Revenue Cycle

Six steps to manage charity care processes

Patient Financial Services Weekly Advisor, December 3, 2004

Making sure your charity care policies are in place and are being followed throughout the facility is a challenge, but it can be done. Here are six tips manage the process:

1. Some of the complaints in well-publicized class-action suits against nonprofit organizations allege violations of the Emergency Medical Treatment and Labor Act (EMTALA), so assess your facility's guidelines. Make sure there is no discussion of ability to pay prior to treatment.

  • The emergency department (ED) is more in the limelight because of EMTALA issues, but the big dollars are not going to be there, says Sandra Wolfskill, FHFMA, president of Wolfskill & Associates, a consulting firm in Chardon, OH. "We need to make sure staff are trained to get the consent for treatment and assignment of benefits and [that they] explain that in no way is the signature going to result in them being turned away. You need to make sure the ED staff say the right things so you don't get an EMTALA complaint."

    2. Make sure discounts are appropriate and consistent based on your charity care policy.

    3. Build appropriate levels into the policy by using the Federal Poverty Guidelines or make your own determinations. "It's a management decision, and a lot of it has to do with the bill amount and the patient's income level," says Steven Orvis, MPH, senior consultant at Sinaiko Healthcare Consulting in Los Angeles. "You should encourage staff to follow the policy, but to bring any exceptions to your attention."

    To view the 2004 Federal Poverty Guidelines, click here.

    4. Make sure the collectors understand the qualifications for all programs for which patients may be eligible-including Medicaid-or whether they're victims of crime, Orvis says. Then patients can be referred to a financial counselor who can conduct the follow-up.

    5. Make sure every collector receives a copy of the policy. Is it consistent, and is it clear to them how to implement it?

    6. If you're in a facility that has facility and professional charges, the policies should be the same.

    To read the American Hospital Association's guidelines on charity care policies, click here.

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