Finding 395173 (2023-002)

Criteria or specific requirement. - Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition - During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" two (2) selections out of a sample size of twenty-five (25) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, two (2) selections out of a sample size of twenty-five (25) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs - None. Effect - The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause - Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation - Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Responce - Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHD billing supervisors will be obtain a weekly report of client's that have not turned in proof of income in order to proactively reach out and attempt to obtain the information.