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Tip: How to apply charity-care criteria

Compliance Monitor, June 22, 2005

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Because a number of factors are involved in making an appropriate charity determination, staff should have the flexibility to apply sound judgment to each case.

Providers are free to apply similar criteria in different ways. For example, one provider may establish a procedure to deem certain types of cases as automatically qualified for charity, while another provider may require case-by-case determinations.

Likewise, a provider may define medical indigence as a patient covered by Medicare and Medicaid and may allow charity processing based on the validity of this insurance coverage. Another provider may opt to require completed charity applications for this class of patients.

A similar situation exists in relationship to convertible/liquid assets, the patient's net worth, and a catastrophic medical situation. One provider may require that the patient apply a percentage of his or her assets to the outstanding medical bills, whereas another provider may execute the charity determination based on the catastrophic nature of the medical expenses.

Providers must also discuss two other issues regarding the criteria used to make charity determinations:

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