Charity Care Policy

Origin Date:   March 11, 2005

Purpose

This policy is designed to assist uninsured and under-insured patients, receiving emergency services that are financially unable to pay for healthcare services.

Scope

Person Memorial Hospital shall offer Charity Care adjustments to medically Indigent patients who are uninsured or are under-insured due to a health insurance policy that pays a minimal benefit, and to satisfy an element or component of the Hospital's charitable mission. Charity Care and Medical Indigence eligibility shall be determined using the most current Federal Poverty Guidelines, including patient income and asset information.

Applications for coverage under Charity Care Services, having complete and required documentation, will be submitted for review and approval. All documentation must be completed and returned to facility within 30 days. The decision will be based on the patient's gross income for the current year, not to exceed 200% of the Federal Poverty Guidelines.

Definitions

  • Charity Care is deemed as health services that do not result in cash flows. Charity Care Services results from a provider's policy to provide healthcare services free of charge, or on a discounted basis, to the uninsured and under-insured individuals who meet the financial criteria.
  • Charity Care Adjustment is defined as a write-off on a self-pay balance, or one that the patient is not able to pay, as determined by the criteria of this policy.
  • Medical Indigence is defined as individuals (or their guarantors) whose ability to pay has been negatively impacted due to the occurrence of a catastrophic medical event for which full payment for medical expenses would result in their inability to meet basic living needs.
  • Federal Poverty Guidelines are defined as the guidelines published annually in the Federal Register by the U.S. Department of Health and Human Services.

Policy

  1. To be eligible for Charity Care, the patient/guarantor must cooperate fully with Person Memorial Hospital regarding all processes and information to assist patient with applying for any other third party coverage that would result in reimbursement to Hospital for services provided.
  2. For patients who become eligible for Medicaid, any open or active balance will be eligible for Charity Care.
  3. Patient or guarantor must complete and sign a Patient Financial Statement with documentation that includes full disclosure for all financial information and return within 30 days from service date.
  4. Person Memorial Hospital reserves the right to reverse Charity Care Adjustments provided by the policy, if the information provided by the patient during the disclosure and information-gathering process is determined to be false, or if Person Memorial Hospital obtains proof that the patient has received compensation for services from other sources.

Procedure

1. All accounts require a complete application from the patient or from their   guardian. Exception: Previously approved applications cover all active services previously provided, as well as those related to the originating episode of care, for a period of 30 days.

2. Valid supporting documentation:
a)    Federal Income Tax form 1040 for prior year
b)    Pay stub for four prior pay periods.
c)    Written verification of income received

  • Social Security
  • Aid to Dependent Children (ADC)
  • Child Support
  • Alimony

d)    Property/Asset verification

3. Applicants will be reviewed, according to the following, for Charity Care Adjustment:
a)    Income - Sliding scale is used to determine eligibility.
b)    Family Size - Eligibility is determined by family size. Family for this policy refers to immediate spouse, children and legal guardians.
c)    Percent of income between 125% and 200% of the Federal Poverty Guidelines.

Inpatient and Outpatient Charity Approval Levels:

Percent of Federal Poverty Guidelines    Percent of Charity Adjustment

Up to 125%                                                     100%
126 – 150%                                                     75%
151 – 175%                                                     50%
176 – 200%                                                     25%
Over 200%                                                       0%

4. Applicants will receive a written notice regarding their eligibility for Charity Care within thirty days of the Charity Care completed application with supporting documentation.
a)    If approved, a written notice will be sent to the patient with the amount discounted, and a payment request for any remaining balance, and discount will be posted in accordance to policy.
b)    If denied, written notice will provide explanation of denial and account will remain in Self-Pay status, and billing to proceed as to Policy.

Guidelines & criteria for qualifications

  1. To be eligible for Charity Care, the patient/guarantor must cooperate fully with Person Memorial Hospital regarding all processes and information to assist patient with applying for any other third party coverage that would result in reimbursement to Hospital for services provided.
  2. For patients who become eligible for Medicaid, any open or active balance will be eligible for Charity Care.
  3. Patient or guarantor must complete and sign a Patient Financial Statement with documentation that includes full disclosure for all financial information.
  4. Person Memorial Hospital reserves the right to reverse Charity Care Adjustments provided by the policy, if the information provided by the patient during the disclosure and information-gathering process is determined to be false, or if Person Memorial Hospital obtains proof that the patient has received compensation for services from other sources.
  5. Approval Requirements:

a)    Financial counselor              up to $3,000
b)    Business Office Manager    $3,001 - $24,999
c)    CFO                                     $25,000 - $50,000
d)    CEO                                     Over $50,001

 January 27, 2014 (Revised)