The Surgery Center shall offer charity adjustments when the following conditions are met :

  1. All insurance or outside funding assistance proceeds have been received and applied to the patient account.
  2. The patient and/or guarantor meets the current Federal Poverty Guidelines.
  3. The patient and/or guarantor has complied with the Agency for Healthcare Administration income verification guidelines.
  4. The patient and/or guarantor has completed a Financial Evaluation/Income Certification Form listing income and expenses, assets and liabilities.

The Surgery Center shall not offer charity adjustments to patients and/or guarantors who have not complied with Outside funding assistance requirements.

The Surgery Center shall maintain adequate documentation of charity care by placing approved form in the patient’s chart.

The Surgery Center shall offer charity accounts immediately after final billing if the patient and/or guarantor:

  • Has no insurance
  • Cannot qualify for outside funding assistance
  • Is charity eligible according to the Federal Poverty Guidelines