Audit 378097

Criteria: Health centers that receive funding under ALN 93.224 – Health Center Program, are required to prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted based on the patient’s ability to pay. Condition: During testing of the application of the Network’s slide scale fees, we noticed that 25 out of 66 testing selections applied a fee that was different than the slide for which the patient qualified. Cause: In twenty-one of the twenty-five exceptions, the billing error appeared to be due to misapplication of the slide scale to the patient’s verified income level. The other four exceptions appeared to be due to minor clerical billing errors because the correct slide had been applied in those instances. Possibly contributing to the errors was the fact that 16 of the 66 selections lacked signatures of appropriate levels of the Network’s staff on the patient’s application forms, possibly indicating that a proper review had not been completed. Effect: The pervasiveness and amount of these errors were projected to the entire population resulting in an estimated $20,071 which sliding patients were undercharged. Recommendation: We recommend that the Network implement a more robust review process for information that is input into the billing system. This includes a verifiable review process in which management, or someone assigned by management reviews each case and indicates their review by properly signing the patient’s application form. Auditor’s Conclusion: Because the amount of the error is not material to the major program, this finding does not constitute a material weakness but is a control deficiency that requires attention to strengthen the accuracy of the application of the slide scale fees.