Audit 326899

Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “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”. In one identified instance, an incorrect sliding fee discount was applied. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a 75% sliding fee discount, however, a nominal fee of $15 was applied to the patient's charges. Effect: Incorrect sliding fee discount was applied to the transaction tested. Recommendation: We recommend the Clinic implement a process for ensuring the level of sliding fee discount determined is the discount applied to the patient’s charge. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the reviewer to verify each data point of the application and compare the entries between the sliding fee form and the information entered in the electronic health record. The checklist will be completed electronically and stored in patient’s electronic health record account and is available for review as needed. The verification checklist will be moved into production on August 23, 2024, and site supervisors will train staff on the new process.

Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “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”. In one identified instance, an incorrect sliding fee discount was applied. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a 75% sliding fee discount, however, a nominal fee of $15 was applied to the patient's charges. Effect: Incorrect sliding fee discount was applied to the transaction tested. Recommendation: We recommend the Clinic implement a process for ensuring the level of sliding fee discount determined is the discount applied to the patient’s charge. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the reviewer to verify each data point of the application and compare the entries between the sliding fee form and the information entered in the electronic health record. The checklist will be completed electronically and stored in patient’s electronic health record account and is available for review as needed. The verification checklist will be moved into production on August 23, 2024, and site supervisors will train staff on the new process.

Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “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”. In one identified instance, an incorrect sliding fee discount was applied. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a 75% sliding fee discount, however, a nominal fee of $15 was applied to the patient's charges. Effect: Incorrect sliding fee discount was applied to the transaction tested. Recommendation: We recommend the Clinic implement a process for ensuring the level of sliding fee discount determined is the discount applied to the patient’s charge. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the reviewer to verify each data point of the application and compare the entries between the sliding fee form and the information entered in the electronic health record. The checklist will be completed electronically and stored in patient’s electronic health record account and is available for review as needed. The verification checklist will be moved into production on August 23, 2024, and site supervisors will train staff on the new process.

Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “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”. In one identified instance, an incorrect sliding fee discount was applied. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a 75% sliding fee discount, however, a nominal fee of $15 was applied to the patient's charges. Effect: Incorrect sliding fee discount was applied to the transaction tested. Recommendation: We recommend the Clinic implement a process for ensuring the level of sliding fee discount determined is the discount applied to the patient’s charge. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the reviewer to verify each data point of the application and compare the entries between the sliding fee form and the information entered in the electronic health record. The checklist will be completed electronically and stored in patient’s electronic health record account and is available for review as needed. The verification checklist will be moved into production on August 23, 2024, and site supervisors will train staff on the new process.

Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “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”. In one identified instance, an incorrect sliding fee discount was applied. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a 75% sliding fee discount, however, a nominal fee of $15 was applied to the patient's charges. Effect: Incorrect sliding fee discount was applied to the transaction tested. Recommendation: We recommend the Clinic implement a process for ensuring the level of sliding fee discount determined is the discount applied to the patient’s charge. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the reviewer to verify each data point of the application and compare the entries between the sliding fee form and the information entered in the electronic health record. The checklist will be completed electronically and stored in patient’s electronic health record account and is available for review as needed. The verification checklist will be moved into production on August 23, 2024, and site supervisors will train staff on the new process.

Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “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”. In one identified instance, an incorrect sliding fee discount was applied. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a 75% sliding fee discount, however, a nominal fee of $15 was applied to the patient's charges. Effect: Incorrect sliding fee discount was applied to the transaction tested. Recommendation: We recommend the Clinic implement a process for ensuring the level of sliding fee discount determined is the discount applied to the patient’s charge. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the reviewer to verify each data point of the application and compare the entries between the sliding fee form and the information entered in the electronic health record. The checklist will be completed electronically and stored in patient’s electronic health record account and is available for review as needed. The verification checklist will be moved into production on August 23, 2024, and site supervisors will train staff on the new process.