Finding 2022-001 ? Special Tests and ProvisionsThe auditee acknowledges the findings of the auditors. It has been noted that two patients were billedat discounts above eligibility levels and one patient was billed at a discount below the eligible amount.Review of the samples noted revealed that one ...
Finding 2022-001 ? Special Tests and ProvisionsThe auditee acknowledges the findings of the auditors. It has been noted that two patients were billedat discounts above eligibility levels and one patient was billed at a discount below the eligible amount.Review of the samples noted revealed that one of the 3 individuals included in the finding occurredas a result of staff inputting the incorrect salary information into the system for those patients and/ornot selecting the proper frequency for patient income, i.e., monthly, weekly, biweekly, annually, etc.These are simple human errors that occur when staff are inundated with tasks during registrationmissing detailed steps as they enter the patient?s income.Another instance of the noted error existed as a result of the staff failing to include the income for allindividuals in the household income calculation which provided a greater than applicable discount.The final error occurred as a result of failure to follow up and adjust patient accounts for those patientswho present and apply for the sliding fee. This patient applied for the sliding fee discount at the timeof the visit, but because he did not have the income verification, he was listed as self-pay and givena 30 day notice to provide the information. The patient paid toward the balance and once he providedinformation it was determined that his payment on the day of the visit exceeded the required paymentper the sliding fee. Supervisors failed to adjust the account and provide the patient with a refund, asa result patient?s account did not reflect the proper discount.Plan of Action:Management reviewed the findings and began to rationalize the reasons that these findings occurredand measures that will help to reduce these errors. The course of action to be taken includes thefollowing to be implemented immediately:? Reduction of Turnover in PAR. A contributing factor to the errors with sliding fees is turnoverin the department. There is a considerably high percentage of turnover average of 6%. Errorsare existing due to the turnover of staff, and the constant training.? Strengthened procedures for Supervisors of employees registering patients are nowcompleting audits of patients? charts to review the sliding fee scale and the attacheddocumentation. The audits are conducted on the patient account as they present for service.Because of the nature of the Sliding Fee Program, the documentation required toparticipated, and the setup of our Patient Management System (Athena), these areperformance audits and are based on how accurate each employee enters information intothe system.? Training to reiterate avoiding common mistakes while registering patients and workingwith patient information.? Also, as recommended, we have scheduled a date to renew the annual sliding fee scaleand notify patients. As an added measure, we will also commit to documenting the effectivedates for any leniency in the corresponding Board minutes.