This customizable document, Financial Responsibility, is taken from MCN Healthcare’s Hospice Policy and Procedure Manual. For more than 20 years, MCN has been the health care industry’s leading provider of policy and procedure templates, forms, competencies and other compliance tools.

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Here is some sample content from Financial Responsibility:

	PURPOSE: To assure that the patient, family or caregiver understands the financial responsibility for Hospice services. POLICY: Hospice staff shall inform the patient of financial responsibility for Hospice services. Hospice shall inform the patient of any subsequent changes in financial responsibility. PROCEDURE: At the admission visit Hospice staff shall explain the patient's insurance coverage and the patient's responsibility for payment information in writing. The Office Manager is contacted if staff need more information to verify coverage. The Office Manager may help the patient in...
Second excerpt:
	...need more information to verify coverage. The Office Manager may help the patient in developing a tailored payment plan. Hospice shall notify the patient, who may incur financial liability, in writing within 30 calendar days from the date Hospice became aware of a financial change. Hospice will document all written or verbal notifications of the patient's financial responsibility in the billing record. 1 SUBJECT:FINANCIAL RESPONSIBILITYREFERENCE #1004PAGE: 1DEPARTMENT: HOSPICE ...