstetrics & Gynecology 

Guzman  Suheil  CNM  Obstetrics & Gynecology 

Milov  Seva  MD  Obstetrics & Gynecology 

Perez  Jasmine  CNM  Obstetrics & Gynecology 

Pieri  Danielle  DO  Obstetrics & Gynecology 

Riley‐Spoltore  Ann  CNM  Obstetrics & Gynecology 

Scaffidi  Rose  CNM  Obstetrics & Gynecology 

Silk  Maanasi  DO  Obstetrics & Gynecology 

Smart  Claire  CNM  Obstetrics & Gynecology 

Sosa  Jamie  CNM  Obstetrics & Gynecology 

Toidze  Tamara  MD  Urogynecology 

Wesley  Louis  MD  Obstetrics & Gynecology 

White  Tarika  CNM  Obstetrics & Gynecology 

APG Pathology  Dantas  Bruno  MD  Pathology 

Miller  Nicole  DO  Pathology 

Ren  Zhiyong  MD, PhD  Pathology 

Todd  William  MD  Pathology 

APG Rheumatology  Haija  Anan  MD  Rheumatology 

APG Surgical Associates  Kassis  Kamal  MD  Vascular Surgery 

APG Surgical Associates ENT  Kenner  George  MD  Otolaryngology 

Morrison  Daniel  MD  Otolaryngology 

APG Trauma  Ali  Ayoola  MD  Trauma Surgery 

Burns  Richard  MD  Trauma Surgery 

DeAngelo  Frank  MD  Trauma Surgery 

Donovan  Linda  APN  Trauma Surgery 

Dudick  Catherine  MD  Trauma Surgery 

Eakins  James  MD  Trauma Surgery 

Kerstetter  Kathleen  APN  Trauma Surgery 

McNulty  Kathleen  APN  Trauma Surgery 

Prol  Andrew  PAC  Trauma Surgery 

Talucci  Raymond  MD  Trauma Surgery 

Thompson  Peter  MD  Trauma Surgery 

Page 17: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 17 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Willman  Kelly  MD  Trauma Surgery 

Yakopcic  Erin  APN  Trauma Surgery 

Associates in Podiatric Medicine & Surgery, PC  Iezzi  Alfred  DPM  Podiatric Surgery 

Twardzik  Mark  DPM  Podiatric Surgery 

Atlantic Allergy and Asthma Center, PA  Schwartz  Lawrence  DO  Allergy 

Atlantic Cape OB/GYN  Morgan  Daniel  MD  Obstetrics & Gynecology 

Sindoni  Frank  MD  Obstetrics & Gynecology 

Atlantic Cardiology  Chavan  Courtney  APN  Cardiology 

Dib  Haitham  MD  Cardiology 

Flynn  Anthony  MD  Cardiology 

Nair  Nanda  DO  Cardiology 

Van Hook  Jeffrey  DO  Cardiology 

Walker  Tracy  MD  Cardiology 

Atlantic Coast Orthopedics LLC  Cristini  John  MD  Orthopaedic Surgery 

Atlantic Emergency Associates  Acunto  Brian  DO  Emergency Medicine 

Andrews  Mary  APN  Emergency Medicine 

Aversa  Eileen  APN  Emergency Medicine 

Becher  John  DO  Emergency Medicine 

Brabson  Thomas  DO  Emergency Medicine 

Campo  Theresa  APN  Emergency Medicine 

Contino  Christopher  APN  Emergency Medicine 

Cusella  Joseph  APN  Emergency Medicine 

Dombchewsky  Orest  MD  Emergency Medicine 

Dubin  Reva  MD  Emergency Medicine 

Dyce  Michael  MD  Emergency Medicine 

Ellis  Daniel  MD  Emergency Medicine 

Farnsworth  Marie  MD  Emergency Medicine 

Feld  Ross  DO  Emergency Medicine 

Ferrer  Darlene  APN  Emergency Medicine 

Greenfield  Brett  DO  Emergency Medicine 

Guerrieri  Ave Maria  APN  Emergency Medicine 

Guerrieri  EvaMarie  DO  Emergency Medicine 

Hudson  Valerie  APN  Emergency Medicine 

Keogh  John  MD  Emergency Medicine 

Page 18: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 18 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Khebzou  Zaki  MD  Emergency Medicine 

Lenz  Denise  APN  Orthopaedic Surgery 

Licata  Thomas  DO  Emergency Medicine 

Ludan  Lia  APN  Emergency Medicine 

Luyber  Todd  DO  Emergency Medicine 

MacBride  David  DO  Emergency Medicine 

Merz  Daniel  DO  Emergency Medicine 

Peterson  Casey  APN  Emergency Medicine 

Pinkerton  Gerald  DO  Emergency Medicine 

Roger  Scott  DO  Emergency Medicine 

Sabatini  Louis  DO  Emergency Medicine 

Salvatore, Jr.  Francis  MD  Emergency Medicine 

Scheets  Kristen  DO  Emergency Medicine 

Seibert  H. Edward  MD  Emergency Medicine 

Toffoli  Kelley  APN  Emergency Medicine 

Tolova  Vera  MD  Emergency Medicine 

Tomasino  Garrett  DO  Emergency Medicine 

Torres‐Cruz  Joshua  MD  Emergency Medicine 

Trager  Mathaus  APN  Emergency Medicine 

Urban  Scott  DO  Emergency Medicine 

Westrol  Michael  MD  Emergency Medicine 

Wolk  Eric  DO  Emergency Medicine 

Atlantic Foot & Ankle Care, P.C.  Hall  David  DPM  Podiatric Surgery 

Reilly  Jeannette  DPM  Podiatric Surgery 

Atlantic Gastroenterology Associates, PA  Bartholomew  John  APN  Gastroenterology 

Kaufman  Barry  MD  Gastroenterology 

Keklak  Peter  PAC  Gastroenterology 

Mehta  Nikhilesh  MD  Gastroenterology 

Randolph  Judith  APN  Gastroenterology 

Rosman  Gary  MD  Gastroenterology 

Santoro  John  DO  Gastroenterology 

Spaar  Joseph  MD  Gastroenterology 

Verrengia  Melissa  MD  Gastroenterology 

Atlantic Heart Rhythm Center  Ghaly  Nader  MD  Cardiology 

Page 19: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 19 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

