The Principles and Practices Board of the Healthcare Financial Management Association 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."
HFMA says the sample policy is intended to serve as a template to help hospitals establish their own policies and procedures for offering charity care to patients.
HFMA's guidelines provide definitions on 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 – such as 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, HFMA advises that hospitals require that patients 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 sample 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.