Recommendation: The Organization should develop formal procedures to ensure patients are given the opportunity to provide demographic information, and that this information is reviewed for accuracy when input into the patient billing system. Such procedures could include placing a placard in the mai...
Recommendation: The Organization should develop formal procedures to ensure patients are given the opportunity to provide demographic information, and that this information is reviewed for accuracy when input into the patient billing system. Such procedures could include placing a placard in the main area of the clinic and in the treatment rooms informing patients of their right to receive a discount to encourage patients to provide the required information, and implementing a periodic review process to ensure accuracy of data input and the application of sliding scale discounts. Action Taken: CAP acknowledges the finding and has the following action steps: Prism has a placard posted in the lobby with information about our sliding fee scale, information is provided on our website as well as in the initial paperwork signed by patients when establishing care. All new patients are given and must sign the Prism Health Patient Rights and Responsibilities, Consents, and Financial Agreement form. This form outlines the financial options available to all patients including information about the Sliding Fee Discount Program and assistance in determining eligibility for the Oregon Health Plan if a patient is uninsured. Prism will add placards in all exam rooms in addition to sending out notification to patients annually via email. Mode of patient applications. Completed applications reside in patient registration records. Staff cannot notate their Federal Poverty Level (FPL) calculation or determination of award, or who reviewed the completed form unless the form is printed from the chart, notated, and then rescanned. Therefore, the MyChart version of the Sliding Fee Discount Program application will be removed from MyChart and replaced with a fillable demographic form that explains why Prism Health is required to annually collect patient income and household size, as well as other additional HRSA required data points (I.e., seasonal or migrant farm worker, veteran status, housing status). Unless the patient declines to provide income and household size information, staff will use the information provided to determine FPL and outreach to the patient if their FPL makes them eligible to apply for the Sliding Fee Discount Program. If the patient expresses interest, staff will provide them with the Sliding Fee Discount Program application and the Zero Income Form.A two-person verification system will be implemented to ensure that the discount application is fully completed and signed by the patient, that staff?s calculation of annual income is done accurately, and that staff have completed the Prism Health portion of the application before it is scanned into the patient?s registration record. Additionally, a calculation guide for determining (FPL) will be added to the ?Office Use Only? section of the application to help staff more accurately calculate a patient?s annual income (e.g., if a patient is paid once a week their weekly pay is multiplied by 52 weeks to get an accurate annual income amount). The Prism team has embarked on a PDSA (Plan-Do-Study-Act) cycle to review our data collection procedures, look for opportunities to improve, and check on progress. We have identified four key areas to improving the collection of accurate income and household size: staff and patient discomfort, the electronic health record (EHR), in-person versus telemedicine visits, and staff pre- appointment data scrubbing processes. The Prism team is activating plans on these four identified needs.