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Practice Management Alert

Sample This Sample Charity Policy

Published on Wed Oct 01, 2003

Not sure where to begin with your practice's charity standards policy? You can use the following policy as a springboard from which to craft your own:
 
Patients who request consideration and who do not have sufficient financial resources nor maintain sufficient insurance coverage may be considered for charity care or a reduction in the patient's fee. Criteria for determining the amount of charity service for which a patient is eligible generally takes into account the following factors:

 

  • Individual or family income [specify thresholds]
     
  • Individual or family net worth [specify thresholds]
     
  • The employment status of the individual or family, and evaluation of the likelihood of future earnings sufficient to meet the obligation within a reasonable period of time.
     
  • Number of family members dependent on the patient's income and assets.
     In determining the patient's financial obligations, living expenses and other items of a reasonable and necessary nature should be included. The amount and frequency of bills for healthcare services must be considered in evaluating a patient's ability to pay.
     
    A separate determination of the amount of charity service or fee reduction for which a patient is eligible is made on a case-by-case basis. The appropriate amount of charity or reduction in fee is determined in relation to amounts due after applying all other resources. However, any reduction in fee shall not be based or conditioned upon the availability or amount of reimbursement expected or received from a third party payer or other person. A patient's ability to pay and the resources available for services to a patient may change over time. For example, a patient may have agreed to a payment plan that was reasonable in relation to the circumstances at the time, but subsequent events, such as a change in employment status or another need for healthcare services, could change the patient's ability to pay.
     
    If appropriate under the particular circumstances, the administrative staff may assist the patient to obtain from other sources financial subsidies or assistance in connection with particular services or medications, and/or in connection with obtaining or maintaining insurance coverage.

    Source: Attorney Wayne J. Miller, Esq. with the Compliance Law Group, a health care law firm in Woodland Hills, CA. The above policy is not intended to be legal advice and is only an example of a policy that should be reviewed under the laws of the provider's jurisdiction.

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