Audit 314797

Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found one error in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued noncompliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 1 of the 40 patients tested were not billed for the proper slide category based on the sliding fee scale provided by the Center. No questioned costs were identified. Cause: The error resulted from a claim with a date of service near the end of the effective date of the sliding fee scale schedule. The claim was processed after the new schedule and annual income levels were effective and the improper schedule was used to apply the sliding fee scale adjustment. Additionally, the sample size for internal auditing was too small to detect errors. Primary and secondary review of sliding fee scale applications requires additional training and resources to ensure errors are detected timely. Recommendation: We recommend that the Center strengthen its internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.

Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found one error in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued noncompliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 1 of the 40 patients tested were not billed for the proper slide category based on the sliding fee scale provided by the Center. No questioned costs were identified. Cause: The error resulted from a claim with a date of service near the end of the effective date of the sliding fee scale schedule. The claim was processed after the new schedule and annual income levels were effective and the improper schedule was used to apply the sliding fee scale adjustment. Additionally, the sample size for internal auditing was too small to detect errors. Primary and secondary review of sliding fee scale applications requires additional training and resources to ensure errors are detected timely. Recommendation: We recommend that the Center strengthen its internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.

Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found one error in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued noncompliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 1 of the 40 patients tested were not billed for the proper slide category based on the sliding fee scale provided by the Center. No questioned costs were identified. Cause: The error resulted from a claim with a date of service near the end of the effective date of the sliding fee scale schedule. The claim was processed after the new schedule and annual income levels were effective and the improper schedule was used to apply the sliding fee scale adjustment. Additionally, the sample size for internal auditing was too small to detect errors. Primary and secondary review of sliding fee scale applications requires additional training and resources to ensure errors are detected timely. Recommendation: We recommend that the Center strengthen its internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.

Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found one error in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued noncompliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 1 of the 40 patients tested were not billed for the proper slide category based on the sliding fee scale provided by the Center. No questioned costs were identified. Cause: The error resulted from a claim with a date of service near the end of the effective date of the sliding fee scale schedule. The claim was processed after the new schedule and annual income levels were effective and the improper schedule was used to apply the sliding fee scale adjustment. Additionally, the sample size for internal auditing was too small to detect errors. Primary and secondary review of sliding fee scale applications requires additional training and resources to ensure errors are detected timely. Recommendation: We recommend that the Center strengthen its internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.