Finding 1156004 (2024-001)

U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Item 2024-001 - Special Tests and Provisions Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended December 31, 2024. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended December 31, 2024. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of fifty-five patients selected for testing based on the sliding fee scale in effect for the year ended December 31, 2024. Identification as a Repeat Finding This is not a repeat finding. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts are being properly calculated. Supervisors should monitor and review the sliding fee calculations on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee is calculated properly. Views of Responsible Official Employees received training in January 2025 to ensure the sliding fee discounts are correctly applied. Additionally, DVCH is planning an annual refresher training for staff. The Patient Account Counselor Team Leader conducts a monthly internal audit of sliding fee discounts. Findings are reviewed with staff and the Director of Revenue Cycle Management. The audit samples each site and department to ensure accuracy across the organization. DVCH will explore the possibility of engineering a change in our practice management system to facilitate and remind the registration and revenue cycle staff to complete the sliding fee calculations when needed