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.