Audit 406272

Health Center Program Cluster – Assistance Listing No. 93.224 U.S. Department of Health and Human Services Award No. 6 H80CS00506-22-02, March 1, 2023 – February 29, 2024 Award No. 2 H80CS00506-23-00, March 1, 2024 – February 28, 2025 Criteria or Specific Requirement – Special Tests and Provisions: 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 sliding fee discounts that were inconsistent with the stated sliding fee discount categories under the Organization’s policy. Cause – The Organization did not comply with their sliding fee policy. Effect or potential effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee discount policy. Questions costs – None. Context – A selection of 40 encounters were tested out of a total population of 33,787 encounters. The sampling methodology used is not and is not intended to be statistically valid. 3 encounters received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their family size and household income determination. Identification as a repeat finding, if applicable – Not a repeat finding. Recommendation – The Organization should 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 and reviewed to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual. Views of responsible officials and planned corrective actions – Management concurs with the auditor’s finding. The Organization acknowledges that patients received sliding fee discounts that were inconsistent with the stated sliding fee discount categories under the Organization’s policy. All billing staff will receive retraining on the correct manual posting procedures for sliding fee scale adjustments after insurance payments, ensuring compliance with patient income verification and applicable percentage guidelines. We will also continue ongoing monitoring and review of accounts receiving sliding fee scale adjustments to ensure accurate and compliance application of the approved discount and percentages. Anticipated Completion Date – 90 days from audit issuance Responsible Contact Person – Donald Griffis, Business Analyst