Audit 1359

2023-001 – Department of Health and Human Services Health Centers Cluster – CFDA# 93.224 Criteria: Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Condition: As a result of our audit procedures, we found multiple errors in the sliding fee categories patients were put into based on information retained in the Athena Billing System. Context: During our testing, we found 1 of the 15 patients tested were not in the proper slide category based on the income backup received for the patient. We also found 1 of the 15 patients tested did not have backup for income on file for the sliding fee scale but was on the scale and had visits that were applied to the scale. Effect: The result of including patients in the wrong category could be either over or under billing to the patient. Cause: The cause is due to errors in calculating and entering the patient’s income into the software and ensuring the software put the patient in the correct category. Recommendation: We recommend all applications have support attached for income verification and are reviewed and approved by someone other than the person gathering the information to ensure they are in the proper category and also verifying the software has assigned the proper category. Auditee Response and Corrective Action Plan: Management agrees with this finding. OVH recognizes and values the importance of the sliding fee program as integral to our mission as a federally-qualified community health center. We intend to take the necessary steps to ensure full compliance with the provisions of the program, identified specifically as Sliding Fee Discount Program (SFDP) within our organization. These steps include: Auditee Response and Corrective Action Plan: a) Implementing a new process for adding the sliding fee discount to patient accounts. Each patient that applies for the slide will be scheduled under “eligibility” with an appointment. After the patient has completed the application, the information will be entered into Athena, and then the plan will be calculated. The paperwork will then be uploaded as an attachment to the Sliding Fee Discount Policy. Each week, a report will be generated in Athena and sent to the Clinical Services Manager. This report will list all patients that had an appointment with eligibility for the prior week. The Clinical Services Manager will then use that report and verify that all information is uploaded and entered correctly. b) Training on the new process will occur. All support staff responsible for entering and uploading the Sliding Fee Discount will go through thorough training of the new process. Additionally, the Clinical Services Manager will complete peer-to-peer training on the verification process.

2023-001 – Department of Health and Human Services Health Centers Cluster – CFDA# 93.224 Criteria: Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Condition: As a result of our audit procedures, we found multiple errors in the sliding fee categories patients were put into based on information retained in the Athena Billing System. Context: During our testing, we found 1 of the 15 patients tested were not in the proper slide category based on the income backup received for the patient. We also found 1 of the 15 patients tested did not have backup for income on file for the sliding fee scale but was on the scale and had visits that were applied to the scale. Effect: The result of including patients in the wrong category could be either over or under billing to the patient. Cause: The cause is due to errors in calculating and entering the patient’s income into the software and ensuring the software put the patient in the correct category. Recommendation: We recommend all applications have support attached for income verification and are reviewed and approved by someone other than the person gathering the information to ensure they are in the proper category and also verifying the software has assigned the proper category. Auditee Response and Corrective Action Plan: Management agrees with this finding. OVH recognizes and values the importance of the sliding fee program as integral to our mission as a federally-qualified community health center. We intend to take the necessary steps to ensure full compliance with the provisions of the program, identified specifically as Sliding Fee Discount Program (SFDP) within our organization. These steps include: Auditee Response and Corrective Action Plan: a) Implementing a new process for adding the sliding fee discount to patient accounts. Each patient that applies for the slide will be scheduled under “eligibility” with an appointment. After the patient has completed the application, the information will be entered into Athena, and then the plan will be calculated. The paperwork will then be uploaded as an attachment to the Sliding Fee Discount Policy. Each week, a report will be generated in Athena and sent to the Clinical Services Manager. This report will list all patients that had an appointment with eligibility for the prior week. The Clinical Services Manager will then use that report and verify that all information is uploaded and entered correctly. b) Training on the new process will occur. All support staff responsible for entering and uploading the Sliding Fee Discount will go through thorough training of the new process. Additionally, the Clinical Services Manager will complete peer-to-peer training on the verification process.