White  Melvin  MD  Cardiology 

Atlantic Medical Imaging, LLC  Altin  Robert  MD  Diagnostic Imaging 

Austin  Amy  MD  Diagnostic Imaging 

Avagliano  Margaret  MD  Diagnostic Imaging 

Begleiter  David  MD  Diagnostic Imaging 

Brezel  Mitchell  MD  Diagnostic Imaging 

Cummings  Allan  MD  Diagnostic Imaging 

Falciani  Amerigo  DO  Diagnostic Imaging 

Ferretti  James  DO  Diagnostic Imaging 

Friedman  Alan  MD  Diagnostic Imaging 

Gerhardt  William  MD  Diagnostic Imaging 

Glassberg  Robert  MD  Diagnostic Imaging 

Glick  Craig  MD  Diagnostic Imaging 

Graule  Melissa  MD  Diagnostic Imaging 

Graziano  Robert  MD  Diagnostic Imaging 

Gualtieri  Louis  DO  Diagnostic Imaging 

Ibrahim  Nancy  MD  Diagnostic Imaging 

Kaplan  Sheldon  MD  Diagnostic Imaging 

Kenny  David  DO  Diagnostic Imaging 

Koven  Marshall  MD  Diagnostic Imaging 

Lee  Jacob  MD  Diagnostic Imaging 

Levi  David  MD  Diagnostic Imaging 

McManus  Stephen  MD  Diagnostic Imaging 

Menghetti  Richard  MD  Diagnostic Imaging 

Mesham  James  MD  Diagnostic Imaging 

O'Laughlin  Richard  MD  Diagnostic Imaging 

Pack  Jonathan  MD  Diagnostic Imaging 

Patel  Hiren  MD  Diagnostic Imaging 

Patel  Rajesh  MD  Diagnostic Imaging 

Petruzzi  Nicholas  MD  Diagnostic Imaging 

Saad  Sherif  MD  Diagnostic Imaging 

Schmidling  Michael  MD  Diagnostic Imaging 

Shah  Ankur  MD  Diagnostic Imaging 

Shakarshy  Jack  MD  Diagnostic Imaging 

Page 20: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 20 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Simpson  Alan  MD  Diagnostic Imaging 

Tiger  Eric  MD  Diagnostic Imaging 

Tran  Thomas  MD  Diagnostic Imaging 

Vu  Hung  MD  Diagnostic Imaging 

Atlantic Off Shore Medical Associates  Kern  Carrie  DO  Family Practice 

Ricciardi  Leah  APN  Internal Medicine 

Soucier  Ronald  DO  Internal Medicine 

Atlantic Oral & Maxillofacial Associates  Jungels  Bradford  DMD  Oral and Maxillofacial Surgery 

Atlantic Primary Care  Dasondi  Vivekkumar  MD  Internal Medicine 

Sloyan  Claire  APN  Internal Medicine 

Atlantic Pulmonary  Griswold  Karen  APN  Pulmonary 

Higgins  Nancy  MD  Pulmonary Disease 

Atlantic Pulmonary & Critical Care Assoc.  Bansal  Aditya  MD  Pulmonary Disease 

Costantini  Peter  DO  Pulmonary Disease 

Loftus  Frances  DO  Pulmonary Disease 

Sadik  Nadia  MD  Pulmonary Disease 

Sivaraman  Sivashankar  MD  Pulmonary Disease 

Atlantic Shore Orthopedic Associates, LLC  Harhay  Joseph  MD  Orthopaedic Surgery 

Atlantic Surgical Assistants, LLC  Calimer  Pamela  CRNFA  General Surgery 

AtlantiCare Health Engagement  McGettigan  Suzanne  APN  Internal Medicine 

AtlantiCare HealthCare at Home  Sudol  Nancy  APN  Infectious Diseases 

AtlantiCare Occupational Medicine  Bisk  Bradley  DO  Family Practice 

Scharf  Christine  APN  Family Practice 

Schulman  Jared  MD  Occupational Medicine 

AtlantiCare Urgent Care Center  Altamura  Richard  MD  Emergency Medicine 

Armbruster  Thomas  MD  Family Practice 

Ballentine  Laurel  APN  Emergency Medicine 

Barnett  Jordan  MD  Emergency Medicine 

Barrett  Bryan  DO  Family Practice 

Belle  Susan  APN  Emergency Medicine 

Bridge‐Jackson  Teresa  MD  Family Practice 

Carroll  Elizabeth  DO  Family Practice 

Cascarino  Raymond  DO  Emergency Medicine 

Champion  Anthony  PAC  Physician Assistant 

Page 21: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 21 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Chen  Chih‐Lung  MD  Emergency Medicine 

Chugh  Rajinder  MD  Internal Medicine 

Cimino  Robert  MD  Emergency Medicine 

Coletta  Domenic  MD  Emergency Medicine 

Cutler  Marna  DO  Family Practice 

DeTata  Gerald  MD  Family Practice 

Donaldson  James  DO  Emergency Medicine 

Fog  Edward  DO  Emergency Medicine 

Freas  Glenn  MD  Emergency Medicine 

Gaffney  John  DO  Family Practice 

Hill  Adam  APN  Urgent Care 

Hinchliffe  Susan  DO  Emergency Medicine 

Holtzin  Robert  DO  Family Practice 

Husted  Evan  MD  Emergency Medicine 

Khatiwala  Manisha  MD  Emergency Medicine 

Malta  Raymond  DO  Emergency Medicine 

Mastrokyriakos  Paul  DO  Emergency Medicine 

McNulty  Robert  DO  Emergency Medicine 

Menet  Scott  DO  Emergency Medicine 

Merewitz  Glenn  MD  Emergency Medicine 

Morone  Teresa  DO  Urgent Care 

Morris  Christie  PAC  Emergency Medicine 

Morros  Jay  MD  Emergency Medicine 

Najafi  Nawid  MD  Family Practice 

Nicholls  Brian  DO  Emergency Medicine 

Nicholls  Victoria  PAC  Urgent Care 

Nussey Jr  Richard  DO  Emergency Medicine 

Patel  Ronak  PAC  Physician Assistant 

Pecora  Arthur  DO  Emergency Medicine 

Pepe  Salvatore  MD  Emergency Medicine 

Piarulli  Michael  MD  Internal Medicine 

Riguerra  Rosalia  MD  Urgent Care 

Rodino  Theresa  APN  Urgent Care 

Roncone  Ashley  PAC  Emergency Medicine 

Page 22: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 22 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Ruskey  John  DO  Emergency Medicine 

