Audit 23640

2022-001 - Health Centers Cluster Federal Agency ? U.S. Department of Health and Human Services Grant Period ? Year ended December 31, 2022 Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center?s SFDS. Condition - We attempted to recalculate the applied discount using Oak Orchard?s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Oak Orchard?s SFDS. Cause - Early in 2022, the individual assigned to review the adjustments resigned and there was no individual assigned to review the process. Effect - Out of our sample of 20 selections, we identified eight exceptions based on the SFDS. Three selections had adjustments made incorrectly to the patient accounts by the outsourced billing company. Five selections had the adjustment applied incorrectly based on the information in the patient?s application or other patient information on file. Further, 15 of our 20 selections had adjustments applied without proper documentation or review which was not in accordance with Oak Orchard?s policies and procedures. Recommendation - We recommend evaluating the current process and either changing it to match what is being done or provide education those involved in the process to adhere to Oak Orchard?s existing written policies and procedures in this area. We also encourage Oak Orchard to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Oak Orchard?s billing processes and procedures. We acknowledge that Oak Orchard?s sliding fee is complex and have discussed with management that there could be opportunity to simplify the process to reduce the administrative burden as well as the likelihood for errors such as those described above.

2022-001 - Health Centers Cluster Federal Agency ? U.S. Department of Health and Human Services Grant Period ? Year ended December 31, 2022 Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center?s SFDS. Condition - We attempted to recalculate the applied discount using Oak Orchard?s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Oak Orchard?s SFDS. Cause - Early in 2022, the individual assigned to review the adjustments resigned and there was no individual assigned to review the process. Effect - Out of our sample of 20 selections, we identified eight exceptions based on the SFDS. Three selections had adjustments made incorrectly to the patient accounts by the outsourced billing company. Five selections had the adjustment applied incorrectly based on the information in the patient?s application or other patient information on file. Further, 15 of our 20 selections had adjustments applied without proper documentation or review which was not in accordance with Oak Orchard?s policies and procedures. Recommendation - We recommend evaluating the current process and either changing it to match what is being done or provide education those involved in the process to adhere to Oak Orchard?s existing written policies and procedures in this area. We also encourage Oak Orchard to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Oak Orchard?s billing processes and procedures. We acknowledge that Oak Orchard?s sliding fee is complex and have discussed with management that there could be opportunity to simplify the process to reduce the administrative burden as well as the likelihood for errors such as those described above.

2022-001 - Health Centers Cluster Federal Agency ? U.S. Department of Health and Human Services Grant Period ? Year ended December 31, 2022 Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center?s SFDS. Condition - We attempted to recalculate the applied discount using Oak Orchard?s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Oak Orchard?s SFDS. Cause - Early in 2022, the individual assigned to review the adjustments resigned and there was no individual assigned to review the process. Effect - Out of our sample of 20 selections, we identified eight exceptions based on the SFDS. Three selections had adjustments made incorrectly to the patient accounts by the outsourced billing company. Five selections had the adjustment applied incorrectly based on the information in the patient?s application or other patient information on file. Further, 15 of our 20 selections had adjustments applied without proper documentation or review which was not in accordance with Oak Orchard?s policies and procedures. Recommendation - We recommend evaluating the current process and either changing it to match what is being done or provide education those involved in the process to adhere to Oak Orchard?s existing written policies and procedures in this area. We also encourage Oak Orchard to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Oak Orchard?s billing processes and procedures. We acknowledge that Oak Orchard?s sliding fee is complex and have discussed with management that there could be opportunity to simplify the process to reduce the administrative burden as well as the likelihood for errors such as those described above.

2022-001 - Health Centers Cluster Federal Agency ? U.S. Department of Health and Human Services Grant Period ? Year ended December 31, 2022 Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center?s SFDS. Condition - We attempted to recalculate the applied discount using Oak Orchard?s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Oak Orchard?s SFDS. Cause - Early in 2022, the individual assigned to review the adjustments resigned and there was no individual assigned to review the process. Effect - Out of our sample of 20 selections, we identified eight exceptions based on the SFDS. Three selections had adjustments made incorrectly to the patient accounts by the outsourced billing company. Five selections had the adjustment applied incorrectly based on the information in the patient?s application or other patient information on file. Further, 15 of our 20 selections had adjustments applied without proper documentation or review which was not in accordance with Oak Orchard?s policies and procedures. Recommendation - We recommend evaluating the current process and either changing it to match what is being done or provide education those involved in the process to adhere to Oak Orchard?s existing written policies and procedures in this area. We also encourage Oak Orchard to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Oak Orchard?s billing processes and procedures. We acknowledge that Oak Orchard?s sliding fee is complex and have discussed with management that there could be opportunity to simplify the process to reduce the administrative burden as well as the likelihood for errors such as those described above.