HFMA's Principles and Practices Board has created a sample charity care policy "to assist hospitals to manage their resources responsibly and to provide the appropriate level of assistance to the greatest number of persons in need." The document offers hospitals a template to help establish their own policies and procedures for offering charity care to their patients.
The guidelines provide definitions of how a patient's family income can be calculated to determine eligibility for charity care and illustrates healthcare services that can be covered under the policy--emergency, medically necessary as determined on a case-by-case basis, non-elective procedures and treatment to prevent an adverse health effect. To assess a patient's need for charity care, hospitals are advised to require patients to submit an application with relevant financial information, check public data sources such as credit scores, make “reasonable efforts” to determine if the patient is covered by public or private payers, and examine the patient’s outstanding accounts receivable for previous medical services and payment history. The policy recommends that financial evaluations for needy patients be done once a year or when new information becomes known, and that patients be notified if they qualify for charity care within 30 days of applying.
The guidance also outlines how hospitals should determine presumptive financial assistance eligibility, using outside agencies or life circumstances, when there is no documentation of the patient’s income. It also offers suggestions on how to disseminate information about the charity program to patients and the public, and describes how collection practices will take into account the patient’s efforts and cooperation in applying for public assistance or charity care and in complying with payment agreements.
Hospitals should consider the P& P Board’s charity policy a sample, not a standard. "As your organization considers adopting this policy, you should keep in mind the communities you serve, any applicable state and local laws and regulations, and the individual mission of your organization," it says.