Schumacher  William  DO  Urgent Care 

Siekierka  John  DO  Urgent Care 

Simonian  Hasmik  MD  Emergency Medicine 

Siwinski  Denise  MD  Family Practice 

Stegmuller  Joseph  DO  Family Practice 

Stone  Mark  DO  Emergency Medicine 

Terrels  Mary Ellen  DO  Family Practice 

Urquhart  Megan  DO  Urgent Care 

AtlantiCare Regional Medical Center (ARMC)  Gerth  David  MD  Otolaryngology 

Koshkareva  Yekaterina  MD  Otolaryngology 

Foxx  Roseanne  APN  Pulmonary Disease 

Smith  Rebecca  APN  Critical Care 

Myers  Renee  RNFA  Orthopaedic Surgery 

Viswambharan  Ajay  MD  Diagnostic Imaging 

AtlantiCare Regional Medical Center, Cardiac Diagnostics  Estrada  Colette  APN  Cardiology 

Mutchko  Dawn  APN  Cardiology 

Sales  Emelita  APN  Cardiology 

Countouris  Deborah  APN  Cardiology 

Bacharach Rehabilitation Medicine  Alfaro  Abraham  DO 

Physical Medicine and Rehabilitation 

Anmuth  Craig  DO 

Physical Medicine and Rehabilitation 

Berlin  Ross  MD 

Physical Medicine and Rehabilitation 

Enterlante  Teresa  APN 

Physical Medicine and Rehabilitation 

Jansson  Joy  PAC  Infectious Diseases 

Sturr  Marianne  DO 

Physical Medicine and Rehabilitation 

Weber  Cheryl  APN 

Physical Medicine and Rehabilitation 

Xu  Wei  MD 

Physical Medicine and Rehabilitation 

Page 23: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 23 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Bharat Jhaveri MD  Jhaveri  Bharat  MD  Pathology 

Birendra N Tandan  MD LLC  Tandan  Birendra  MD  Urology 

Boardwalk Surgical Associates, PA  Previti  Francis  MD  General Surgery 

Brigantine  Eye Care Center, PC  DiMarco  Eugene  DO  Ophthalmology 

Brighton Pediatrics  Kessler  Barry  MD  Pediatrics 

Buena Family Practice Center  Hargrave  Douglas  DO  Family Practice 

Peterson, III  Paul  DO  Internal Medicine 

Pirolli  John  DO  Family Practice 

Cape Atlantic Internal Medicine  Pieretti  Gordon  DO  Internal Medicine 

Wilson  Donna  DO  Internal Medicine 

Cape Heart Clinic  Nanavati  Suketu  MD  Cardiology 

Spielman  Charles  MD  Cardiology 

Cape Regional Physicians Associates  Drake  Andrew  DO  Internal Medicine 

Cedar Brook Family Practice  Goudsward  Sean  DO  Family Practice 

Central Jersey Plastic Surgery,Stephen A. Chidyllo  Chidyllo  Stephen  MD  Plastic and Reconstructive Surgery 

Charles Meusburger, MD  Meusburger  Charles  MD  Psychiatry 

E. Charles Velnosky, PhD  Velnosky  E. Charles  PhD  Psychology 

Children's Hospital Of Philadelphia  Vatsky  Seth  DO  Telemedicine 

Chona Santos‐Miranda, MD, PA  Miranda  Chona  MD  Family Practice 

CHOP Care Network at AtlantiCare  Grayson  Stephanie  MD  Pediatrics 

CHOP Care Networks‐ Harborview Pediatrics  Bross  George  DO,FACP  Pediatrics 

Deliz  Yasmin  DO  Pediatrics 

Drexler  Christopher  DO  Pediatrics 

Held  Sharon  DO  Pediatrics 

Keenan  Christopher  DO  Pediatrics 

Share  Lisa  MD  Pediatrics 

Thorp  Andrea  DO  Pediatrics 

Vekteris  Gerald  DO  Pediatrics 

CHOP/AtlantiCare Neonatal Intensive Care Unit  Asiegbu  Benedict  MD  Neonatology 

Celestial  Rommel  MD  Neonatology 

Mehta  Taral  MD  Neonatology 

Muhumuza  Catherine  MD  Neonatology 

Myers  Catherine  MD  Neonatology 

Tioseco  Jennifer  MD  Neonatology 

Page 24: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 24 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Villasis  Cynthia  MD  Neonatology 

CHOP/AtlantiCare Pediatric Hospitalists  Bochenski  Jacek  MD  Pediatrics 

Concha Leon  Alonso  MD  Pediatrics 

Dias  Magna  MD  Pediatrics 

Grewal  Kamaldeep  MD  Pediatrics 

Hendricks  Elizabeth  APN  Pediatrics 

Krauss  Joel  MD  Pediatrics 

Mah  Sue  MD  Pediatrics 

Mallari  Rolando  MD  Pediatrics 

Mogavero Theoret  Jeannine  MD  Pediatrics 

Ritson  Brenda  MD  Pediatrics 

Zamel  Yaacov  MD  Pediatrics 

Christine Gasperetti, MD  Gasperetti  Christine  MD  Cardiology 

Coastal Infectious Disease Consultants  Tridente  Rachael  APN  Infectious Diseases 

Trivedi  Manish  MD  Infectious Diseases 

Coastal OB/GYN Associates, PA  Sung  Edward  MD  Obstetrics & Gynecology 

Coastal Oral & Maxillofacial Surgeons, PA  Preziosi  Benaifer  DMD  Oral and Maxillofacial Surgery 

