Finding Text
Finding 2023-002 – Health Centers Cluster
Federal Agency – U.S. Department of Health and Human Services
Grant Period – Year ended December 31, 2023
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 patient’s ability to pay. The health center must demonstrate adjustments to
charges are consistent with the health center’s SFDS.
Condition - We attempted to recalculate the applied discount using the Center’s policy and the
patient documentation provided, noting instances where the adjustments to charges were
inconsistent with the Center’s SFDS.
Cause - Lack of controls to ensure that staff are obtaining required documentation and
entering the information correctly.
Effect - Out of our sample of 20 selections, we identified five exceptions based on the SFDS.
Three of the discounts entered lacked the required slide documentation, the slide form had
expired and was not updated, or the document was updated, but the data in the system was
not resulting in the slide that was provided not being supported or applied incorrectly. Two of
the discounts were improperly adjusted during the billing or review process based on
insurance or payments received, or incorrect charges being calculated and applied to the total
slide for the remaining patient balance.
Recommendation - Providing the sliding fee to patients is a requirement of specific grant
funds received. As such, we recommend the Center review the current procedures in place
and consider additional and more frequent training for all employees involved in the process.
We encourage management to consider appointing an individual at the various locations to
assist the front desk staff with the sliding fee process to ensure required documentation is
captured and recorded accurately in the billing system.
We also encourage the Center to consider assigning a dedicated individual to regularly review
the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of
the sliding fee requirements and the Center’s billing processes and procedures.