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 forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits where a sliding fee application could not be found to support the slide provided. We noted that both visits selected by our random sample were related to the same patient.
Effect
Potential that a patient would not receive the appropriate sliding fee discount.
Questioned Costs
None identified.
Cause
Clerical error in which the sliding fee application was not saved in the patients file.
Recommendation
We recommend the Organization to review internal controls in regards to retaining the completed sliding fee applications in the patients record to support the sliding fee discount provided to the patient.
Views of Responsible Officials
Management agrees that this is a clerical error and an isolated incident. Currently, eligibility staff receives completed applications, scans them into the electronic health record, and discards the hard copy. To minimize error, the procedure will be changed, whereby staff maintains hard copies for the week, and at the end of the week verifies that all applications have been scanned into the system. This will act as a double check of the scanning process.