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This month’s form: Sample charity care application

The following is a sample charity care application form. To be considered for charity care for medically necessary services, this confidential application must be completed.

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Patient Access Advisor, June, 2007

Check out the June 2007 edition of Patient Access Advisor, which features:

  • UNCHCS improves financial assistance communications
  • Cash collections: Develop a thorough program for your organization’s entire patient financial services team
  • Charity care: Find balance between budget, patient needs
  • CMS steps toward severity-adjusted DRG payments
  • CMS offers Medicare NPI deadline flexibility for facilities

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