Audit 18108

Criteria Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Condition and Context During our testing of 40 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits that received the incorrect sliding fee discount and one visit where the sliding fee application was not able to be found. Questioned Costs None noted. Effect Potential that a patient would not receive the appropriate sliding fee discount. Cause Clerical error resulted in incorrect sliding fee discount. Recommendation We recommend the Corporation take measures to ensure that appropriate sliding fee rates/categories are used for each sliding fee encounter. Views of Responsible Officials and Planned Corrective Actions The Corporation utilizes an external billing company. The external billing company has implemented an automated revision using robotics to ensure that sliding fee adjustments are made accurately according to the patients? sliding fee scale. Also, as required by HRSA, the Corporation records household income in our EMR for both sliding fee and non-slide-fee patients. Enrollment Specialists process and record household income based on documentation supplied within a sliding fee application. Customer Service Associates record household income based on verbal representations for non-sliding fee patients. The around involving not having a sliding fee application on file was caused by a Customer Service Associate incorrectly recording a verbal representation as a renewal of a sliding fee application. The Corporation will reinforce to all Customer Service Associates that renewal of sliding fee discounts must be performed by Enrollment staff so that the income can be verified by documentation.

Criteria Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Condition and Context During our testing of 40 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits that received the incorrect sliding fee discount and one visit where the sliding fee application was not able to be found. Questioned Costs None noted. Effect Potential that a patient would not receive the appropriate sliding fee discount. Cause Clerical error resulted in incorrect sliding fee discount. Recommendation We recommend the Corporation take measures to ensure that appropriate sliding fee rates/categories are used for each sliding fee encounter. Views of Responsible Officials and Planned Corrective Actions The Corporation utilizes an external billing company. The external billing company has implemented an automated revision using robotics to ensure that sliding fee adjustments are made accurately according to the patients? sliding fee scale. Also, as required by HRSA, the Corporation records household income in our EMR for both sliding fee and non-slide-fee patients. Enrollment Specialists process and record household income based on documentation supplied within a sliding fee application. Customer Service Associates record household income based on verbal representations for non-sliding fee patients. The around involving not having a sliding fee application on file was caused by a Customer Service Associate incorrectly recording a verbal representation as a renewal of a sliding fee application. The Corporation will reinforce to all Customer Service Associates that renewal of sliding fee discounts must be performed by Enrollment staff so that the income can be verified by documentation.

Criteria Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Condition and Context During our testing of 40 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits that received the incorrect sliding fee discount and one visit where the sliding fee application was not able to be found. Questioned Costs None noted. Effect Potential that a patient would not receive the appropriate sliding fee discount. Cause Clerical error resulted in incorrect sliding fee discount. Recommendation We recommend the Corporation take measures to ensure that appropriate sliding fee rates/categories are used for each sliding fee encounter. Views of Responsible Officials and Planned Corrective Actions The Corporation utilizes an external billing company. The external billing company has implemented an automated revision using robotics to ensure that sliding fee adjustments are made accurately according to the patients? sliding fee scale. Also, as required by HRSA, the Corporation records household income in our EMR for both sliding fee and non-slide-fee patients. Enrollment Specialists process and record household income based on documentation supplied within a sliding fee application. Customer Service Associates record household income based on verbal representations for non-sliding fee patients. The around involving not having a sliding fee application on file was caused by a Customer Service Associate incorrectly recording a verbal representation as a renewal of a sliding fee application. The Corporation will reinforce to all Customer Service Associates that renewal of sliding fee discounts must be performed by Enrollment staff so that the income can be verified by documentation.

Criteria Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Condition and Context During our testing of 40 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits that received the incorrect sliding fee discount and one visit where the sliding fee application was not able to be found. Questioned Costs None noted. Effect Potential that a patient would not receive the appropriate sliding fee discount. Cause Clerical error resulted in incorrect sliding fee discount. Recommendation We recommend the Corporation take measures to ensure that appropriate sliding fee rates/categories are used for each sliding fee encounter. Views of Responsible Officials and Planned Corrective Actions The Corporation utilizes an external billing company. The external billing company has implemented an automated revision using robotics to ensure that sliding fee adjustments are made accurately according to the patients? sliding fee scale. Also, as required by HRSA, the Corporation records household income in our EMR for both sliding fee and non-slide-fee patients. Enrollment Specialists process and record household income based on documentation supplied within a sliding fee application. Customer Service Associates record household income based on verbal representations for non-sliding fee patients. The around involving not having a sliding fee application on file was caused by a Customer Service Associate incorrectly recording a verbal representation as a renewal of a sliding fee application. The Corporation will reinforce to all Customer Service Associates that renewal of sliding fee discounts must be performed by Enrollment staff so that the income can be verified by documentation.

Criteria Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Condition and Context During our testing of 40 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits that received the incorrect sliding fee discount and one visit where the sliding fee application was not able to be found. Questioned Costs None noted. Effect Potential that a patient would not receive the appropriate sliding fee discount. Cause Clerical error resulted in incorrect sliding fee discount. Recommendation We recommend the Corporation take measures to ensure that appropriate sliding fee rates/categories are used for each sliding fee encounter. Views of Responsible Officials and Planned Corrective Actions The Corporation utilizes an external billing company. The external billing company has implemented an automated revision using robotics to ensure that sliding fee adjustments are made accurately according to the patients? sliding fee scale. Also, as required by HRSA, the Corporation records household income in our EMR for both sliding fee and non-slide-fee patients. Enrollment Specialists process and record household income based on documentation supplied within a sliding fee application. Customer Service Associates record household income based on verbal representations for non-sliding fee patients. The around involving not having a sliding fee application on file was caused by a Customer Service Associate incorrectly recording a verbal representation as a renewal of a sliding fee application. The Corporation will reinforce to all Customer Service Associates that renewal of sliding fee discounts must be performed by Enrollment staff so that the income can be verified by documentation.

Criteria Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Condition and Context During our testing of 40 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits that received the incorrect sliding fee discount and one visit where the sliding fee application was not able to be found. Questioned Costs None noted. Effect Potential that a patient would not receive the appropriate sliding fee discount. Cause Clerical error resulted in incorrect sliding fee discount. Recommendation We recommend the Corporation take measures to ensure that appropriate sliding fee rates/categories are used for each sliding fee encounter. Views of Responsible Officials and Planned Corrective Actions The Corporation utilizes an external billing company. The external billing company has implemented an automated revision using robotics to ensure that sliding fee adjustments are made accurately according to the patients? sliding fee scale. Also, as required by HRSA, the Corporation records household income in our EMR for both sliding fee and non-slide-fee patients. Enrollment Specialists process and record household income based on documentation supplied within a sliding fee application. Customer Service Associates record household income based on verbal representations for non-sliding fee patients. The around involving not having a sliding fee application on file was caused by a Customer Service Associate incorrectly recording a verbal representation as a renewal of a sliding fee application. The Corporation will reinforce to all Customer Service Associates that renewal of sliding fee discounts must be performed by Enrollment staff so that the income can be verified by documentation.