Audit 8529

Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Condition: Some patients did not receive the proper sliding fee discount. Cause: Unknown. Questioned Costs: Known or likely questioned costs are less than $25,000. Context: Of the 60 patients sampled, 12 patients did not receive the proper adjustment or discount. Effect: Improper adjustments or discounts could lead to inaccurate financial statements as well as improper patient billings. Auditor's Recommendation: Management should have procedures in place ensureing that each eligible patient receives the proper discount or adjustment based on their ability to pay. Management's Response: We previously identified this as an area of concern and implemented additional controls designed to ensure that the proper sliding fee discount categories are applied by the Patient Service Representatives and that the correct sliding fee discount is applied by the Billing Department. Since the implementation of additional controls, the errors were reduced by 16%. Teche will continue to aggressively audit the existing controls, by increasing internal audits from monthly to weekly. We will also implement additional controls and will perform focused and ongoing education and training to all Patient Service Representatives and Billing Department staff to ensure that the proper sliding fee discount categories are applied by the Patient Service Representatives and that the correct sliding fee discount is applied by the Billing Department. These errors were due in large part to the significant staff turnover in both the Patient Service Representative and Billing Departments; as well as identified errors with the implementation, training and set up, of Teche Action Clinic’s new electronic health record system, which was initially implemented virtually due to COVID. In an effort to address the system implementation errors, we have retained subject matter experts to evaluate and correct the system implementation protocols within the EHR system with regards to the application of the sliding fee discount categories.

Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Condition: Some patients did not receive the proper sliding fee discount. Cause: Unknown. Questioned Costs: Known or likely questioned costs are less than $25,000. Context: Of the 60 patients sampled, 12 patients did not receive the proper adjustment or discount. Effect: Improper adjustments or discounts could lead to inaccurate financial statements as well as improper patient billings. Auditor's Recommendation: Management should have procedures in place ensureing that each eligible patient receives the proper discount or adjustment based on their ability to pay. Management's Response: We previously identified this as an area of concern and implemented additional controls designed to ensure that the proper sliding fee discount categories are applied by the Patient Service Representatives and that the correct sliding fee discount is applied by the Billing Department. Since the implementation of additional controls, the errors were reduced by 16%. Teche will continue to aggressively audit the existing controls, by increasing internal audits from monthly to weekly. We will also implement additional controls and will perform focused and ongoing education and training to all Patient Service Representatives and Billing Department staff to ensure that the proper sliding fee discount categories are applied by the Patient Service Representatives and that the correct sliding fee discount is applied by the Billing Department. These errors were due in large part to the significant staff turnover in both the Patient Service Representative and Billing Departments; as well as identified errors with the implementation, training and set up, of Teche Action Clinic’s new electronic health record system, which was initially implemented virtually due to COVID. In an effort to address the system implementation errors, we have retained subject matter experts to evaluate and correct the system implementation protocols within the EHR system with regards to the application of the sliding fee discount categories.