What can this patient actually be charged?

Two calculations that decide whether a self-pay balance becomes charity care or bad debt. Amounts Generally Billed sets the ceiling under 501(r). Presumptive eligibility decides who gets there without filling in a form. Only about 29 percent of patients with unaffordable bills receive assistance they qualify for, and roughly half were never told the programme existed.

2026 POVERTY GUIDELINES IRC 501(r)(5) LOOK-BACK DISCOUNT ONLY, NEVER SURCHARGE

Policy profile

Configure once. Everything on this page is saved to this browser and can be exported as a file for the rest of your team to import.

Household

Income and household size only. Race, ethnicity, national origin, sex, age, disability, language and ZIP code are deliberately not collected. See the note at the foot of this page.

Presumptive triggers

Any one of these supports a determination without an application. Under 501(r), an account granted presumptive eligibility is financial assistance rather than bad debt, and counts on Schedule H.

Your policy bands

Set these to match your own Financial Assistance Policy. Defaults follow the common pattern of full write-off to 200 percent FPL with a sliding scale to 400 percent.
Catastrophic provision. Many policies also grant assistance above the top band when the balance exceeds a share of annual income, regardless of FPL. Set that here.

Determination

$0
Maximum the patient may be charged

Letter details

Pulls the determination from the first tab. Fill in what identifies the account, then copy or download. Nothing here leaves your browser.

Letter

Written for a general audience. Patients receiving these letters are by definition under financial strain, and a dense notice is a notice that does not get read.

What this letter must do

Look-back method

Sum the claims allowed over a twelve month period, divide by the gross charges for those same claims. Recalculate annually and begin applying the new figure within 120 days of calculating it.
Which claims count. Only claims that were allowed, meaning adjudicated and paid or applied to patient responsibility. Denied claims and claims still open are excluded. The numerator and denominator must describe the same set of claims, or the percentage is meaningless.

Published statement

Your FAP must state the AGB percentage and describe how it was calculated, or explain how the public can obtain both free of charge. This is a starting draft for your counsel to review.

Amounts generally billed

0.0%
AGB percentage
This is the ceiling, not the price. A FAP-eligible patient may not be charged more than this for emergency or medically necessary care. It applies whether or not they completed an application, and anything collected above it after a later eligibility finding must be refunded.
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Educational tool. Not legal, tax, or compliance advice. 501(r) applies to nonprofit hospital facilities and your Financial Assistance Policy governs. State law frequently adds requirements, and several states restrict counting assets or prohibit application deadlines. This tool collects no race, ethnicity, national origin, sex, age, disability, language or geographic data, and uses none of them in any determination. That is deliberate: Section 1557 at 45 CFR 92.210 prohibits proxy discrimination in decision support tools, and geography-derived deprivation indices are well established proxies for race. Every determination here reduces a balance and none can increase one. Verify against your FAP and current IRS guidance before relying on any output.