Finding Text
2025-002 Information on the Federal Program: Assistance Listing Number 93.224/93.527; Health Center Program Cluster; Department of Health and Human Services Criteria Or Specific Requirement: Special Tests and Provisions – Sliding Fee Discounts: Health centers must prepare and apply a sliding fee discount schedule, so the amounts owed for health center services by eligible patients are discounted based on patient’s ability to pay. Condition: The Organization had incorrect slide discounts applied to patient encounters based on family size and income on initial intake of information. Also, there were multiple billing codes that received discounts based on commercial insurance allowed costs rather than the Organization’s fee schedule, which is not allowed. Cause: The intake personnel filed the incorrect slides based on family size and income that eventually got applied to the electronic health records system. There was also incorrect discount methodologies coded to the electronic health records system that resulted in unallowed applied discounts. Effect or Potential Effect: Inaccurate discounts provided to patients based on their ability to pay which could result in over or under payment. Questioned Costs: None. Context: There were 25 patient encounters tested and there were improper discounts applied to 6 during the year. The sample was not statistically valid. Identification as a Repeat Finding, if Applicable: Is a repeat finding. Recommendation: We recommend management review their sliding fee policies and schedules for complexity and increase training provided to their full revenue cycle team. Views of Responsible Officials and Planned Corrective Actions: Management acknowledged the sliding fee adjustment errors resulted from incorrect calculation of sliding fee discount. Management will add an additional layer of review over the application of the sliding fee scale. Further, the Organization will implement a process to periodically review sliding fee adjustments throughout the year for accuracy.