Finding Text
Finding 2023-001 – Material Weakness and Nonmaterial Noncompliance in Internal Control over Retention of Supporting Documentation Relating to Sliding Fee Test.
Condition: During the audit, 40 sliding fee payments were selected for testing; however, the sliding scale was applied incorrectly for 7 sample items based on reported patient household income and number of residents who resided within the household.
Criteria: The Organization is responsible for charging a sliding fee based on household income and number of residents that reside within the patient’s household.
Cause: The Organization did not have fully operating controls in place to ensure the sliding scale was applied correctly for patients who received services.
Effect: Eight patients were charged incorrectly based on patient household income and number of residents who resided within the household.
Recommendation: We recommend controls and procedures be implemented to ensure the sliding scale application and assessed rate is reviewed by a secondary reviewer prior to billing.
Management’s Response: Management agrees with the finding and is in the process of developing and implementing a comprehensive plan to ensure appropriate documentation regarding household income and number of residents who reside within the individual’s household is obtained and retained prior to any services being provided to a patient.