Audit 374174

U.S. Department of Health and Human Services Criteria: Special Tests and Provision: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition: Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy. Questioned Costs: None Context: A sample of 25 encounters out of a population of 6,030 encounters were tested and two errors were noted where patients received an incorrect sliding fee adjustment. The sampling methodology used is not and is not intended to be statistically valid. Two patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation. Effect: Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee discount policy. Cause: The Organization did not comply with their sliding fee policy. Identification as a repeat finding: Not a repeat finding Recommendation: We recommend management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale. Views of responsible officials: The Organization agrees with the finding. See separate report for planned corrective actions.