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Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, services, including the legally required medical screening examination and stabilization of the patient, are performed without delaying to obtain insurance information. In non-emergency circumstances or for elective procedures and services, it is our policy to verify insurance prior to a patient being treated; however, there are various exceptions that can occur. Such exceptions can include, for example, instances where (1)&#160;we are unable to obtain verification because the patient&#8217;s insurance company was unable to be reached or contacted, (2)&#160;a determination is made that a patient may be eligible for benefits under various government programs, such as Medicaid or Victims of Crime, and it takes several days or weeks before qualification for such benefits is confirmed or denied, and (3)&#160;under physician orders we provide services to patients that require immediate treatment.</font></p> <p style="MARGIN: 0in 0in 0pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 10pt" size="2">&#160;</font></p> <p style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 10pt" size="2">We provide for an allowance against accounts receivable that could become uncollectible by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. We estimate this allowance based on the aging of our accounts receivable by hospital, our historical collection experience by hospital and for each type of payer over an 18-month look-back period, and other relevant factors. A significant portion of our provision for doubtful accounts relates to self-pay patients, as well as co-payments and deductibles owed to us by patients with insurance. Payment pressure from managed care payers also affects our provision for doubtful accounts. We typically experience ongoing managed care payment delays and disputes; however, we continue to work with these payers to obtain adequate and timely reimbursement for our services. There are various factors that can impact collection trends, such as changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients, the volume of patients through our emergency departments, the increased burden of co-payments and deductibles to be made by patients with insurance, and business practices related to collection efforts. 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Providers can become eligible for annual Medicare incentive payments by demonstrating meaningful use of EHR technology in each period over four periods. Medicaid providers can receive their initial incentive payment by satisfying AIU criteria, but must demonstrate meaningful use of EHR technology in subsequent years in order to qualify for additional payments. Hospitals may be eligible for both Medicare and Medicaid EHR incentive payments; however, physicians and other professionals may be eligible for either Medicare or Medicaid incentive payments, but not both. Hospitals that are meaningful users under the Medicare EHR incentive payment program are deemed meaningful users under the Medicaid EHR incentive payment program and do not need to meet additional criteria imposed by a state. Medicaid EHR incentive payments to Providers are 100% federally funded and administered by the states. The Centers for Medicare and Medicaid Services (&#8220;CMS&#8221;) established calendar year 2011 as the first year states could offer EHR incentive payments. Before a state may offer EHR incentive payments, the state must submit and CMS must approve the state&#8217;s incentive plan.</font></p> <p style="MARGIN: 0in 0in 0pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 10pt" size="2">&#160;</font></p> <p style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 10pt" size="2">We recognize Medicaid EHR incentive payments in our consolidated statements of operations for the first payment year when: (1)&#160;CMS approves a state&#8217;s EHR incentive plan; and (2)&#160;our hospital or employed physician acquires certified EHR technology (i.e., when AIU criteria are met). Medicaid EHR incentive payments for subsequent payment years are recognized in the period during which the specified meaningful use criteria are met. We recognize Medicare EHR incentive payments when: (1)&#160;the specified meaningful use criteria are met; and (2)&#160;contingencies in estimating the amount of the incentive payments to be received are resolved. During the years ended December&#160;31, 2012 and 2011, certain of our hospitals and physicians satisfied the CMS AIU and/or meaningful use criteria. 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The increase in provision for doubtful accounts primarily related to the increase in uninsured patient volumes in the year ended December&#160;31,&#160;2012 compared to the year ended December&#160;31, 2011, partially offset by the impact of a 120 basis point improvement in our collection rate on self-pay accounts.</font></p> <p style="MARGIN: 0in 0in 0pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 10pt" size="2">&#160;</font></p> <p style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 10pt" size="2">Accounts that are pursued for collection through the regional business offices of Conifer are maintained on our hospitals&#8217; books and reflected in patient accounts receivable with an allowance for doubtful accounts established to reduce the carrying value of such receivables to their estimated net realizable value. 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Our estimated costs (based on the selected operating expenses described above) of caring for charity care patients for the years ended December&#160;31, 2012, 2011 and 2010 were approximately $133 million, $117 million, and $113 million, respectively. Most states include an estimate of the cost of charity care in the determination of a hospital&#8217;s eligibility for Medicaid disproportionate share hospital (&#8220;DSH&#8221;) payments. Revenues attributable to DSH payments and other state-funded subsidy payments for the years ended December&#160;31, 2012, 2011 and 2010 were approximately $283 million, $255 million and $178&#160;million, respectively. These payments are intended to mitigate our cost of uncompensated care, as well as reduced Medicaid funding levels. Our method of measuring the estimated costs uses adjusted self-pay/charity patient days multiplied by selected operating expenses per adjusted patient day. 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