Sample questions - General health care & IRC Section 501(r) General health care Use for cases involving electronic health records 1. If you are operating consistent with the U.S. Department of Health and Human Services standards, an officer, director, trustee or other governing body member (not an authorized representative) must attest to the following representation: We represent that from the date of formation, [mm/dd/yyyy], our activities to facilitate the electronic use and exchange of health-related information have been, and will continue to be, consistent with the standards adopted by the U.S. Department of Health and Human Services. Signature ________________________________ Date ____________________________ 2. Please answer the following regarding your charity care and uncompensated care: Explain your policy regarding charity cases, including how you distinguish between charity care and bad debts. Submit a copy of your written charity care policy. Do you provide services on a sliding scale fee schedule depending on financial ability to pay? If “Yes,” submit a copy of your sliding scale fee schedule. Describe any arrangements you have with federal, state or local governments or government agencies for paying for the cost of treating charity care patients (Medicare, Medicaid, etc.). Submit copies of any written agreements. Do you make provisions for any uncompensated care and, if so, explain. 3. Explain whether your organization conducts any of the following activities to promote charity care: Displaying posters (sometimes multi-lingual posters) in admitting and registration areas, financial offices, emergency rooms, websites and other locations to notify patients that uncompensated care is available. Placing uncompensated care brochures or flyers in admitting and registration areas. Registration personnel referring uninsured or low-income patients to financial counselors or advisors to discuss payment options. Making financial counselors and advisors available to explain uncompensated care options, eligibility criteria and payment plan options with patients. Notifying patients on their billing statements that financial assistance is available and providing the contact information of a financial counselor or other account representative. IRC Section 501(r) 4. Internal Revenue Code Section 501(r)(1) provides that a hospital organization described in IRC Section 501(r)(2) will be treated as an IRC Section 501(c)(3) tax-exempt organization only if the organization meets the requirements of IRC Sections 501(r)(3) through 501(r)(6). To meet the requirements, the organization must: Conduct a community health needs assessment (CHNA) at least once every three years and adopt an implementation strategy to meet the community health needs identified in the assessment as required by Section 501(r)(3). Establish a written financial assistance policy (FAP) and a written policy relating to emergency medical care as required by Section 501(r)(4). Limit amounts charged for emergency or other medically necessary care provided to individuals eligible for assistance under your FAP to not more than amounts generally billed to individuals who have insurance covering such care and prohibit use of gross charges as required by Section 501(r)(5). Make reasonable efforts to determine whether an individual is FAP-eligible before engaging in extraordinary collection actions as required by Section 501(r)(6). Sign below if you have met or plan to meet each of these requirements separately for each hospital facility you operate. Signature ________________________________ Date ____________________________