Coastal Physicians & Surgeons, PA  Gottfried  Maureen  DO  Neurology 

Cooper Maternal‐Fetal Medicine  Cardonick  Elyce  MD  Maternal Fetal Medicine 

Dinh  Tuan  MD  Maternal Fetal Medicine 

Fischer  Richard  MD  Maternal Fetal Medicine 

Khandelwal  Meena  MD  Maternal Fetal Medicine 

Perry  Robin  MD  Maternal Fetal Medicine 

Timms  Diane  DO  Maternal Fetal Medicine 

Westover  Thomas  MD  Maternal Fetal Medicine 

Cooper Perinatology Associates  Modena  Alisa  MD  Maternal Fetal Medicine 

David J. Smith, M.D., P.A.  Dunn  Eric  MD  Ophthalmology 

Smith  David  MD  Ophthalmology 

David L. Sykes, DMD Oral & Maxillofacial Surgeon  Sykes  David  DMD  Oral and Maxillofacial Surgery 

Delaware Hospice  Altamuro  Christopher  DO  Family Practice 

Devineni R. Prasad, M.D., PA  Prasad  Devineni  MD  Pediatrics 

Diego Fiorentino DO  Fiorentino  Diego  DO  Internal Medicine 

Dr. John W. Welsh, F.A.A.P.  Welsh  John  DO  Pediatrics 

Eagle Hospital Physicians  Chang  Ira  MD  Neurology 

Page 25: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 25 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Miller  Chad  MD  Neurology 

Renda  Natalie  MD  Neurology 

Sheth  Kevin  MD  Neurology 

Tilwalli  Shilpa  MD  Neurology 

Wagner  Jeffrey  MD  Neurology 

East Coast Orthopedics & Sports Medicine  Weiand  Raymond  DO  Orthopaedic Surgery 

Elena V. Selina, M.D.  Selina  Elena  MD  Internal Medicine 

Eugene C. Carroccia, M.D., P.A.  Carroccia  Eugene  MD  Plastic and Reconstructive Surgery 

Feldman‐Rayfield Cosmetic Surgery, PA  Feldman  Marc  MD  Plastic and Reconstructive Surgery 

Rayfield  David  MD  Plastic and Reconstructive Surgery 

Rayfield  Rachael  PAC  Plastic and Reconstructive Surgery 

Fernando Delasotta, MD, FACS  Delasotta  Fernando  MD  Neurosurgery 

Scibilia  Marisa  APN  Neurosurgery 

FirstCare LLC  Nanfara  Marcantonio  MD  Internal Medicine 

Luzzi  Angelo  DPM  Podiatric Surgery 

Foot and Ankle Center of South Jersey  Welch  Michael  DPM  Podiatric Surgery 

Fox Chase Cancer Center  Gandhi  Vijaykumar  MD  Hematology and Oncology 

Galloway Pediatrics, LLC  Lopez Bernard  Edwin  MD  Pediatrics 

Gary S. Hymes, DPM, PA  Hymes  Gary  DPM  Podiatric Surgery 

George J. Halko, DO FACP, FACR  Halko  George  DO  Rheumatology 

GFH. Surgical Associates  D'Angelo‐Donovan  Desiree  DO  General Surgery 

Feinberg  Gary  MD  General Surgery 

Galler  Leonard  MD  General Surgery 

Herrington  James  MD  General Surgery 

Global Neurosciences Institute  Strenger  Scott  MD  Neurosurgery 

Gordon Callender, MD  Callender  Gordon  MD  General Surgery 

Hamilton Pediatrics, PA  Goldman  Stuart  MD  Pediatrics 

Harbor Family Medicine  Richwine  Charles  DO  Family Practice 

Richwine  Lori  DO  Family Practice 

Health Med Associates PC  Stern  Marcel  MD  Internal Medicine 

Homayoun Homayouni  MD  Homayouni  Homayoun  MD  Infectious Diseases 

Hope Community Cancer Center  Ahmad  Kaleem  MD  Hematology and Oncology 

Childs  Julianne  DO  Hematology and Oncology 

Dave  Hemang  MD  Hematology and Oncology 

Page 26: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 26 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Rizvi  Muhammad  MD  Hematology and Oncology 

Horizon Eye Care, PA  Gross  Howard  MD  Ophthalmology 

Pritz  Nicole  MD  Ophthalmology 

Independent Surgical First Assist of NJ  Pinkham  Clint  CRNFA  Thoracic Surgery 

Infections Limited East., PC  Papastamelos  Athanasios  DO  Infectious Diseases 

Infectious Disease Specialist, Inc  Marchesani  Diane  DO  Infectious Diseases 

Paparone  Pamela  APN  Infectious Diseases 

Paparone  Philip  DO  Infectious Diseases 

IPC Health Care  Hahn  Robert  DO 

Physical Medicine and Rehabilitation 

Ira M Trocki MD PA  Trocki  Ira  MD  Plastic and Reconstructive Surgery 

Island Medical Associates  Kuponiyi  Olatunji  MD  Internal Medicine 

Mendoza  Maureen  APN  Internal Medicine 

Jeffrey Gong, DO  Gong  Jeffrey  DO  Internal Medicine 

Jersey Shore Gastroenterology Assoc  Beswick  Maureen  APN  Gastroenterology 

Bucsek  Deborah  APN  Gastroenterology 

Deshpande  Nikhil  MD  Gastroenterology 

Genova  Judith  APN  Gastroenterology 

Jalaj  Sujai  MD  Gastroenterology 

Krachman  Joel  DO  Gastroenterology 

Krachman  Michael  MD  Gastroenterology 

Kropilak  Tricia  APN  Gastroenterology 

Nelson  Carolyn  APN  Gastroenterology 

Ognibene  Lawrence  DO  Gastroenterology 

O'Neil  Sarah  APN  Gastroenterology 

Jersey Shore Gastroenterology Associates, PA  Ljubich  Paul  MD  Gastroenterology 

Schwab  Kenneth  MD  Gastroenterology 

Jersey Shore Sports Medicine  Sokalsky  Brian  DO  Family Practice 

Jersey Urology Group  Hirsh  Andrew  MD  Urology 

Lehrfeld  Todd  MD  Urology 

McKinney  Megan  PAC  Urology 

Miller  Charles  PAC  Urology 

Nosseir  Sandy  MD 

Female Pelvic Medicine & Reconstruc 

Page 27: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 27 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Perry  Meredith  DO  Urology 

