Charity Care Policy & Financial Assistance Policy

Charity Care Policy

Purpose: The Charity Care Policy provides guidelines and procedures to be followed in determining charity care.  The policy will enable Administration to differentiate between the unwillingness of the patient to pay (Bad Debt) and the demonstrated inability of the patient to pay (Charity Care).

Policy: Madison Healthcare Services, hereinafter referred to as “Facility”, is committed to identifying charity care accounts during preadmission, admission, discharge and following discharge.  Patients who meet the criteria for charity care will be eligible for a discount, in accordance with this policy, for all or part of a bill that a patient is normally expected to pay.  Collection efforts, including the use of outside collection agencies, do not preclude eligibility for a charity care discount.


  1. The patient must have residence in the Facility’s primary service area – within a 50 mile radius of Madison.
  2. Request made that the patient apply for Medical Assistance or alternate source of coverage through existing public programs, but failure to apply will not disqualify them from Charity Care.
  3. The patient may be denied charity care discount if they declined insurance coverage under an employer sponsored plan.
  4. The patient or guarantor should, if at all possible, complete the Facility charity care application and return the completed application within thirty (30) days of receipt. An extension may be granted if requested.
  5. The patient has expired leaving no estate.
  6. Not all accounts have to be sent to collection agency to be eligible. If the facility has placed the account with a collection agency and the agency has determined that the account cannot be collected, they are eligible for charity care.
  7. The patient’s family income falls in the Poverty level guidelines and/or family net assets are less than $10,000.
  8. The patient has been on Medical Assistance or similar source of coverage within the past 12 months and has no change in employment or income status. If the patient is now on Medical Assistance or similar source of coverage and has past due accounts, the past due accounts may be considered for charity care.
  9. The patient has filed and been approved for bankruptcy.
  10. Charity Care discounts apply only to services provided at this Facility.
  11. Once a patient completes a charity care application it will be good for 1 year, at which time the individual will need to re-apply thru the charity care process if they so chose.
  12. If the patient is eligible for Medical Assistance or similar source of coverage, but Medical Assistance or other source will not pay for services in the facility (swing bed, etc), the patient qualifies for charity care.
  13. If the application is not returned or returned not completed in full – other patient markers can be used to approve for charity care – example WIC, food stamps, free lunches, MA spend down, low income housing, etc
  14. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing an application.


  1. After any of the criteria are met to qualify, the percentages included with this policy will be used to determine the amount of discount applied to the outstanding balance.
  2. The CFO will have the authority to approve or deny charity care assistance.
  3. When an application for charity care is approved:
  4. The Patient Account Manager will “write off” the discounted amount as charity care.
  5. A letter will be sent to the patient or estate notifying them that their application was approved, the amount discounted and the remaining balance due from patient if any.
  6. Charity Care information will be kept on file for year end audit, cost report and surveys.
  7. When application for charity care is denied:
  8. A denial letter will be sent to the patient.
  9. Regular collection efforts will resume.

Charity Services Policy It is the policy of Madison Healthcare Services (MHS), consistent with our mission and values, to provide services to all persons, regardless of age, sex, race, religion, origin or ability to pay.  Upon completion of charity care application, and verifying an inability to pay.  MHS will provide financial assistance to qualifying patients to relieve them of their financial obligation in whole or part for health care services provided by Madison Healthcare Services.  An inability to pay may be identified at any time.  Based on poverty guidelines the following percentages will be discounted from the patient’s bill: If the patient falls in the 0 to 100 % of Poverty Level – a 100% discount will be applied If the patient falls in the 100 to 140% of Poverty Level – a 75% discount will be applied If the patient falls in the 140 to 200% of Poverty Level – a 50% discount will be applied If the patient falls in the 200 to 275% of Poverty Level – a 25% discount will be applied

Charity Care Application


Financial Assistance Policy

Policy: Madison Healthcare Services policy is to provide financial assistance for patients who have limited or no health insurance; have applied for government assistance, such as Medicare or Medical Assistance, but did not qualify; demonstrate financial need; reside in the primary service area of Madison Healthcare Services; supply Madison Healthcare Services with necessary information about household finances.

Financial assistance is available for eligible patients who require: Emergency Services; Non-elective services for urgent life-threatening conditions, outside the Emergency Department; Other mediclly necessary services, on a case-by-case basis.

Patient charge is lowest rate negotiated by insurance.

Depending on the individuals need, either free care or reduced patient financial obligations to Madison Healthcare Services may be offered. Madison Healthcare Services does not have the authority to waive any charges from physicians or other health professionals who are not employed by Madison Healthcare Services.

Madison Healthcare Services is committed to publicizing its Financial Assistance Program within the communities it serves.

Each patient has the opportunity to apply for assistance at all times throughout his or her relationship with Madison Healthcare Services: Prior to treatment; throughout treatment; up to the resolution of his or her account.

The providers delivering emergency or other medically necessary care at our facility and covered under this financial assistance policy are: Dr Brant Hacker, Dr Laura Hong, Dr. Maria Nolte, Dr Ralph Gerbig, Michael Deyo PA, MariBeth Olson PA, Paul Hodge NP, Jan Briones NP, any new providers practicing at our facility and all locum providers from Acute Care covering our facility

Collections letters mailed to the patient indicate we have financial assistance available which indicates for them to request appointment with office manager to discuss or to request and complete charity care application.  A copy of the facility charity care application will be included with the 4th collection letter if not requested by the patient sooner.

Procedure: Determination of Eligibility for Financial Assistance will request the patient or their representative to submit the charity care application, disclosing household income and expenses. Reasonable amount of time will be given to complete the application.

Applicants are treated with dignity and respect throughout the process; all information is handled with confidentiality. The patient’s cooperation in providing Madison Healthcare Services with necessary information is crucial to the process.

Assistance with the application process is available by contacting the business office manager at 320-598-7536 or in person at Madison Healthcare Services, 900 Second Avenue, Madison, MN 56256.

Madison Healthcare Services will not engage in extraordinary collection actions before reasonable efforts have been made to determine if the person qualifies for financial assistance.

Reasonable effort will be taken to request and assist in completing application, including meeting with individual and assisting in process.

If the individual fails to submit the Charity Care application within 120 days of the first billing statement the facility has the option to proceed with collection process. At least 30 days prior to initiating collection process a written notice will be provided indicating if individual does not submit the application or pay the amount due by indicated deadline the account will be sent to a collection agency.  The facility has the discretion to consider for charity care without completion of charity care application.

If the individual completes the application within the 240 day requirement following treatment, the facility will suspend any collection efforts. If the individual submits an incomplete application written notice will be provided with additional information needed and reasonable time will be given to submit missing information.