Audit 377539

Federal Programs – AL 93.224 and 93.527 – Health Center Cluster Criteria – Section 42 USC 254b(K)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR section 56.303(e), (f), and (g) requires that health centers provide discounted fees for individuals and families with incomes above 100% and at or below 200% of the federal poverty guidelines. Condition – For the year ended June 30, 2025, we selected a sample of 40 visits with adjustments related to the sliding fee scale policies established by Family Healthcare. We identified one visit where the patient had correctly been identified as eligible for a full discount down to the minimum copay within the billing system, however, the charges were not slid, and the patient was charged the full fee for the visit. Cause – In the month immediately following the conversion to the new patient management system, there were software issues identified that caused patient visits to be sent directly to self-pay responsibility before billing staff had the chance to evaluate or apply the appropriate sliding fee payor types in the system. This caused some balances to be labeled as self-pay when the guarantor had qualified and been correctly identified as eligible for sliding fee adjustments. Effect – Patient service revenue may not be appropriately adjusted in accordance with the policies Family Healthcare has established for charity care under the health center cluster requirements listed above. Repeat Finding – This is not a repeat finding. Recommendation – A review of all visits that may have similar errors should be performed and manual corrections made. During the year the billing staff did perform a detailed review of similar transactions and corrected those identified. View of Responsible Officials – Management recognizes the deficiency and plans to implement additional procedures to address the errors noted.