Audit 389534

While adequate allowable expenditures were present, for a sample of drawdowns tested, the entity did not maintaing complete supporting documentation (such as a complete payroll report) demonstrating that allowable expenditures equaled or exceeded the drawdown amount.

The health center's governing board has approved a sliding fee discount schedule (SFDS); however, the front-line registration, billing, and clinical staff were not aware of the current SFDS or its specific discount tiers. Staff interviews and process walkthroughs indicated that staff rely on informal practices and legacy schedules rather than board-approved SFDS.

For 8 of the 40 patients tested, the documented family size on the sliding fee discount application did not match the family size recorded in the billing/registration software used to calculate the patient's sliding fee discount level. These family size differences were a result of additional patient inquiries clarifying the proper family size, but the sliding fee application was not subsequently updated. Also, for 2 of the 40 patients tested, the income used to determine sliding fee discount eligibilty was calculated using an incorrect pay frequency. As a result, the annualized income recorded in the sliding fee determination did not agree with the income documentation provided, and in some cases placed patients in the wrong discount pay class.