Audit 362631

Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted or discounted based on the patient’s ability to pay. Condition: Some patients did not receive the proper sliding fee discount. For other patients, there was also a discrepancy between the amounts paid for services and the amounts charged. Cause: Errors within the setup of the Center’s billing software. Questioned Costs: Known or likely questioned costs are less than $25,000. Context: Of the 60 patients tested, 2 patients received an improper adjustment or discount, and 3 patients paid for lab charges that were not billed in the Center’s billing software. Effect: Improper adjustments and billings could lead to inaccurate financial statements. Auditor’s Recommendation: Management should have procedures in place to ensure that each eligible patient receives the proper discount and adjustment based on their ability to pay. There should also be procedures in place to ensure that all patient charges get properly billed. View of Responsible Officials and Planned Corrective Actions: The Center acknowledges the audit finding and has taken corrective actions to address the issue identified in 2024-005. This included collaborating with the electronic health record (EHR) vendor to resolve the sliding fee setup in the system. However, some remaining issues require additional improvements through updated standard operating procedures (SOP). To address these, the Center will create SOPs for fee updates related to sliding fee schedules and provide clarification on how the system calculates discounts. Additionally, the Center identified an error in the sliding fee discount setup for dental fee calculations, which will be resolved by the end of March 2025. Staff have been directed to manually verify sliding fee calculations performed by the EHR system until all identified issues with the billing system have been resolved.

Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted or discounted based on the patient’s ability to pay. Condition: Some patients did not receive the proper sliding fee discount. For other patients, there was also a discrepancy between the amounts paid for services and the amounts charged. Cause: Errors within the setup of the Center’s billing software. Questioned Costs: Known or likely questioned costs are less than $25,000. Context: Of the 60 patients tested, 2 patients received an improper adjustment or discount, and 3 patients paid for lab charges that were not billed in the Center’s billing software. Effect: Improper adjustments and billings could lead to inaccurate financial statements. Auditor’s Recommendation: Management should have procedures in place to ensure that each eligible patient receives the proper discount and adjustment based on their ability to pay. There should also be procedures in place to ensure that all patient charges get properly billed. View of Responsible Officials and Planned Corrective Actions: The Center acknowledges the audit finding and has taken corrective actions to address the issue identified in 2024-005. This included collaborating with the electronic health record (EHR) vendor to resolve the sliding fee setup in the system. However, some remaining issues require additional improvements through updated standard operating procedures (SOP). To address these, the Center will create SOPs for fee updates related to sliding fee schedules and provide clarification on how the system calculates discounts. Additionally, the Center identified an error in the sliding fee discount setup for dental fee calculations, which will be resolved by the end of March 2025. Staff have been directed to manually verify sliding fee calculations performed by the EHR system until all identified issues with the billing system have been resolved.