Piskun  Michael  MD  Urology 

Schutz  Michael  MD  Urology 

Spence  Abraham  MD  Urology 

Steixner  Brian  MD  Urology 

Wren  Francis  MD  Urology 

Jodi Abramowitz, D.O., PA  Abramowitz  Jodi  DO  Internal Medicine 

John C Baker MD LLC  Baker  John  MD  Orthopaedic Surgery 

John F Kasper DO PA  Kasper  John  DO  Internal Medicine 

Kenneth A Leight PhD  Leight  Kenneth  PhD  Psychology 

Kenneth Kunzman, MD  Kunzman  Kenneth  MD  Otolaryngology 

Ladies Choice OB/GYN  Biswas  Linda  CNM  Obstetrics & Gynecology 

Bredin  Sherilyn  MD  Obstetrics & Gynecology 

Spurlock  Monica  CNM  Obstetrics & Gynecology 

Larry Kaufman, MD, LLC  Kaufman  Larry  MD  Obstetrics & Gynecology 

Lawrence Naame  Naame  Lawrence  MD  Orthopaedic Surgery 

Lourdes Cardiology Services, PC  Akula  Devender  MD  Cardiology 

Khaw  Kenneth  MD  Cardiology 

Saia  John  DO  Cardiology 

Sandler  Matthew  MD  Cardiology 

Sholevar  Darius  MD  Cardiology 

Thirunahari  Nandan  MD  Cardiology 

Ukrainski  Gerald  MD  Cardiology 

Wroblewski  Edward  MD  Cardiology 

Zheng  Jing  MD, PhD  Cardiology 

Lourdes Medical Associates  ElGenaidi  Hisham  MD  Internal Medicine 

Lowe‐Greenwood Zerbo Spinal Associates  Dignazio  Nicholas  PAC  Orthopaedic Surgery 

Greenwood  Henry  MD  Neurosurgery 

Lowe  James  MD  Spine Surgery 

Zerbo  Joseph  DO  Orthopaedic Surgery 

Manahawkin Urgent Care  Cafaro  Dana  PAC  Emergency Medicine 

Maria Chiara Carta, MD,PA Integrated Neurological Care  Carta  Maria  MD  Neurology 

Mark Menaquale DPM  Menaquale  Mark  DPM  Podiatric Surgery 

Page 28: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 28 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Mark Pernice DO PA  Pernice  Mark  DO  Family Practice 

Marvin R. Hyett, M.D., PA  Hyett  Marvin  MD  Gynecology 

Mays Landing Foot & Ankle Center  Boxman  Charles  DPM  Podiatric Surgery 

MD Anderson Cooper GYN Oncology  Crisp  Meredith  MD  Gynecologic Oncology 

Med 4 Kids, P.A.  Andrews  Roji  MD  Pediatrics 

MedAmerica Group, LLC  Alexander  Mark  MD  Internal Medicine 

MedCom Health Services PA  Ahmed  Sujood  MD  Cardiology 

Jackson  Julianne  PAC  Cardiology 

Rajput  Ilyas  MD  Cardiology 

Rajput  Zubeda  MD  Internal Medicine 

Zantua  Rose  APN  Cardiology 

Medcorps Asthma and Pulmonary Specialists  Silvey  Allen  DO  Pulmonary Disease 

Medical One Multi Specialties PA  Dunn  Michael  MD  Internal Medicine 

Glasser  Barry  MD  Internal Medicine 

Michael Falcone MD, LLC  Falcone  Michael  MD 

Physical Medicine and Rehabilitation 

Minimally Invasive Surgeons of South Jersey, LLC  Del Rosario  Michael MD, FACS, FASCRS  Colon and Rectal Surgery 

Mission Health Care  Bishop  Robert  APN  Psychiatry 

Griffith  Nediya  APN  Internal Medicine 

Nasser Borai, MD, PA  Borai  Nasser  MD  Oncology 

Nazha Cancer Center  Nazha  Naim  MD  Oncology 

Stoyko  Zoryana  MD  Hematology and Oncology 

Wang  Le  MD  Oncology 

Neurology Institute of South Jersey  Boxman  Jeffrey  DO  Neurology 

New Jersey Health Network LLC  Brown  Anjeanette  MD  Breast Surgery/Disease 

Cassir  Jorge  MD  Radiation Oncology 

Kulkarni  Nandini  MD  Surgery 

Wilson  Vasthi  MD  Radiation/Oncology 

Wurzer  James  MD, PhD  Radiation Oncology 

Nik Parikh, MD, PA  Parikh  Nikhil  MD  Internal Medicine 

Niranjan G. Trivedi MD  Trivedi  Niranjan  MD  Cardiology 

Nisrin Q. Dahodwala, MD, PC  Dahodwala  Nisrin  MD  Pediatrics 

Ocean Internal Medicine Associates, PA  Infantolino  Edward  MD  Internal Medicine 

Page 29: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 29 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

PACE Orthopedics and Sports Medicine  Anapolle  David  MD  Orthopaedic Surgery 

Pagnani‐Braga‐Kimmel Urologic Associates PA  Braga  Gene  MD  Urology 

Kimmel  Barry  MD  Urology 

Pagnani  Alexander  MD  Urology 

Paras C. Udani, DO  Udani  Paras  DO  Infectious Diseases 

Pediatric Associates of Atlantic County, PA  Budnick  Glenn  MD  Pediatrics 

Pediatric Pulmonary and Asthma Associates of South Jersey LLC  Leong  Mila  MD  Pediatric Pulmonary 

