Audit 45668

Federal Program: Assistance Listing 93.224 Health Center Program Cluster: Consolidated Health Center Compliance Requirement: Special Tests and Provisions Condition: One patient?s sliding scale category was not correctly input into the billing system. Criteria: The Office of Management and Budget Compliance Supplement requires that health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. Questioned Costs: Unknown Context: In a sample of 40 sliding scale patients, one patient?s sliding scale category was incorrectly entered into the system. Effect: One application was not entered correctly into the system, resulting in an incorrect amount being billed to the patient. Cause: Adequate procedures were not in place to ensure that required administrative responsibilities, including ensuring that patient eligibility determinations were correctly entered into the system, were being performed and reviewed for accuracy. Recommendation: We recommend Comtrea revisit their processes and procedures regarding the sliding scale process focusing on adequate education and review to ensure timely and accurate conclusions, input, reporting, and billing. Management's Response: Community Treatment, Inc has in place a policy regarding sliding fee discount program that includes review and random audits of individual sliding fee applications. The error found during the course of the financial audit was the result of incorrect data entry into the EMR for the specific patient. The application itself was correct. Corrective action to reduce the risk of this happening in the future includes, training to all staff of the policy and procedures and the importance of accurate data entry. Additional audit steps will include verification of the data entered and actual calculation on the patient ledger. The audit sample selected by the billing department will be increased for each clinic location and additional reporting of any findings to the appropriate management staff will be shared on a weekly basis.

Federal Program: Assistance Listing 93.224 Health Center Program Cluster: Consolidated Health Center Compliance Requirement: Special Tests and Provisions Condition: One patient?s sliding scale category was not correctly input into the billing system. Criteria: The Office of Management and Budget Compliance Supplement requires that health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. Questioned Costs: Unknown Context: In a sample of 40 sliding scale patients, one patient?s sliding scale category was incorrectly entered into the system. Effect: One application was not entered correctly into the system, resulting in an incorrect amount being billed to the patient. Cause: Adequate procedures were not in place to ensure that required administrative responsibilities, including ensuring that patient eligibility determinations were correctly entered into the system, were being performed and reviewed for accuracy. Recommendation: We recommend Comtrea revisit their processes and procedures regarding the sliding scale process focusing on adequate education and review to ensure timely and accurate conclusions, input, reporting, and billing. Management's Response: Community Treatment, Inc has in place a policy regarding sliding fee discount program that includes review and random audits of individual sliding fee applications. The error found during the course of the financial audit was the result of incorrect data entry into the EMR for the specific patient. The application itself was correct. Corrective action to reduce the risk of this happening in the future includes, training to all staff of the policy and procedures and the importance of accurate data entry. Additional audit steps will include verification of the data entered and actual calculation on the patient ledger. The audit sample selected by the billing department will be increased for each clinic location and additional reporting of any findings to the appropriate management staff will be shared on a weekly basis.