Finding Text
Criteria or Specific Requirement Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.” Condition and Context During our testing of sixty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three visits that received the incorrect sliding fee discount. Effect Potential that a patient would not receive the appropriate sliding fee discount. Questioned Costs None identified. Cause Clerical error in which the incorrect discount was applied due to lack of an oversight process in place. Recommendation We recommend the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter and that the support for the sliding fee discounts is retained. Views of Responsible Officials The Organization has recognized and acknowledges the deficiency in internal controls in regards to the determination, recording, and monitoring of the sliding fee discount process. Along with the safeguards that have been implemented previously, we are implementing a process that includes: - verification, during front desk eligibility check that slide information is complete; - if patient qualifies for the slide, note in billing notes, effective dates, slide category, and fee to be collected; - identify patients that are checking in that day and double check slide category and fee to collect; - if there is a discrepancy with any documentation, reach out to slide coordinator. The Organization will continue to double-check and audit the applications monthly to cure our deficiencies. If the U.S. Department of Health and Human Services has questions regarding this plan, please call Tricia Lippert, Comptroller, at 970-327-0537.