Finding Number: 2025-001, 2024-001, 2023 01, 2022-001, 2021-001: Material Weakness and Material Noncompliance - Sliding Fee Recommendation We recommend that sliding fee applications be completed for each sliding fee patient. Procedures should be implemented to verify that applications are completed before the encounter is billed. Sliding fee discounts per policy should be agreed upon in the billing system to ensure the proper discounts are entered into and updated. In addition, the Center could consider increasing its internal sampling throughout the year to verify that sliding fee applications are obtained, completed, and agree to the discount applied. Action Taken CHASS management concurs with the audit findings and will put the following corrective action plan in place to mitigate this finding in the future. CHASS has developed and implemented a comprehensive series of improvements. After the last fiscal audit (March 2025), it was discovered that the EPIC system had the old Sliding Fee Schedule that had not been updated since 2022 (https://aspe.hhs.gov/poverty-guidelines ). The new sliding fee schedule was implemented in the EPIC system, and since then, the fee schedule has been updated as the government guidelines change (February). Continuing the current implementation will reinforce the process of verification of patients receiving a sliding fee discount. To achieve this, the Center's Customer Service team now generates personalized labels for each eligible patient and cross-checks their entries by the end of each day. The Supervisor/Team Leader will continue to conduct a second review of the labels to ensure the accuracy of the data for each patient utilizing the sliding scale discount program. This review also includes the actual charges in EPIC and the discount being verified with CPT Tables. Third implementation, Clinical Intern Staff will be responsible for reviewing encounters to ensure that the CPT code is correct and charges on patients' accounts have the appropriate sliding scale fee applied. They will be utilizing direct reports from EPIC on all Slide Fee encounters. Any discrepancies will be immediately forwarded to the supervisor for corrections and adjustments. Fourth implementation, the Center's Billing Department is now responsible for performing regular quarterly audits, sampling at least 40 encounters. During these audits, they look at sliding fee discounts and examine the applied fees and the corresponding discounts applied to the patient's account (using the approved CPT Table). This process will also include what sliding discount the patient qualifies for according to their income and family size. Results of the audit will be forwarded to the Chief Operations Officer to review and address appropriately. Through these improvements, CHASS aims to ensure that the Sliding Fee Discount Policy is used accurately and appropriately. These methods have been incorporated into the Center's Sliding Fee Discount Policy to guarantee their utilization and accuracy, and to further strengthen the Center's initiatives in providing access to needed health care services. Responsible Parties: Mariana Guitierrez, Billing Manager, and Angela Salgado, Interim Chief Financial Officer