Finding 27961 (2022-001)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-09-06

AI Summary

  • Core Issue: One patient was billed incorrectly due to errors in sliding scale fee adjustments.
  • Impacted Requirements: The Organization's policy on sliding scale fee calculations was not followed, affecting program income.
  • Recommended Follow-Up: Management should train staff on the sliding scale fee policy and implement procedures to ensure accurate billing for eligible patients.

Finding Text

Condition: Patients were given inappropriate sliding scale fee adjustments based on supporting sliding scale fee calculation documentation in accordance with the Organization's policy. Criteria: Out of 1,721 patients who received sliding scale fee adjustments, a sample of 98 patients who received sliding scale fee adjustments were tested. One patient was billed an inappropriate amount based on the Organization's sliding scale fee adjustment. Cause: Organization personnel recorded the sliding scale level incorrectly in the medical billing software. Effect: Improper sliding scale fee adjustments were given. Recommendation: Management should ensure all personnel understand the sliding scale fee policy and adhere to the requirements and guidelines set forth in the policy. Because the policy affects program income, procedures should be implemented to ensure that all patients are billed the appropriate amount based on the sliding fee scale and only individuals who qualify under the policy guidelines receive sliding scale fee adjustments.

Corrective Action Plan

Action: During the 2022 reporting year, we created and filled a Sliding Fee Discount Coordinator position for the primary purpose of ensuring completeness and processing accuracy of Sliding Fee Discount Program applications. This staff person meets with a majority of patient applicants to discuss the Program features and process steps as well as to assist in collection of supporting documentation and completion of the application itself. In addition, this staff member provides both scheduled and ad hoc training to other staff on the Program and audits those applications and practice management inputs completed by others. The performance and results of this employee has been excellent; however, the position was not filled with role responsibility until after the reported finding which occurred in 2022. There were no reported findings on selected samples processed in the second half of 2022 and subsequent to when the position took over responsibility for the Sliding fee Discount Program and we are confident the risk of future findings has been minimized. Anticipated Date of Completion: Completed Responsible Party: Steve Bevans, CFO and Ryan Willoughby, Sliding Fee Discount Coordinator

Categories

Program Income

Other Findings in this Audit

  • 27962 2022-001
    Significant Deficiency Repeat
  • 27963 2022-001
    Significant Deficiency Repeat
  • 27964 2022-001
    Significant Deficiency Repeat
  • 27965 2022-001
    Significant Deficiency Repeat
  • 604403 2022-001
    Significant Deficiency Repeat
  • 604404 2022-001
    Significant Deficiency Repeat
  • 604405 2022-001
    Significant Deficiency Repeat
  • 604406 2022-001
    Significant Deficiency Repeat
  • 604407 2022-001
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.527 Grants for New and Expanded Services Under the Health Center Program $2.23M
93.224 Health Center Program $1.87M
93.224 American Rescue Plan Act Funding for Health Centers $1.63M
93.498 Provider Relief Funds $452,440
93.332 Medical Assistance Program $85,970
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement Program $48,726
93.217 Family Planning Services $47,850
93.778 Medical Assistance Program $47,196
93.323 Medical Assistance Program $43,533
93.800 Medical Assistance Program $22,130
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $17,806
93.224 Affordable Care Act Grants for New and Expended Services Under the Health Center - Fy 2021 Ending the Hiv Epidemic-Primary Care Hiv Prevention $17,779
93.436 Well-Integrated Screening and Evaluation for Women Across the Nation $6,329
93.224 Affordable Care Act Grants for New and Expended Services Under the Health Center - Health Center Program Service Expansion-School Based Service Sites $3,122