Finding Text
Special Tests and Provisions
Federal Program and Specific Federal Award
U.S. Department of Health and Human Services (HHS)
93.224/93.527 Consolidated Health Centers (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, Public Housing Primary Care, and School Based Health Centers); (HHS Community Health Center Program)
Type of Finding: Compliance and significant deficiency in internal control over compliance
Specific Requirement-Criteria
Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients’ ability to pay.
Condition-Context
During a sample of 60 patient encounter visits; we noted seven encounter visits where the sliding fee adjustment applied to a patient’s account was applied at the incorrect amount per the Association’s sliding fee scale.
Cause
Due to the employee turnover within the front desk and the finance department, the Organization has had difficulty in training and assuring skilled intake staff are correctly applying the sliding fees.
Effect or Potential Effect
Applicants assessed are not charged according to the Association’s sliding fee scale and ability to pay.
Questioned Costs
None.
Repeat Finding
Yes, see finding 2022-002.Recommendation
We recommend that management continue to work and educate front desk and intake staff on the importance of the required patient application documentation so that the required support is filed before applying a sliding fee discount to a patient account. In addition, continue with the system of monitoring that was established during fiscal year 2023 to review random samples of applications and sliding fees applied.
Management Response
We agreed with the above comment, and we are working with our intake and finance staff to ensure all documentation is maintained on file and scanned into the EMR system to maintain the required supporting documentation. During 2023 we have implemented a system of monitoring sliding fees applied to patient accounts.