Salvia Jr.  Joseph  DO  Pediatric Pulmonary 

Penn Cardiology  Chang  Gene  MD  Cardiology 

Fenning  Robert  MD  Cardiology 

Khandhar  Sameer  MD  Cardiology 

Li  Robert  MD  Cardiology 

Matthai  William  MD  Cardiology 

Moak  Alan  MD  Cardiology 

Penn Cardiology Somers Point  Stone  Cheryl  APN  Cardiology 

Zitzer  Eileen  APN  Cardiology 

Point Medical  Hierholzer  Paul  DO  Internal Medicine 

Ulrich  Kathleen  APN  Internal Medicine 

Premier Infectious Disease Care  Kaur  Amrita  DO  Infectious Diseases 

Premier Oncology LLC  Ajay  Rajasree  MD  Hematology and Oncology 

Presbyterian Medical Center  Frankil  Craig  DO  Cardiology 

Professional Pain Management Associates PA  Corda  Peter  DO  Pain Medicine 

Perkins  Vannette  MD  Pain Medicine 

Polcer  Jeffrey  DO  Pain Medicine 

Psych Intervention Program  Isaacson  Brian  MD  Psychiatry 

Panah  Daud  MD  Psychiatry 

Smith  Lizbeth  APN  Psychiatry 

Quality Care Pediatrics LLC  Molina  Maria  MD  Pediatrics 

Quality Eye Associates  Huang  Jun (Jim)  MD  Ophthalmology 

Quality Medical Associates  Maio  Sun  MD  Internal Medicine 

Rainbow Pediatrics PC  Bherwani  Poonam  MD  Pediatrics 

Dierkes  Thomas  DO  Pediatrics 

Dragos  Simona  MD  Pediatrics 

Page 30: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 30 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Flick  Jeffrey  DO  Pediatrics 

Freund  William  DO  Pediatrics 

McGrath  Teresa  DO  Pediatrics 

Petrucci  James  DO  Pediatrics 

Rainbow Pediatrics, PC  Cavaliere  Ava  DO  Pediatrics 

Mathur  Ajit  MD  Pediatrics 

Ramamurthi  Iyer  MD  Iyer  Ramamurthi  MD  Endocrinology / Metabolism 

Ramchand Thadhani, MD  Bedsole  William  APN 

Physical Medicine and Rehabilitation 

Thadhani  Ramchand  MD  Family Practice 

Regional Internal Medicine Associates PC  Choudhry  Rafat  MD  Internal Medicine 

Regional Nephrology Associates, PA  Behl  Nitin  MD  Internal Medicine 

Blecker  David  MD  Nephrology 

Bonner  Jessica  APN  Nephrology 

Mathews  Robert  MD  Nephrology 

Nnewihe  Charles  MD  Nephrology 

Pandya  Melind  DO  Nephrology 

Schaefer  Lynn  APN  Nephrology 

Schreyer  Raymond  MD  Nephrology 

Shastri  Jay  DO  Nephrology 

Thakkar  Priyesh  DO  Nephrology 

Regional Pain Care PC  Qadir  Abdul  MD  Pain Medicine 

Regional Women's Health Group LLC  Bravoco  Michael  MD  Gynecology 

Reliance Medical Group  Alcarez  Catherine  MD  Internal Medicine 

Alfaro  Rosario  APN  Internal Medicine 

Baumgartel  Jenna  PAC  Family Practice 

Dearden  Albert  MD  Pediatrics 

Lurakis  Michael  DO  Internal Medicine 

Nnewihe  Adebola  MD  Obstetrics & Gynecology 

Parlett  Deborah  APN  Internal Medicine 

Petit  Anne  MD  Obstetrics & Gynecology 

Solari  Tina Marie  APN  Pediatrics 

Reliance Medical Group, LLC  Cruz  Avelino  MD  Nephrology 

Lunt  David  MD  Family Practice 

Page 31: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 31 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Retinal & Ophthalmic Consultants, PC  Foxman  Brett  MD  Ophthalmology 

Foxman  Scott  MD  Ophthalmology 

Margolis  Thomas  MD  Ophthalmology 

Thakker  Manoj  MD  Ophthalmology 

Ricardo Barzaga  Barzaga  Ricardo  MD  Infectious Diseases 

Ricardo Oasin MD  Oasin  Ricardo  MD  Psychiatry 

Rita Kammiel, MD & Associates  Kammiel  Rita  MD  Psychiatry 

Robert Chorney PsyD, LLC  Chorney  Robert  PsyD  Psychology 

Robert M. Goldberg, MD, PA  Goldberg  Robert  MD  Hematology and Oncology 

Rothman Institute  Mammano  Joseph  PAC  Orthopaedic Surgery 

Rothman Institute of New Jersey  Adams  Christopher  PAC  Orthopaedic Surgery 

Anderson  David  MD  Orthopaedic Surgery 

Armstrong  Joshua  DO 

Physical Medicine and Rehabilitation 

Austin  Luke  MD  Orthopaedic Surgery 

Bazylewicz  Daniel  MD  Orthopaedic Surgery 

Boyle  Peter  DO  Orthopedic Surgery 

Chhipa  Irfan  MD  Sports Medicine 

Falcon  Natacha  DO 

Physical Medicine and Rehabilitation 

Fiorentino  Diego  PAC  Orthopaedic Surgery 

Geary  Thomas  PAC  Orthopaedic Surgery 

Katz  David  PAC  Orthopaedic Surgery 

Krieg  James  MD  Orthopaedic Surgery 

Lapinski  Andrew  PAC  Orthopedic Surgery 

Leinberry  Charles  MD  Orthopaedic Surgery 

Luskin  Conor  PAC  Orthopaedic Surgery 

Lutsky  Kevin  MD  Orthopaedic Surgery 

Matzon  Jonas  MD  Orthopaedic Surgery 

McIntyre  Gabrielle  PAC  (blank) 

Mehnert  Michael  MD 

Physical Medicine and Rehabilitation 

Molter  Michael  DO 

Physical Medicine and Rehabilitation 

Page 32: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 32 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Nutini  Dennis  MD 

