Finding 1061824 (2024-001)

CRITERIA: SPECIAL TESTS AND PROVISIONS UNDER THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTH CENTER CLUSTER, REQUIRE THAT A FULL SLIDING FEE DISCOUNT IS APPLIED TO FEES FOR HEALTH CENTER SERVICES PROVIDED TO INDIVIDUALS AND FAMILIES WITH ANNUAL INCOMES AT OR BELOW 100 PERCENT OF THE FPG, OR THE HEALTH CENTER APPLIES ONLY A NOMINAL CHARGE. CONDITION: FIVE INSTANCES WERE NOTED WHERE A PATIENT WAS GIVEN A SLIDING FEE DISCOUNT WITHOUT ADEQUATE INCOME VERIFICATION SUPPORTING THE DISCOUNT PROVIDED. OF THESE FIVE INSTANCES, TWO INSTANCES RESULTED IN THE PATIENT RECEIVING A SLIDING FEE DISCOUNT LOWER THAN THE DISCOUNT ACCORDING TO THEIR FEDERAL POVERTY LEVEL (FPL), AND ONE INSTANCE RESULTED IN THE PATIENT RECEIVING A SLIDING FEE DISCOUNT HIGHER THAN THE DISCOUNT ACCORDING TO THEIR FPL. CAUSE: INCONSISTENT CONTROL ACTIVITIES RELATED TO THE APPLICATION OF SLIDING FEE DISCOUNTS. EFFECT: THE INCORRECT FEE WAS CHARGED TO THREE PATIENTS. RECOMMENDATIONS: WE RECOMMEND THAT THE ORGANIZATION MODIFY EXISTING WRITTEN BILLING PROCEDURES AND CONTROLS TO ENSURE SLIDING FEE DISCOUNTS ARE CONSISTENTLY AND ACCURATELY APPLIED TO ALL ELIGIBLE PATIENTS. VIEWS OF RESPONSIBLE OFFICIALS AND PLANNED CORRECTIVE ACTION PLAN: MANAGEMENT AGREES WITH THE FINDING AND IS IN THE PROCESS OF IMPLEMENTING AND DOCUMENTING PROCEDURES TO PROVIDE ADDITIONAL OVERSIGHT ON THE APPLICATION OF SLIDING FEE DISCOUNTS.