Management Response and Root Cause Management agrees with the finding. Five of 40 encounters tested received an incorrect sliding fee adjustment, and the approved schedule for certain dental services was not fully compliant for patients at or below 100% of the Federal Poverty Guidelines. The repeat ...
Management Response and Root Cause Management agrees with the finding. Five of 40 encounters tested received an incorrect sliding fee adjustment, and the approved schedule for certain dental services was not fully compliant for patients at or below 100% of the Federal Poverty Guidelines. The repeat condition resulted from incomplete alignment among the approved schedules, written policy, expanded dental services, staff workflows, income documentation, and eClinicalWorks configuration. Prior training and system optimization did not fully eliminate manual interpretation or provide sufficiently frequent monitoring across all sliding fee levels and service lines. Corrective Action Plan HealthCore Clinic will redesign and implement a single, compliant, system-supported Sliding Fee Discount Program for all services within scope. The revised process will align Board-approved policy and schedules, dental and medical workflows, income and family-size documentation, eClinicalWorks configuration, adjustment and reversal controls, staff competency, and ongoing internal audit monitoring. HealthCore Clinic will provide training on the updated program to all registration, eligibility, billing, and other affected staff. HealthCore Clinic will implement monthly internal audits using samples across tiers and service lines and investigate any errors to identify the root cause for noncompliance with the policy.