Views of Responsible Officials and Planned Corrective Actions – Management agrees that the Sliding scale has been incorrectly applied on patient accounts and intends to do the following: A root cause analysis should determine whether the errors resulted from: • Staff calculation errors when annualiz...
Views of Responsible Officials and Planned Corrective Actions – Management agrees that the Sliding scale has been incorrectly applied on patient accounts and intends to do the following: A root cause analysis should determine whether the errors resulted from: • Staff calculation errors when annualizing income. • Failure to properly verify income documentation. • Incorrect data entry in the practice management system. • Inadequate training on sliding fee eligibility determination procedures. • Lack of secondary review or quality assurance monitoring by the revenue cycle team. In addition to the root cause analysis Piedmont Health Services will do the following: 1. Correct the three identified patient accounts and process any necessary refunds, adjustments, or account corrections. 2. Conduct a targeted review of a broader sample of recent sliding fee determinations to identify any additional errors and implement corrective action where necessary. 3. Retrain registration, eligibility, and financial counseling staff on income verification requirements, family-size determination, documentation standards, and sliding fee calculation procedures. 4. Implement secondary review procedures for sliding fee determinations until system enhancements are in place. 5. Continue monthly quality assurance audits of sliding fee eligibility determinations and monitor error rates. 6. Transition to OCHIN Epic in August 2026. The new EMR platform is expected to significantly strengthen internal controls through enhanced workflow automation, improved documentation, standardized eligibility processes, and expanded reporting capabilities. These features will provide greater visibility into sliding fee eligibility determinations, improve management's ability to monitor compliance, and reduce the risk of manual calculation and data-entry errors. 7. Following Epic implementation, management will conduct post-go-live validation testing to confirm that sliding fee determinations are functioning as designed and that eligibility calculations are accurate and compliant with HRSA requirements. Expected Outcome The combination of staff retraining, enhanced monitoring, and migration to OCHIN Epic is expected to improve the accuracy of sliding fee eligibility determinations, strengthen compliance oversight, and reduce the risk of future errors. The Director of Revenue and the CFO will monitor error rates through periodic audits and leverage Epic reporting tools to support ongoing compliance and quality assurance efforts. Individuals Responsible Beth Moseley, Chief Financial Officer and Daniella Jaimes-Colina, Chief Executive Officer