Finding Text
Finding 2025-001 Application of Sliding Fee Discount Program Information: Federal AgencyU.S. Department of Health and Human Services Federal Assistance Listing Number 93.224 and 93.527 Health Center Program Cluster Award NumberH80CS000564 Criteria[X] Compliance Finding [X] Significant Deficiency [ ] Material Weakness OMB 2 CFR 200, Subpart F Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay.” Condition In our testing of 25 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified 1 instance where a patient was eligible to receive a sliding fee discount but no discount was applied. We also identified 1 instance where the incorrect sliding fee was applied to the patient. We also noted 1 application did not indicate review and approval of the sliding fee application by an appropriate staff at the Organization. Cause The Center did not have a review process in place to verify eligible patients completed the required application to receive a sliding fee discount and that each application contained the required information. Additionally, the Center did not verify the correct sliding fee discount was based on the Center’s sliding fee scale. Context The finding appears to be a systemic problem. Effect Incomplete applications could indicate that patients who received a sliding fee discount may not have been eligible. Additionally, the sliding fee discount could be applied incorrectly and not in accordance with the Center’s policy. Recommendation We recommend continued effort in training personnel on applying the appropriate sliding fee discount based on the Center’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action The CFO, Revenue Cycle Manager, Revenue Cycle Coordinator, and billing staff will begin to implement a peer review process of the sliding fee scale applications monthly. Management will develop a peer review form, train the staff on the form and process to review each application to ensure compliance with the approved policy.