Physical Medicine and Rehabilitation 

Ong  Alvin  MD  Orthopaedic Surgery 

Orozco  Fabio  MD  Orthopaedic Surgery 

Patel  Mitesh  MD  Sports Medicine 

Pepe  Matthew  MD  Orthopaedic Surgery 

Pino  Alexis  PAC  Orthopaedic Surgery 

Post  Zachary  MD  Orthopaedic Surgery 

Radcliff  Kristen  MD  Orthopaedic Surgery 

Ramsi  Martin  PAC  Orthopedic Surgery 

Riotta  Paul  PAC  Orthopaedic Surgery 

Rivlin  Michael  MD  Orthopaedic Surgery 

Rothman  Richard  MD  Orthopaedic Surgery 

Rubenstein  Craig  MD  Sports Medicine 

Salibi  Jordan  PAC  Orthopaedic Surgery 

Schick  Faith  DPM  Podiatric Surgery 

Shelby  Kevin  PAC  Orthopaedic Surgery 

Tjoumakaris  Fotios  MD  Orthopaedic Surgery 

Tucker  Bradford  MD  Orthopaedic Surgery 

Winters  Brian  MD  Orthopaedic Surgery 

Woods  Barrett  MD  Orthopaedic Surgery 

Woods  Shailen  MD 

Physical Medicine and Rehabilitation 

Young  George  DO 

Physical Medicine and Rehabilitation 

Salartash Surgical Associates, LLC  Boyle  Melanie  DO  General Surgery 

Fry  Sarah  APN  General Surgery 

Robinson  Karima  APN  General Surgery 

Rohani  Pejman  DO  Vascular Surgery 

Salartash  Alimorad  MD  General Surgery 

Salartash  Khashayar  MD  General Surgery 

Schwenker  Laura  APN  General Surgery 

Scott D. Tzorfas, MD  Tzorfas  Scott  MD  Neurology 

Sentient  Garcia Lopez De  Elizabeth  MD  Telemedicine 

Page 33: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 33 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Victoria 

Hoffman  Stuart  DO  Neurology 

Micic  Vesna  MD  Neurology 

Rashidzada  Wahid  MD  Neurology 

Stauber  Ziva  MD  Neurology 

Shore Kidney & Hypertension Specialists  Shah  Chetan  DO  Nephrology 

Villarosa  Ma Pauleen  APN  Nephrology 

Shore Memorial Physicians Group  Rodriguez  Marlene  MD  Family Practice 

Shore Oral and Maxillofacial Surgery  Kalika  Boris  DMD  Oral and Maxillofacial Surgery 

Meyliker  Roman  DMD  Oral and Maxillofacial Surgery 

Shore Orthopaedic University Associates  Bagnato, III  Ralph  PA  Orthopaedic Surgery 

Dalzell  Frederick  MD  Orthopaedic Surgery 

DeMorat  Eugene  MD  Orthopaedic Surgery 

Fox  Ira  DPM  Podiatric Surgery 

Galego  Andrew  APN  Orthopaedic Surgery 

Krome  Charles  DO  Sports Medicine 

Marczyk  Stanley  MD  Orthopaedic Surgery 

Shore Physicians Group  Cilursu  Ana Maria  MD  Rheumatology 

Cunanan  Manuel  MD  Internal Medicine 

Del Re  Sallustio  MD  Pulmonary Disease 

Eckman Brown  Monica  PAC  Pulmonary Disease 

Geraci  Brian  MD  Internal Medicine 

Kralick  Francis  DO  Neurosurgery 

O'Connor  James  MD  Pulmonary Disease 

Yangala  Ravi  MD  Neurology 

Shore Surgical Assistant Services, LLC  Buck  Gary  CRNFA  Obstetrics & Gynecology 

SOCH Medical Group  Ng  Tommy  MD  Cardiology 

Soll Eye PC of NJ  Markovitz  Bruce  MD  Ophthalmology 

Soll  Stephen  MD  Ophthalmology 

Somers Manor OB/GYN Division of Regional Women's Health Group LLC  Korzeniowski  Philip  MD  Gynecology 

Rezvina  Natalia  MD  Gynecology 

Somers Medical Care, LLC  Michael  Wedad  MD  Internal Medicine 

South Jersey E.N.T. Surgical Associates LLC  Orquiza  Clodualdo  MD  Otolaryngology 

Page 34: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 34 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Siliunas  Vytas  DO  Otolaryngology 

Wagle  Priya  MD  Otolaryngology 

South Jersey Fertility Center  Kuzbari  Oumar  MD  Reproductive Endocrinology 

Packin  Gary  DO  Reproductive Endocrinology 

Sawin  Stephen  MD  Reproductive Endocrinology 

Skaf  Robert  MD  Reproductive Endocrinology 

Van Deerlin  Peter  MD  Reproductive Endocrinology 

South Jersey Gastroenterology  Tulman  Alan  MD  Gastroenterology 

South Jersey Infectious Disease, PA  Lucasti  Christopher  DO  Infectious Diseases 

South Jersey Pain Management  Cerniglia  Salvatore  DO  Anesthesiology 

South Jersey Pediatric Endocrinology  Chikezie  Augustine  MD  Pediatric Endocrinology 

South Jersey Pediatric Gastroenterology LLC  Tung  John  MD  Pediatric Gastroenterology 

Southern Jersey Family Medical Center  McFarlane  Owen  MD  Obstetrics & Gynecology 

Southern Jersey Family Medical Center, Inc.  Bejaran  Juan  MD  Internal Medicine 

Capiro  Rodney  MD  Obstetrics & Gynecology 

Collins  Gregory  MD  Internal Medicine 

Irvis  Kenneth  MD  Obstetrics & Gynecology 

Marfo  Victor  MD  Pediatrics 

Mullin  Eileen  CNM  Obstetrics/Gynecology (DNU) 

Yon  Katherine  MD  Pediatrics Southern Jersey Women & Children's   Health Pavilion  Palermo  Andrea  DO  Pediatrics 

Solomon‐Bergen  Peggy  MD  Pediatrics 

Southern Shores Eye Center, PA  Nguyen  Truc  MD  Ophthalmology 

Specialty Medconsultants LLC  Bursheh  Samar  MD  Endocrinology / Metabolism 

Daisey  Christine  APN  Endocrinology / Metabolism 

Naber  Tamim  MD  Nephrology 

Shahateet  Omar  MD  Nephrology 

Srisai Gowda MD  Gowda  Srisai  MD  Psychiatry 

St Francis Xavier, Aerospace Medicine  Penaloza Aranibar  Carlos  MD  General Surgery 

