Finding Text
Special Provisions Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Number: 93.224 Federal Award Identification Numbers and Year: 6 H80CS29010; 6 H80CS29011 Award Period: June 1, 2024 – May 31, 2025; June 1, 2025 – May 31, 2026 Criteria or Specific Requirement: 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 (42 USC 254(k)(3)(G); 42 CFR sections 51c.303(f), and (g); and 42 CFR sections 56.303(f), and (g)). Condition: The Organization did not maintain documentation to show that patients had been evaluated for eligibility under its sliding fee scale policy and did not apply sliding fee adjustments consistent with the sliding fee scale assigned. Questioned Costs: None. Context: Eleven (11) of seventeen (17) encounters tested could not be verified as having received an appropriate sliding fee discount as their family size and income information was missing or outdated. Cause: This matter seems to be caused by a lack of adherence to policy and procedure by the front desk for obtaining all necessary information to appropriately determine the type of sliding fee discount for which a patient is eligible. Additionally, management is still working to identify the extent to which any of these issues are the result of the electronic medical records system's configuration. Effect: Patients may not be assessed a correct sliding fee discount according to their ability to pay and the Organization's sliding fee scale. Repeat Finding: No Recommendation: Management should provide training and education to front desk staff related to the EMR and the process for collecting and retaining family size and income information in addition to inputting it into the electronic medical records. We also recommend enhancing any current internal audits of patient visits to determine all required patient information and has been obtained and charges are appropriately billed in accordance with the Organization's policies. Views of Responsible Officials: There is no disagreement with this finding.