CHASS management concurs with the audit findings and will put the following corrective action plan in place to mitigate this finding in the future: During the Sliding Fee Testing, it was found that the actual charge to the patient (after the sliding fee was applied) did not match the actual discount...
CHASS management concurs with the audit findings and will put the following corrective action plan in place to mitigate this finding in the future: During the Sliding Fee Testing, it was found that the actual charge to the patient (after the sliding fee was applied) did not match the actual discount that the patient should have allocated. We have reviewed all processes on how EPIC loads up charges (table with applied sliding fee tiers) and found that no one had a master list of the charges. When the Billing Department requests a CPT to be added, they alert the Accounting Department to add them, as well as when they request changes on charges for CPT codes. There is not one set of approved CPT charges/discounts creating discrepancies in patients' accounts. In response to these audit findings, CHASS has developed and implemented a comprehensive series of improvements. First, the implementation of key improvements involves the implementation of one person only authorized to request changes on the table of charges to EPIC. Second, implementation of a verification process for every patient receiving a sliding fee discount. To achieve this, the Center's Customer Service team now generates personalized labels for each eligible patient and cross-checks their entries by the end of each day. This process ensures each item is diligently reviewed to ensure no errors are made within this process, and if identified, they are rectified immediately via a Supervisor/Team Leader. Through this process, the Supervisor/Team Leader now conducts a second review of the labels to ensure the accuracy of the Center's labeling system for each patient utilizing the sliding scale discount program. This review also includes the actual charges on EPIC, verified with the CPT Tables. This process will also include what sliding discount the patient qualifies for according to their income and family size. Third, the Center's Billing Department is now responsible for performing regular weekly audits. During these audits, the Billing Department will now randomly select five claims with sliding fee discounts and examine the applied fees, and the corresponding discounts applied to the patient's account (using the approved CPT Table). This process will also include what sliding discount the patient qualifies for according to their income and family size. Through these improvements, CHASS aims to ensure that the Sliding Fee Discount Policy is used accurately and appropriately. These methods have been incorporated into the Center's Sliding Fee Discount Policy to guarantee their utilization and accuracy and to further strengthen the Center's initiatives in providing access to needed healthcare services.