Stephen T. Dudick, MD  Dudick  Stephen  MD  Plastic and Reconstructive Surgery 

Sterling Surgicare  Adeyeri  Ayotunde  MD  General Surgery 

Stockton College Health Services  Hess  Linda  APN  Family Practice 

Page 35: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 35 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Stuart Sackstein, MD, PA  Sackstein  Stuart  MD  Gynecology 

Stuart W. Honick, DPM, PT, LLC.  Honick  Stuart  DPM  Podiatric Surgery 

Susan Sarkos, CRNFA  Sarkos  Susan  CRNFA  Orthopaedic Surgery 

Susan A. Senese, DO, PA  Senese  Susan  DO  Family Practice 

Tender Care Pediatrics  Gaynor  Lauren  APN  Pediatrics 

Mandalapu  Padma  MD  Pediatrics 

Mercedes‐Salas  Aixell  MD  Pediatrics 

The Cancer Center, P.C.  Cole  Robert  MD  Radiation Oncology 

The Children's Hospital of Philadelphia  Anupindi  Sudha  MD  Pediatric Radiology 

Back  Susan  MD  Pediatric Radiology 

Bellah  Richard  MD  Telemedicine 

Biko  David  MD  Pediatric Radiology 

Chauvin  Nancy  MD  Telemedicine 

Francavilla  Michael  MD  Telemedicine 

Ho‐Fung  Victor  MD  Telemedicine 

Johnson  Ann  MD  Telemedicine 

Kaplan  Summer  MD  Pediatric Radiology 

Khwaja  Asef  MD  Telemedicine 

Mahboubi  Soroosh  MD  Pediatric Radiology 

Markowitz  Richard  MD  Telemedicine 

Meyer  James  MD  Pediatric Radiology 

Nazario Malave  Maricarmen  MD  Telemedicine 

Oliver  Edward  MD  Telemedicine 

Pollock  Avrum  MD  Telemedicine 

Reid  Janet  MD  Telemedicine 

Saul  David  MD  Telemedicine 

Servaes  Sabah  MD  Telemedicine 

Srinivasan  Abhay  MD  Telemedicine 

States  Lisa  MD  Telemedicine 

Victoria  Teresa  MD  Telemedicine 

White  Ammie  MD  Telemedicine 

The Children's Hospital of Philadelphia, Neurology  DiGiovine  Marissa  MD  Pediatric Neurology 

Hopkins  Sarah  MD  Pediatric Neurology 

Page 36: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 36 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Ryan  Nicole  MD  Pediatric Neurology 

The Children's Hospital of Philadelphia, Specialty Care Center  Anderson  Terry  MD  Pediatric Cardiology 

Bhargava  Hema  MD  Pediatric Cardiology 

Dorfman  Aaron  MD  Pediatric Cardiology 

Lee  Hae‐Rhi  MD  Pediatric Cardiology 

Levinson  Katharine  MD  Pediatric Cardiology 

Sanchez  Guillermo  MD  Pediatric Cardiology 

The Neuropsychology Center LLC  Chelder  Mark  PhD  Psychology 

The Plastic Surgery Center  Abdollahi  Hamid  MD  Plastic and Reconstructive Surgery 

Chrisostomou  Michele  PAC  Plastic and Reconstructive Surgery 

Cuffs  Lindsey  PAC  Plastic and Reconstructive Surgery 

Duffy  Elizabeth  PAC  Plastic and Reconstructive Surgery 

Hering  Gina  PAC  Plastic and Reconstructive Surgery 

Kaufman  Matthew  MD  Plastic and Reconstructive Surgery 

Onisk  Alexandra  PAC  Plastic and Reconstructive Surgery 

Saad  Adam  MD  Plastic and Reconstructive Surgery 

Wimmers  Eric  MD  Plastic and Reconstructive Surgery 

The South Jersey Hand Center PC  Kane  Patrick  MD  Orthopedic Surgery 

Trilogy Pain Associates  Barbella  Joseph  DO  Pain Medicine 

University Cardiology  Aji  Janah  MD  Cardiology 

Ventnor Pediatrics Center LLC  Asemota  Emiola  MD  Pediatrics 

Patel  Krupa  PAC  Pediatrics 

Veterans Administration  Pericles  John  DO  Family Practice 

Vineland Gynecological Associates  Gewirtz  Jonathan  MD  Gynecology 

Virtua Atlantic Shore Family Practice  Silverman  Farrel  DO  Family Practice 

Virtua Surgical Group, P.A.  Andrew  Constantine  MD  Vascular Surgery 

Derivaux  Christopher  MD  Thoracic Surgery 

Field  Charles  MD  Vascular Surgery 

Kuchler  Joseph  MD  Thoracic Surgery 

Luciano  Pasquale  DO  Thoracic Surgery 

Monteith  Duane  MD  Thoracic Surgery 

Steinberg  Jay  DO  Thoracic Surgery 

Weatherby Locums Inc.  Baehser  Mark  MD  Pediatrics 

Page 37: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 37 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance

Who Test Associates, PA  Test  Doctor  MD  Thoracic Surgery 

Williams Family Medicine  Williams Jr  Robert  MD  Family Practice 

Wise Family Eye Center  Wise  Richard  MD  Ophthalmology 

Page 38: Policy & Procedure - AtlantiCare...Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee Source: NJ Public Law 1992,

Effective: 1/1/16 Reviewed: Revised: Review Cycle: Annual Owner: AtlantiCare Board of Directors – Finance Committee

Source: NJ Public Law 1992, c.160 regarding charity care; NJ Public Law 2008, c.60; IRC Section 501 (r)

Authorized By: AtlantiCare Board of Directors – Finance Committee - 9/28/2015

Page 38 of 38

Policy & Procedure Subject:

Financial Assistance Category: Patient Rights and Organizational

Facility Scope: ARMC Locations:

Mainland Campus, Pomona, NJ, Atlantic City Campus, Atlantic City, NJ,

Health Plex Atlantic City, NJ, Cancer Center Institute, Egg Harbor Township, NJ, Cancer Center Institute, Cape May Courthouse, NJ,

Wound Care, Egg Harbor Township, NJ, Wound Care, Hammonton, NJ,

Adult Partial Care, Pomona, NJ, Child Partial Care, Egg Harbor Township, NJ,

Satellite Emergency Department, Hammonton, NJ.

Department: Finance