Finding Text
Criteria or Specific Requirement
Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.”
Condition and Context
During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified one visit where a sliding fee application could not be found to support the slide provided.
Effect
Potential that a patient would not receive the appropriate sliding fee discount.
Questioned Costs
None identified.
Cause
Clerical error in which the sliding fee application was not saved in the patients file.
Recommendation
We recommend the Organization to review internal controls in regards to retaining the completed sliding fee applications in the patients record to support the sliding fee discount provided to the patient.
Views of Responsible Officials
Management agrees that this was a clerical error and an isolated incident. To improve the process and minimize errors, eligibility applications will now be processed at the Grand Junction, Colorado office by a different eligibility staff. This team will enter applications into the electronic medical record system and maintain either paper or digital copies for one year to ensure no applications are lost. This new procedure will provide an additional safeguard in the application process.